Today we are going to talk about a very important topic, about a part of the body that can either make you live comfortably or in daily pain. 

Today we are going to talk about mouth and teeth health. And to be more specific, we are going to discuss periodontics. 

What is Periodontics? 

Periodontics is the branch of dentistry that exclusively deals with the supporting structures around the teeth that are known collectively as the periodontium. 

The term is derived from the Greek language, “Peri” means around and “Odons” means tooth. 

Periodontics focuses on the inflammatory diseases that destroy the gums and the other supporting structures around the teeth. 

A periodontist is a dentist whose specialty is mainly the prevention, diagnosis and treatment of periodontal diseases and the placement of periodontal implants. The periodontist is also the expert in the treatment of inflammatory dental diseases. 

A periodontist examines the gums to check if there is gum line recession, assesses how the teeth fit together when biting, and checks the teeth to see if they are loose. He or she will also take the small measuring instrument called the probe and place it between the teeth and gums to measure the depth of spaces, called periodontal pockets; all of that is done to assess the health of the gums. 

So, what are these diseases we are talking about? Who should see a periodontist? 

Some of the patients’ periodontal needs can be fulfilled by a general dentist. However, as more patients develop signs of periodontal diseases that a relationship between periodontal diseases and other chronic diseases associated with ageing, the necessity for periodontal treatment is greater. Great levels of expertise and extensive training are needed. 

Patients who complain of mild to moderate symptoms of periodontal diseases are better to be dealt with by a partnership between a general dentist and a periodontist. 

And now, let’s get to know more about periodontal structures and diseases. 

The periodontal structures include:

• The gingiva or commonly known as gums. 
• The alveolar or commonly known as the jawbone. 
• The periodontal ligament, which holds the tooth in place in the jawbone. 
• The cementum, which connects the tooth to the jawbone by anchoring the tooth to the periodontal ligament. 

Each of these structures has its own function and diseases. 

So, let’s start with the gingiva or the gums. What happens to them when they are inflamed? 

The gingiva is the part of the gums surrounding the base of the teeth. 

When the gums are inflamed it is called “Gingivitis”. 

It is a mild and common form of gum disease or periodontal disease. It causes irritation, redness, and swelling. 

Although it may seem a mild problem, it is important to take gingivitis seriously and treat it promptly because it might lead to a more severe form of the disease called periodontitis and tooth loss. 

Healthy gums usually look pink, firm, and fitted tightly around the teeth. But when there is gingivitis, there are some common signs and symptoms that appear on them, including:

• Swollen and puffy gums. 
• Tender gums. 
• Bad breath. 
• Dusky red or dark red gums. 
• Receding gums. 
• Bleeding from gums during brushing or flossing. 

But what causes Gingivitis? 

The most common cause of gingivitis is bad oral hygiene that encourages plaques formation on the teeth. The plaques, consequently, cause inflammation to the surrounding tissues. 

This is how plaques cause inflammation:

1. First, plaque forms on your teeth. What is a plaque? It is a sticky invisible film that is composed mainly of bacteria that forms when the food you eat, especially sugars and starch, interacts with the bacteria normally present in your mouth. These plaques require daily removal because they form so quickly. 
2. Then, the plaque turns into a tartar. When the plaque stays on your teeth it can harden under the gumline into what’s called tartar of calculus, collecting more bacteria. This tartar makes it hard to remove the plaques and acts as a shield that protects the bacteria and causes irritation along the gumline. Tartars, unfortunately, cannot be removed by just brushing, they need professional dental cleaning. 
3. Gingiva becomes inflamed. The longer tartar and plaques stay on your teeth, the more irritation and swelling there will be. The gums become inflamed, red, and bleed easily. Dental caries can also occur. If this inflammation is left untreated, it can lead to periodontitis and, eventually, tooth loss. 

There are some risk factors, if they were eliminated, you would protect yourself from gingivitis. These risk factors include:

• Poor oral care. 
• Smoking or chewing tobacco. 
• Dry mouth. 
• Poor nutrition. 
• Vitamin C deficiency. 
• Crooked teeth that are difficult to treat. 
• Certain drugs such as phenytoin. 

