Periodontics

It is the breakdown of the supporting tissues around the teeth such as bone, ligaments and gum tissue. It is caused by the build-up of bacteria in the form of plaque and tartar in your mouth and can be worsened by defective crowns and fillings or excessive bite forces. Smoking and diabetes may lead to more rapid periodontal bone loss.

You may have periodontal disease without knowing it.  The most common symptoms are bleeding gums, bad breath, sensitive teeth, gum recession, and looseness or drifting of teeth. If you have any of these, immediate gum assessment and treatment is important to avoid losing teeth.

The initial stage of gum or periodontal disease is known as gingivitis with symptoms of inflammation and/or bleeding. Plaque bacteria that have not been removed from the teeth begin to produce toxins (poisons), which lead to infection.  Gingivitis is normally painless which is why many suffering from it do not seek dental advice or treatment. Bleeding gums are never normal. If gingivitis is treated early, it may be reversed. Another factor is smoking as it compromises gum circulation; heavy smokers can have gum disease without any bleeding as a warning sign.

Left untreated, gingivitis turns into periodontitis. During this stage, bacteria penetrate into the deeper tissues like bone and supportive tissues. Supporting bone will be lost and, if left untreated, periodontitis can lead to tooth loss and increase the risk of heart diseases, and can result in poor diabetes control and complications in pregnancy.

• Early Periodontitis:
  • Inflammation progresses into the surrounding structures of the teeth.
  • Loss of up to 20% of supporting bone, which results in deepening pockets or recession.
  • Gums continue to bleed.
  • Teeth may get sensitive to cold drinks.


• Moderate Periodontitis:
  • Continued inflammation and destruction of the supporting structure of the teeth.
  • 20 to 40 percent bone loss and some tooth movement (looseness).
  • Gums continue to bleed and recede.
  • Teeth may get sensitive to cold beverages.


• Advanced Periodontitis:
  • Bone loss is greater than 40% and tooth mobility increases.
  • In place of gum tissue, spaces between teeth and black triangles appear.
  • Acute gum abscesses can develop in deep pockets.
  • Eventually loss of one or more teeth can occur.

The bacteria in plaque are the main cause of periodontal diseases, however there are several other factors like smoking, diabetes, some immune diseases, medicines and bad oral habits which could accelerate bone loss.

These factors can increase your risk of gum disease or make it worse once the infection has set in.

Genetics: Some people are more likely than others to get periodontal disease due to genetics. But your genes do not make gum disease inevitable. Even people who are highly prone to periodontal disease can prevent or control the disease with good oral care.

Smoking and tobacco use: Smoking increases the risk of periodontal disease. The longer you smoke, and the more you smoke, the higher the risk. If you have periodontal disease, smoking makes it more severe.

Crowded teeth, braces or bridgework: Anything that makes it more difficult to brush or clean between your teeth is likely to enhance plaque and tartar formation. The more plaque and tartar you have, the greater your chance of developing gum disease.

Stress: Stress can make periodontal disease worse and harder to treat. Stress weakens your body's immune system. This makes it harder for your body to fight off infection, including periodontal disease.

Fluctuating hormones: Whenever hormone levels go up and down in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease as can menopause.

Medicines: Several types of medicines can cause dry mouth or excessive gum growth. Examples include certain drugs for depression, high blood pressure and epilepsy. If you don't have enough saliva, plaque is more likely to form causing tooth decay (cavities) as well as gum disease.

Diseases: Some medical conditions increase the risk of developing periodontal disease. Diabetics are more likely to get periodontitis than people without diabetes. Their gum disease is also likely to be more severe. Other diseases that can increase periodontal disease risk include inflammatory conditions such as rheumatoid arthritis and HIV infection. Having one of these diseases can make the control of your periodontal disease more difficult. But a good periodontist or dentist who is aware of these problems can give you guidance on how to maintain your periodontal health. Once gum disease is controlled, blood sugar levels in diabetics usually become more stable.

Poor nutrition: Nutrition is important for overall good health, including a working immune system and healthy gums and mouth. Severe vitamin C deficiency can cause bleeding gums.

Every dental check-up should examine the gums as thoroughly as the teeth. Gum pockets (space between gum and tooth) should be measured. If gums are normal, the measurement of pockets should be no more than 3 mm with no bleeding or recession. Measurements between 3mm to 5.5mm can generally be treated by a general dentist or dental hygienist, while any pocket of 6mm or deeper should usually be treated by a gum specialist or a periodontist.

Non-Surgical Treatment

Conservative treatment known as scaling and root planning (cleaning thoroughly below the gum line) involves a careful removal of plaque and tartar from the teeth and their roots while also smoothing away any roughness on the roots to prevent bacteria from gathering again. This procedure is carried out by your periodontist and may take more than one visit to complete.. Combined with improvements in oral hygiene, this will usually reduce deep pockets by between 2 to 3mm (less in smokers).

Surgical treatment

Your periodontist may perform periodontal surgery to eliminate bone infections or to regenerate lost bone. The most common surgical treatments include:

• Pocket reduction procedure

  After scaling and root planning, if the gum tissue is not snugly fitted around the tooth and you can’t keep the deep pocket areas clean, then you may be a candidate for a pocket reduction procedure. By easing back the gum tissue your periodontist can remove infectious bacteria and smoothem areas of damaged bone, allowing the gum tissue to reattach to healthy bone.

• Bone regeneration

  Bone grafting is a surgical procedure that promotes the growth of bone in an area where bone has been destroyed by periodontal disease. During this type of treatment, your periodontist will eliminate bacteria and then place natural or synthetic bone in the area of bone loss to help your body effectively regrow bone and tissue.

• Gum grafts

  Exposed roots due to gum recession can often be covered with gum grafts. Gum tissue is taken from your palate or from another area and used to cover the roots of one or more teeth. Covering exposed roots helps reduce sensitivity and protects your roots from decay while limiting further gum recession and bone loss.

• Cosmetic periodontics

  This can include correcting gummy smiles; covering gum recession and making gum lines more even and in harmony with teeth. Cosmetic gum procedures are often planned with restorative dentists and orthodontists.

• Dental implants

  Over the past 20 years, dental implants have become the most acceptable way of replacing lost teeth. Periodontists are involved in first ensuring the mouth is healthy enough to place implants with highest success rates; then in detailed planning and surgical placing of the implants.

• Periodontal maintenance

  Generally, periodontal diseases are controlled rather than cured. Regular, thorough professional cleanings with an experienced dental hygienist (usually an hour every three to four months) and your personal daily oral care play a big part in successful periodontal treatment. Your periodontist and hygienist at the Dubai Dental hospital will spend time with you to make sure you understand and practice proper brushing and cleaning between teeth at home. They will also ensure regular recall maintenance appointment to ensure long-term success.