Umhlanga Dental
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• The Periodontist
question Who is a Periodontist?
answer A periodontist (the gum specialist) is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire. Often, dentists refer their patients to a periodontist when their periodontal disease is more advanced.

question What is periodontal disease?
answer Periodontal (gum) disease, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colourless film that constantly forms on your teeth) causes the gums to become inflamed.

question What is gingivitis?
answer Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

question How do I know if I have early gum disease (gingivitis) or late stage gum disease (periodontitis)?
answer In the early stages of gum disease, the plaque that remains around the teeth hardens into calculus (tartar). As plaque and calculus continue to build up, the gums begin to recede (pull away) from the teeth, and pockets form between the teeth and gums. At this stage, with treatment, it is fully reversible. As gum disease progresses, the gums recede further, destroying more bone and the periodontal ligament that surrounds the roots. The affected teeth become loose and may need to be extracted. Routine check-ups and periodic measuring of the pockets around the teeth are necessary to monitor and prevent gum disease from progressing.

question What is periodontitis?
answer Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque can irritate the gums, and stimulate a chronic inflammatory response in which the body in essence turns on itself and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

question What are the different forms of periodontitis?
answer There are many forms of periodontitis. The most common ones include the following:
Acute periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction.
Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gums. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur. Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

question How do I know if I have periodontal disease?
answer Periodontal disease is often painless and develops slowly and progressively. Sometimes it may develop quite rapidly. Unless you see your dentist for regular check-ups, you may not realize you have periodontal disease until your gums and bone have been severely damaged to the point of tooth loss. Periodontal disease can occur at any age. In fact, more than half of all people over age 18 show signs of at least the early stages of some type of periodontal disease. Gingivitis is the earliest stage of periodontal disease and affects only the gum tissue. At this stage, it is reversible. If not treated, it could lead to periodontitis, potentially damaging bone and other supporting structures. Such damage can result in loosened teeth.

question What can I expect the first time I have a periodontal evaluation by my dentist or periodontist?
answer During your first visit, your dentist or periodontist will review your complete medical and dental history with you. It's extremely important for your periodontist to know if you are taking any medications or being treated for any condition that can affect your periodontal care. You will be given a complete oral and periodontal exam. Your periodontist will examine your gums, check to see if there is any gum line recession, assess how your teeth fit together when you bite and check your teeth to see if any are loose. Your periodontist will also take a small measuring instrument and place it between your teeth and gums to determine the depth of those spaces, known as periodontal pockets. This helps your periodontist assess the health of your gums. Radiographs (x-rays) may be used to show the bone levels between your teeth to check for possible bone loss.

question Is it true that there is a link between periodontal (gum) disease and heart disease?
answer Studies show periodontal disease can contribute to increased risk of heart attack and stroke. According to some studies, periodontal disease (which affects the bone and tissue surrounding your teeth) has proven to be a stronger risk factor than any of the other conditions usually linked to heart disease (e.g., hypertension, high cholesterol, age and gender). Researchers have concluded that the bacteria found in plaque (the primary etiological factor causing periodontal disease) is clearly linked to coronary disease. People with periodontal disease are up to two times as likely to suffer a fatal heart attack and nearly three times more likely to suffer a stroke as those individuals without this disease.

Aquaflosser question What can I do to prevent periodontal disease?
answer Keep your teeth clean by brushing with fluoridated toothpaste at least twice daily. Use dental floss or a water jet (highly recommended) and mouth rinse. Eat a balanced diet for good general health to secure the proper amount of nutrients to build your mouth's resistance to the infection caused by bacterial plaque. Visit your dentist at least every six months for a check-up and provisional clean and
making sure that a thorough periodontal exam is performed. Avoid other risk factors such as smoking and chewing tobacco, both of which have a detrimental effect on the severity of periodontal disease. Systemic diseases such as AIDS or diabetes can lower the oral tissue's resistance to infection, making periodontal disease more severe. Review your medical history with your dentist. Many of the medications or therapeutic drugs that you may be taking can decrease your salivary flow and adversely affect your teeth and gums.

question What is the link between periodontal disease and diabetes?
answer More and more studies are showing a link between the mouth and the rest of the body regarding the spreading of infections. Over 400 different types of bacteria can exist in the human mouth. Many of them thrive in sugars, including glucose, the sugar linked to diabetes. Persons with diabetes have a greater than normal risk of gingivitis (inflammation and bleeding of the gums) and periodontal disease, the condition that causes millions to lose their teeth. Like any infection, gum disease can make controlling the blood-sugar level very difficult. Diabetes causes the blood vessels to thicken, in turn slowing the flow of nutrients and the removal of harmful wastes. The result is a weakening of the resistance of the gums and bone tissue to the spread of an infection. Researchers have found that diabetes predisposes a patient to periodontal disease. Moreover, recent evidence strongly suggests periodontitis can worsen the severity of one's diabetic condition.

Many diabetic patients with severe cases of periodontal disease struggle to maintain their normal blood-sugar levels. As a result, their need for insulin increases, and infections originating in the mouth can easily spread and may enter the bloodstream. In cases of severe gingivitis and periodontal disease even the simple act of brushing or flossing can introduce bacteria into the bloodstream, aggravating health troubles in other areas of the body. Experts expect that treatment of periodontal disease may lead to diminished fluctuations of blood-sugar levels, along with a decreased risk of diabetic retinopathy and the associated risk of damage to the arteries.