You can easily prevent this disease by good oral hygiene, regular dental visits, and good health practices such as healthy eating and managing blood sugar. 

As for the treatment, it should be punctual and prompt to avoid all the complications. Early treatment reverses the symptoms and inhibits the disease progression. 

Professional gingivitis treatment includes:

• Professional dental cleaning. You should visit your dentist regularly to remove all the plaques, tartars, and bacterial products in a procedure known as scaling and root planing.  Scaling removes bacteria and tartar from the surface and beneath the gums. Root planing removes the bacteria resulting from inflammation and smooths the roots’ surfaces.
• Dental restoration, if needed. Misaligned teeth, poorly fitted crowns, or bridges might contribute to your disease and make it hard to remove plaques on a daily basis. So, you should consult your doctor if any of the dental restorations is causing your inflammation. 
• Continuous care. Keeping continuous good oral hygiene at home and regular dental check-ups will keep your teeth safe. 

If the treatment is neglected, it would lead to more severe disease which would involve other structures. Eventually, it will lead to periodontitis. 

So, what is periodontitis? What is the difference between gingivitis and periodontitis? 

Periodontitis is a serious gum infection that damages the soft tissue and still without treatment, it may lead to a serious bone disease. 

It happens when gingivitis is left untreated and periodontal disease advances. When it develops, the inner layer of the gums and bone pulls away from the teeth forming periodontal pockets with harmful bacteria. Then, plaques grow under the gumline which can lead to tooth and bone loss. 

Symptoms of periodontitis include: 

• Swollen puffy gums.
• Red dusky or dark red purplish gums. 
• Bad breath. 
• Easily bleeding gums. 
• Loose teeth. 
• Painful chewing. 
• Spitting out blood when brushing or flossing. 
• New spaces develop between the teeth. 
• Change in the way teeth fit together when you bite. 
• Pus between the teeth and gums. 
• Tender gums on touch. 
• Receding gums that make your teeth look longer than normal. 

There are also risk factors that increase your risk of periodontitis, such as: 

• Gingivitis. 
• Poor oral care habits. 
• Smoking. 
• Hormonal changes such as those related to pregnancy and menopause. 
• Certain diseases such as Crohn’s, diabetes, and rheumatoid arthritis. 
• Obesity. 
• Bad nutrition and vitamin C deficiency. 
• Genetics. 

Periodontitis can lead to even more serious complications. The bacteria responsible for periodontitis can enter your bloodstream and affect other parts or organs in your body. 

Periodontitis has been also linked to respiratory diseases, rheumatoid arthritis, coronary artery disease, and difficult control of blood sugar in diabetics. 

And just like gingivitis, good oral hygiene and regular dental visits can prevent from the very beginning all these complications.

But how do doctors determine if this is gingivitis or periodontitis? How is it diagnosed?

Your dentist will:

• Review your medical history to identify your risk factors that could contribute to your symptoms. 
• Examine your mouth. Your doctor will look for plaques, tartars, or any bleeding from the gums. 
• Measure the pocket depth. As we mentioned at the beginning of our video, your doctor will use an instrument called the probe to measure the depth of the groove between the gums and the teeth by putting it beside your teeth and beneath the gum line. In a healthy person, this pocket measure between 1 - 3 mm. Pockets deeper than 4 mm might indicate periodontitis. 
• Take dental X-rays. They help to check for any bone loss in areas where there are deep pockets. 

After all the examination and investigations, your doctor will be able to define the stage of your disease according to its severity, your health, and the suitable treatment of your case. 

Treatment of periodontitis can be performed by a periodontist, a dentist or a dental hygienist. 

The goal of the treatment is to clean these resulting pockets around the teeth thoroughly and prevent any damage to the nearby bone. 

Your chance of successful treatment will increase if you adopt a healthy daily dental care routine and quit all the bad habits such as smoking. 

In addition to gingivitis treatment which includes scaling and root planing, periodontics treatment requires antibiotics either topical or oral to control bacterial infection. 

Our role today is to answer most of your questions regarding periodontics. Today we have Dr. Lee, who is a leading doctor at Good Life Dental in Seoul. He is going to discuss with us about periodontics from an experienced medical point of view.

