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Periodontists and Periodontics 101, Dental Specialties

Periodontics is one of the eight dental specialties recognized by the American Dental Association. Periodontists specialize in Periodontal work. Periodontal comes from two Greek words that mean "around the tooth." The periodontium refers to the anatomical structures around teeth: the gum, bone, and the periodontal ligament that attaches the tooth to the bone.

Periodontists are dentists that have three additional years of training to specialize in the prevention, diagnosis, and treatment of the diseases that affect the gums and supporting structures of the teeth. Periodontists also are experts in the placement and treatment of dental implants.

Periodontal disease is the major cause of tooth loss in adults. According to the American Dental Association, three out of four Americans over age 35 have some form of periodontal disease. Gingivitis is the mildest form of periodontal disease and the most common infection in the world. But if left untreated, it can progress to periodontitis -- the loss of bone and tissues that support the teeth.

Periodontal diseases can be localized to a few teeth or generalized, in which most of the teeth are affected. It can affect people of all ages and without proper periodontal treatment, this disease can result in tooth loss and even complications of systemic diseases.

There are several different forms of periodontal disease. Each can progress at different rates. The same disease can have periods when it develops slowly and others when it progresses quite rapidly. Most of the time, periodontal diseases are painless. But they may have acute episodes that result in severe pain and a dental emergency.

The rate of periodontal disease progression is dependent on a multitude of factors, including the presence of certain risk factors that make people more susceptible to periodontal breakdown.

All periodontal disease is caused by an accumulation of bacteria at and below the gum line. The bacteria release toxic substances that trigger the breakdown of the gum and bone. The gums become red, swollen, and bleed easily. The gum tissue then separates from the teeth, forming a gap called a periodontal pocket or exposing the root surface in what is called recession.

The body responds to the bacteria with an inflammatory response in which it essentially 'turns on itself' and destructs the bone and tissues around the teeth. This is the body's way of warding off infectious agents. The teeth can start moving and shifting and eventually if there is advanced bone loss, the teeth can be lost.

Periodontal diseases are treated in three phases by periodontists. The first is to stop the disease activity and progression of bone loss. In the early stages of periodontal disease, scaling and root planning may be the only treatment needed.

The bacterial deposits (plaque and tartar) that formed above and underneath the gums need to be removed and the root surfaces of the teeth smoothed to enhance healing and deter future plaque retention. During this phase of treatment, the periodontist will review the oral hygiene technique, and give advice on the modification of certain risk factors associated with periodontal disease.

If the periodontal disease is more advanced, surgical treatment may be indicated. The purpose of this phase of treatment is to create an environment that is more amenable to health and, if possible, regenerate some of the bone that was lost to the disease.

In some forms of periodontitis, antibiotic treatment may be indicated. If this is the case, a bacterial culture may be required to test for harmful bacteria and to establish what antibiotics they are susceptible to.

Periodontal disease is a chronic disease that, like many other chronic diseases, has to be closely monitored, even after active treatment. The maintenance or third phase is crucial to the success of any treatment.

Daily brushing and flossing is essential in controlling the ever-developing plaque. So is periodic periodontal maintenance care with a Periodontists scaling of the teeth. The periodontal status has to be closely monitored so that changes can be identified and treated as early as possible.

Everyone should be routinely screened for periodontal disease. All periodontists are qualified in detecting and treating the early stages of periodontal disease, but if you suspect that you are at risk, or you know you have periodontal disease, you may want to see a periodontist who has extensive advanced training in the diagnoses and treatment of periodontal diseases.

With today's Periodontists knowledge about periodontal diseases and the new advances in treatment, you can expect to keep your teeth for a lifetime and ward off the effects that periodontal disease may have on your overall health.

By Laura Minsk, DMD

Periodontics: Uses of Periodontic Dental Lasers

Since their introduction in the 1960's, laser use in medicine and dentistry has increased steadily, and it's been no different in Periodontics. The CO2 and the Nd:YAG lasers have both received Food and Drug Administration (FDA) approval for soft tissue surgery and are the most commonly used lasers in dentistry. A dental laser work by delivering concentrated beams of light strong enough to cut through tissue.

Pros & Cons of Dental Lasers

The popularity of lasers results from claims that dental laser gum treatment is painless. Although the FDA has not permitted the manufacturer of any laser to make that claim, the general experience described by patients is that there is less pain and swelling after laser treatment compared to conventional oral surgery. Local anesthesia for pain control is still required during laser surgery.

Another advantage of the laser is that it causes less bleeding in the area of surgery than traditional oral surgery techniques. This is especially helpful in the oral cavity, which has an abundant blood supply. The laser decreases bleeding by sealing the blood vessels at the surgical wound. On the flip side, this can delay healing and create a less stable wound.

Application of Lasers in Periodontal Treatment

The application of lasers in periodontal treatment is restricted to the removal of gum tissue to reduce pocket depth, or for some minor periodontal plastic surgery procedures. These surgeries can be easily performed with traditional instruments without the additional high cost of dental laser treatment.

More recently, lasers have been evaluated for use in scaling and root planing. But in a research study recently published in the Journal of Periodontology, laser therapy appeared to be less effective than traditional scaling and root planing treatment. In fact, research has not conclusively shown that laser therapy is effective in removing the tartar that has accumulated under the gum line and can actually damage the surfaces of teeth and the bone. This damage could delay healing and the ability of the gum tissue to reattach to the root surface.

For all these reasons, the American Academy of Periodontology is concerned about misleading claims regarding the use of lasers in periodontics. It is important to remember that laser treatment in periodontics is limited to soft tissue (gum) for periodontal surgery and that the laser beam should not touch the tooth or bone. Anesthesia is required during dental laser treatment, and dental laser treatment may be more expensive than traditional surgical procedures.

By Laura Minsk, DMD