People with diabetes are also at risk for developing thrush, a yeast infection in the mouth that causes white spots on the tongue. This infection thrives on high glucose levels in saliva. Another oral manifestation found in uncontrolled or undetected diabetics is dry mouth (xerostomia), an ailment that may result in halitosis (bad breath). Smokers are five times more likely to develop gum disease. A smoker with diabetes aged 45 or older is 20 times more likely to get severe gum disease.

question What precautions should I take when I see my dentist if I have diabetes?
answer If you have diabetes, make certain you inform your dentist and book a visit for an examination and cleaning at least every six months. You should schedule your dental appointments about an hour and a half after breakfast and after you have taken your diabetes medication. Try to arrange shorter visits, preferably in the morning.

question Is there a relationship between tobacco use and periodontal disease?
answer Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smokers are much more likely than non-smokers to have calculus form on their teeth, have deeper pockets between the teeth and gums and lose more of the bone and tissue that support the teeth.

question Is it normal for my gums to bleed when I brush my teeth?
answer No, it is not normal for your gums to bleed when you brush. Bleeding gums are one of the signs of gum disease. It is an indication of the beginning of the destructive process involving the supporting tissue around the tooth or possibly some serious underlying systemic problems. The bacteria which causes gingivitis (inflammation of the gums), can turn into tartar build-up, irritate your gums and lead to bleeding. If left unchecked, gingivitis can lead to a more serious form of gum disease called periodontitis. This long-term infection can eventually cause loss of your teeth.

question What are the warning signs of gum disease (Periodontal Disease)?
answer There are a number of warning signs of gum disease, which include the following:
• Red, swollen or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or eating hard food
• Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
• Loose or separating teeth
• Pus between your gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

question What does it mean to have pockets when you check for gum disease?
answer Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space in which bacteria can live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

question Could my periodontal disease be genetic?
answer Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interventive treatment may help them keep their teeth for a lifetime.

question What can I do to avoid periodontal disease?
answer To keep your teeth for a lifetime, you must remove the plaque from your teeth and gums every day with proper brushing and flossing. Regular dental visits are also important. Daily cleaning will help keep tartar formation to a minimum, but it won't completely prevent it. A professional cleaning at least twice a year is necessary to remove tartar from places your toothbrush and floss can’t reach or may have missed. The use of a water jet is highly recommended.

question What kind of oral care products should I use to prevent against gum disease?
answer Begin with the right equipment – use a soft bristled toothbrush that allows you to reach every surface of each tooth. If the bristles on your toothbrush are bent or frayed, buy a new one. A worn-out brush will not clean your teeth properly. In addition to manual toothbrushes, your choices include electric toothbrushes. These are safe and very effective when used properly. Oral irrigators (water spraying devices) are a great adjunct, but will not remove plaque from your teeth unless they are used in conjunction with brushing. Other options include interproximal toothbrushes (tiny brushes that clean plaque between teeth) and interdental cleaners (small sticks or picks that remove plaque between teeth). If used improperly, these dental aids can injure the gums, so it is important to discuss proper use with your periodontist and oral hygienist. Post brushing rinses such as Listerine are encouraged. Of course dental floss, when used properly, will help to prevent against cavities and gum disease. It is also recommended to use a tongue scraper to clean the posterior third of your tongue to prevent oral malodour.

question My gums bleed in the same spot every time I brush my teeth. What can be done to help this?
answer Chances are, if your gums are bleeding in the same spot every time you brush, there is an underlying reason for it. It may be that there is a piece of tartar deep within the pocket surrounding the tooth and it needs to be removed to allow for the gums to reattach to the tooth and become healthy once more. Perhaps there is an overhang of a filling or a piece of cement wedged beneath the gums. Bleeding is a sign of inflammation, and inflammation is usually brought about by some outside stimulus such as a trapped piece of popcorn, a seed, a string of the floss, or simply just the bacteria from the plaque and tartar. Remove the stimulus; maintain the area and the bleeding will disappear. Your dentist or oral hygienist can advise you and in most cases can be resolved very easily. Regular cleaning sessions with the oral hygienist will prevent most gum problems from ever starting in the first place.

question If I neglected my teeth for years, am I able to get them back to a completely healthy state?
answer If your teeth have been neglected for years, chances are you have already done some irreversible damage. Gum disease can cause a loss of bone support, which will not grow back once the mouth returns to a completely healthy state. The gum recession that follows the bone loss will remain evident, unless you are a candidate for certain gum and bone grafting procedures. The good news is that you can arrest bone loss and gum recession by taking perfect care of them. In other words, while you may not get back to where you started, you can prevent further damage from occurring.

question What does it mean to have receding gums? What can be done for this?
answer There are a few reasons why one might develop receding gums. One way is by using an improper brushing technique (i.e. brushing in an up and down or circular motion with a manual brush, rather than with small, vibratory strokes on a 45 degree angle). Another reason involves using a brush that has harder bristles or that is frayed and overdue for being replaced, which can traumatize the gums. Sometimes there may be high muscle attachments (attaching the inner part of the lips to the gums), which pull down on the gum tissue over time as one speaks, smiles, eats, etc. Additionally, gums can recede as a result of periodontal disease, due to the bone loss beneath.

While the gum tissue may not grow back on its own, there are a few things one can do to help prevent gums from receding further. Among the suggestions are:
• Use an electric brush
• If using a manual brush make sure to use soft bristles
• Use the proper brushing and flossing technique
• Use a water jet.

Stages of periodontal disease
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Stages of periodontal disease
Click to enlarge