Who is a Periodontist?
A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and many have advanced training in the placement of dental implants. Periodontists receive extensive training in these areas, including 2 to 3 additional years of education beyond dental school. Although all dentists can legally treat periodontal disease and place dental implants, only periodontists limit their practices to treating periodontal disease and provide dental implant services. Each patient must decide for themselves the level of experience and expertise they require of their provider.
TREATMENT OF PERIODONTAL DISEASE
Periodontal disease is a bacterial infection that penetrates into the gums and into the bone around your teeth, causing inflammation. Periodontal inflammation leads to bone loss and possibly tooth loss and may contribute to other medical conditions.
The periodontal infection must be removed and the area given a chance to heal. There are generally two levels of treatment for this condition depending upon the severity of your infection.
Scaling and Root Planing
The upper level of infection in the pockets around your teeth can be removed using specialized instruments. This procedure is called, “Scaling and Root Planing", “Phase One Treatment" or “Initial Therapy". It is often done under local anesthesia and is quite different from the routine dental cleaning that is traditionally done in the general dentist's office.
If your infection has spread into the bone that supports your teeth, and is below the level that can be reached in "Upper Level Infection Removal", then a surgical procedure must be performed to retract the gums and remove the lower level infection.
When periodontal disease reaches this lower level it is called periodontitis. The bone around the teeth actually dissolves which is seen on X-rays as bone loss. This lower level infection is treated with flap surgery or osseous surgery and the damaged area is often repaired with bone grafting.
Your jawbone is what supports your teeth and gums. Unfortunately, severe periodontal infection dissolves parts of your jawbone. This bone loss can eventually lead to the loss of your teeth. The first step of treatment is to remove the causative factors and infected tissue, which halts the bone loss. Then the damage that has occurred is repaired. In many cases, various bone grafting techniques can be used to re-grow some of the jawbone that was lost.
Procedure: The periodontist administers a local anesthetic and gently opens the area. He then removes the causative factors and diseased tissue, repairs the bone damage and fills in the damaged area with bone grafting material.
Flap surgery and osseous (bone) surgery
Flap surgery and osseous (bone) surgery are often required when deep pockets (spaces under your gums) remain after the completion of non-surgical treatment. This generally indicates that there has been significant bone loss and the ongoing infection is likely to continue.
Flap surgery is a procedure in which the gum tissue is gently pushed away from the roots of the teeth after the patient has been thoroughly anesthetized. This provides the periodontist with access and visualization for root planing.
Sometimes it is necessary to smooth out damaged bone while the tissue is pushed back and this is called osseous surgery. Following these procedures the gum and bone tissue will heal naturally.
Conceptually this is similar to fresh paint continuing to peel off wrought iron which hasn't had the underlying rust removed. The real problem is inadequate preparation not the paint. The situation in periodontics is similar in that the condition beneath the gum line must be made biologically acceptable if the gingiva and bone are to heal properly and remain healthy.