Interview

What is a periodontal department and what makes you specialize in it?

Simply put, a periodontist takes care of issues affecting the dental gums. For example, as many of you know, scaling. Scaling is a non-surgical method to take care of the dental gums, which we do. We also do deep scaling, which requires local anesthesia. Through deep scaling, together with anesthesia, we get rid of scaling build up between the gums and teeth as well as infections. And, in cases where the gum disease is severe, we also do surgery. Like we said, scaling and deep scaling are non-surgical techniques to care for gums and gum surgery is for removing parts of the gum that are infected. In cases where the gum disease keeps recurring even after treatments, leading to the need to remove the teeth or when a patient is missing a tooth, we install implants. So, taking care of the gums, performing surgery when needed, and even performing implants is what a periodontist does. We can also add that we can aid the healthy development of gums, we even carry out grafting of gums, a surgical procedure. Combining, care, maintenance and in some cases replacing the teeth with an implant is what we do. We can also add we help take care, maintain and ultimately give freedom to those who follow our regimen is our ultimate goal. The reason I studied periodontics is because after I graduated from college and worked at a dental clinic I realized the most important aspect is to help take care of the patient’s teeth and gums, and if they are missing, replace them and help them to recover are the most important aspects of why I studied periodontics and became a periodontist.

Doctor Lee, are you in charge of periodontal related treatments at your dental hospital?

The short answer is yes, but our hospital has five or six head doctors doing their specialties. Each of their specialties are different, so we have dentists and orthodontists. So, each of us communicate and try to tailor the best treatment for each patient. So, like I said, the basics of periodontics, namely scaling, surgical scaling, and implants are done to the specific needs of each patient. The most important thing is to guard one’s dental health, and to maintain healthy teeth. For those without teeth or those with needs to remove them, we offer the implant solution and help keep a normal healthy lifestyle. Thus, I help patients in various ways to maintain their healthy teeth here at the clinic.

Implants. It has been really trending lately.

Yes.

What should patients and doctors consider before getting it?

Nowadays information is abundant on the internet. If one types transplant or implants, there is much information. While the majority of information is correct, what the patient needs to know is more or less readily available. However, if I explain simply, if one needs to have one tooth implant or many teeth implant, there are rather many issues one needs to consider. For example, the ampleness of the bone structure that can support the teeth (implant) is needed. The implant needs a certain minimum bone structure base to support the implant. If the bone structure is too shallow or too small, we need to first supplement it through grafting. A key issue for us to decide whether to graft the necessary bone structure prior to implant surgery or simultaneously in conjunction with the procedure. Or should we carry out the procedure without bone grafting. These are the issues we must consider. Also, we just talked about the quantity or ampleness of the supporting bones, but we must also consider the current condition of the bones. Also, the overall health of the patient is important. So, even if we are simply doing one tooth implant, we must plan according to each patient’s condition and need to carry out the best result. Also, patients also need to consider many issues. For example, a patient might think to simply get an implant, but after doing so, it is important to take care of the implant and crown. Patients need to take good care of their health. For example, those who smoke should cease smoking and cut down on drinking. So having an implant is not the end of the process but the start of a new life, which carries many responsibilities.

Complicated! How should patients take care of their implants.

Like I said, patients should realize that getting an implant is not the end but a new start. Many think they can stop visiting the dentist after getting implants and go on eating normally and suddenly are faced with implants that are not stable and move and thus ultimately suddenly visit the dentist. Instead, patients should think of their implants as their own teeth and accordingly take good care. Even implanted teeth can have illnesses. If implants are not well taken care of, the surrounding gums can deteriorate and even have infections just like normal teeth. I tell three things to all my patients, whether they have normal teeth or implants. First, the correct treatment we give to our patients is the key. Second, the care patients do on their own at home when not at a dental clinic – basically how they brush their teeth and gums as well as flossing. Third, regular checkups. So, the work is not over after visiting the dentist. It should be supplemented with good care at home and with regular checkups to the dentist. Some issues arise even with good self-care, so we can catch those issues during regular checkups and prevent worse outcomes with timely treatments. So, once again, our dental treatments, the patient’s self-care, and regular checkups for diagnosis and prevention need to be dutifully kept. Not only for natural teeth but also for implants in order to use them for a long period.

