Periodontist in India

Overview

A periodontist is a specialist dentist who prevents, diagnoses and manages issues related to the gums, bones and other soft tissues of the mouth.

They treat inflamed gums, swelling, bad breath, discoloured gums, and other oral soft-tissue-related problems. A periodontist first assesses oral health and decides on the necessary treatment. They may advise surgical or non-surgical treatment, depending on the extent of the damage to oral tissues.

Periodontists perform a wide range of procedures such as scaling and root planing, periodontal maintenance, periodontal surgeries, smile designing, aesthetic gum corrections and implant placement.

Diseases that Periodontists treat

The early manifestation of gum disease is known as gingivitis. In gingivitis, only the gums are inflamed. Keeping the mouth clean and maintaining proper oral hygiene prevents gingivitis. Sometimes, teeth cleaning, mouthwash, and local astringents can help lower bleeding from gums and swelling.

The advanced stage of gingival inflammation is termed periodontitis. This condition requires more extensive treatment, and the patient needs to consult a periodontist. Periodontists are dentists who specialise in the management of gum diseases. Extensive gum damage can cause bone loss and, eventually, loss of teeth. Periodontists are trained to treat the following conditions:

• Inflammation of gums or gingivitis:Gingivitis is the inflammation of gums that leads to swelling, bleeding on brushing teeth, the release of exudate from the gums, and sometimes pain on chewing food or touching. On examination, periodontists decide their treatment plan based on the cause of inflammation. Some treatment modalities include teeth scaling and root planing, antibiotic or astringent application and, in complex cases, gingivectomy.
• Periodontitis: - Periodontitis is a condition in which the supporting structures of the bone are diseased. These structures include the gingiva or gums, periodontal fibres, bone, and cementum. The characteristic symptoms of periodontitis include the formation of pockets or separation of gums from teeth, bleeding on probing in gums, inflamed gums, swelling, pus or exudate discharge from the gums, and pain on chewing. This condition may need non-surgical or surgical treatment.
• Loss of teeth: This can be treated by placing dental implants and extracting teeth where indicated.
• Smile designing/ Aesthetic corrections: Periodontists are experts in restoring the smile line and making aesthetic corrections such as fixing gummy smiles, missing teeth, swollen gums, discoloured gums, high frenal attachments, and other such problems.
• Bone grafting procedures: This surgical procedure helps restore bone loss or provides a base for implant placement. In addition, periodontists are trained in bone and tissue regenerating procedures that improve aesthetics and smile.
• Crown lengthening procedure: This allows the doctor to increase the clinically visible crown height in order to place a dental crown on the tooth.
• Receding gum line: With age and other factors such as plaque or tartar deposition, gingivitis and periodontitis, and all, the gums tend to detach from the surface of the teeth. This phenomenon is termed gingival recession. This can be treated by performing various gingival surgeries, including raising the gingival flap, bone grafting with membrane placement, gingival repositioning techniques, crown lengthening, and others.

When to see a Periodontist?

Periodontists perform a broad range of procedures to treat various soft-tissue-related oral health issues. Some treatment modalities that they perform include scaling and root planing, periodontal maintenance, periodontal surgeries, smile designing, aesthetic gum corrections and implant placement. A person must visit a periodontist when:

• They have gum problems that fail to improve with teeth cleaning and other at-home measures.
• A gap forms between the gum and teeth, also known as a pocket formation.
• Untreated periodontal diseases sometimes cause infection in the related teeth, leading to a perio-endo lesion. As a result, the infected tooth/teeth must be treated with a root canal.
• Loosening of teeth due to periodontal disease. In such cases, periodontists will try to save the teeth. They might advise extracting them and placing dental implants if that is not possible.
• They have cosmetic concerns such as dark-coloured gums, gummy smiles, missing teeth, and swollen gums in the visible smile line.
• They have gums that bleed easily on touching, brushing or eating food.
• They experience a recession of gums when there is a loss of attachment due to inflammation, plaque tartar deposit or infection.
• Patients require bone regeneration procedures in areas that have extensive bone loss.
• Laser treatments for improving smiles and esthetics.
• Patients with high frenal attachments that cause gummy smiles can be corrected with the help of different surgical or laser methods.
• Tooth crown lengthening by removing surplus gum tissue and making space for placing a dental crown.
• Placing dental implants to replace a tooth or a bridge
• Periodontal pocket reduction procedures, known as osseous surgery, help limit the space around the root of the teeth. This is the space where bacteria thrive.

Diagnosis

On visiting a periodontist, they begin the consultation by taking the medical history that follows a clinical oral examination. The oral examination includes:

• Recording the patient's medical history to identify the factors that may be contributing to the symptoms.
• Performing an oral examination to check for bleeding of gums and the extent of plaque and tartar accumulation on teeth.
• Measuring the pocket depth of gums, i.e., the gap that may have formed between the gums and teeth.
• Taking X-rays to assess bone loss.

X-rays and pocket depth analysis help them create a periodontal treatment plan that aims at improving the health of the gums. Sometimes, they may prescribe topical or systemic antibiotics along with deep cleaning of teeth to control gum disease. Some cases may need surgical intervention.

They also recommend making changes in lifestyle and at-home therapies to follow in order to maintain oral hygiene. Some instructions that they may give are:

• Brush and floss teeth twice a day.
• Using a soft-bristled toothbrush.
• Brushing gently.
• Using an electric toothbrush.
• Rinsing with mouthwash regularly.
• Regular teeth cleanings.
• Quit smoking or chewing tobacco.

Review

Reviewed by Dr. Namita Karna, Principal Consultant - General Dentistry & Periodontology.