When you first introduce periodontics, you mentioned gum transplantation.

Yes.

And, esthetic periodontal surgery. I think there are not many people familiar with this. Can you briefly explain it for us?

In reality many people are well aware of procedures and issues like gum disease, scaling, gum treatment, gum surgery, implant, sinus lift. However, gum tissue grafting, or pre-prosthetic periodontal surgeries are terms not many have heard of. If we first start with gum tissue grafting, which applies to both natural and implants, there are two types of gum tissue that hold the teeth in place – the harder type called gingiva and the looser gum called the alveolar mucosa. If we move air in our mouth, we can feel there are tissues that are flexible and tissue that is tougher and immobile. Those tissues hold the teeth in place and also prevent the encroachment by bacteria. But if the gingiva is absent, and when the cheeks are pulled, the teeth will follow the movement and temporarily create an air pocket or bleed when brushing teeth if the gingiva is weakened and thus add to the chances of developing gum diseases. In such cases, we can perform gum tissue grafting from the roof of the patient’s mouth, resulting in a stronger gum tissue base to hold the teeth securely. This is called gum tissue grafting. We can also use grafting techniques for pre-prosthetic periodontal surgeries. For example, there are patients who have too little height in their gums, exposing their teeth and subjecting them to excessive coldness in their teeth. Some have their gums dug during brushing which results in gum recession and pain. Some complain about pain and some worry about their excessive gums in esthetic terms when smiling. There are many with these issues. Some common treatments are to remove some of the tissue or use medicine to lessen the pain. In pre-prosthetic periodontal surgery, we can graft tissue to raise the gum line and limit the pain as well as add to the psychological satisfaction when the new smile looks more normal in terms of the proportion of gum and teeth showing. So, gum tissue surgeries are also helpful for psychological reasons. Also, if we see other people or actors on TV, we can occasionally see people with too much gum tissue which shows during their smiles. The smile lines can show their gum tissue. For some, the gum line covers more of the teeth than normal, which is the opposite condition than previously discussed. If we assume the normal line for the gum to show is around here, some have it even lower and covering more of their teeth, which ends up showing more of their gums than normal. While this is not common, there are quite a few who have such condition. However, many are not even aware of it. But if it is treatable by periodontists, we can remove some of the gum tissue and limit the gum line exposure when smiling. In cases where that is not possible, we can achieve similar results by using laminates or crowns to increase the size of the teeth and result in a normal look. Some need a combination of those procedures. If any in the audience has gums that are excessive, you can go to a periodontist and have a thorough exam so we can see if there are options to consider

Conclusion

Dr. Lee is a periodontist at Goodlife Dentistry in Seoul. A periodontist might perform deep scaling for your teeth to keep both them and gums healthy by preventing inflammatory conditions.

Periodontists also perform surgery in cases where gum diseases are severe by opening the gum tissue.

Also, when the teeth become unusable due to severe cavities, a periodontist can perform dental implants to recoup the normal function. In some cases, even gum tissue implants (gingival implants) or grafting are performed for patients with gum recession.

When performing implants, it is important to assess the bone mass that can support the implant insertion. If there is lack of depth or size of the bone mass necessary for a successful implant, it has to be supplemented with bone grafting. A periodontist will assess if bone grafting is necessary prior to performing implants, while performing implants or without.

Once an implant has been performed, it is important to care for the implant and crown. Smoking should be ceased, and alcohol intake should be limited. Gum diseases can occur in areas of the implanted teeth, just as with natural teeth. So, continuous care of the new implant is necessary. The implant should be regularly cleaned by brushing thoroughly and flossing supplemented by regular visits to the periodontist.

When gum tissue grafting is necessary, it can be harvested from the roof of the patient’s mouth and grafted where necessary.

Treating gum recessions are not only for medical reasons but also for psychological well-being as some may feel shyness when smiling if the recession is extreme.

In some rare cases, partial removal of the gum tissue is performed for patients with over gum extended coverage of their teeth. Alternatively, the same condition can be also corrected by using crowns and laminates.