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Periodontics (Gum Disease)

Periodontal (gum) disease

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Periodontics, or Periodontology, is the dental specialty dealing with periodontal (gum) disease. Periodontal disease is caused by bacteria in dental plaque - the sticky white gelatinous material that continually builds up on the teeth. The bacteria cause inflammation of the surrounding tissues, which can have two consequences:

1. Gingivitis - fairly superficial inflammation of the gums with redness, swelling and increased tendency to bleeding on brushing.

2. Periodontitis - deeper inflammation of the gums with loss of some of the bone supporting a tooth. As this progresses the tooth may loosen and perhaps eventually need to be removed. The gums may recede as bone is lost or the gum may come away from the tooth creating a 'pocket'. The progression of periodontal disease is extremely variable - a small amount of supporting bone may be lost over a period of many years in mild forms of the disease; with severe forms rapid breakdown of the supporting structures can occur.

Who gets Periodontal Disease?

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All ages can be affected by periodontal disease but chronic periodontitis normally only affects adults. The most common cause, though not the whole story, is inadequate oral hygiene. This results is the accumulation of plaque around teeth and allows the initiation or progression of periodontal disease. If plaque is left on the surface of the tooth for some time, it can start to mineralise and form calculus ('tartar') - this is a hard material and cannot be easily brushed off, but bacteria are still present within it and can cause continued inflammation. There would appear to be some genetic susceptibility to periodontal disease - some people seem much more prone to the condition whereas others are very resistant. Other factors which can increase the risk of disease include:

1. Smoking - smokers have been shown to have higher levels of periodontal disease than non-smokers and the tissues do not respond as well to treatment.

2. Diabetes and some other systemic diseases which can reduce the body's resistance to bacteria. Especially uncontrolled diabetes can lead to increased severity of periodontal disease. Based on the literature improving the gum condition might improve the control of glucose levels and vice-versa.

3. Genetics

4. Hormonal changes - in pregnancy or associated with oral contraceptives.

5. Some medicines can cause an increased tendency for the gums to swell.

6. Tooth anatomy - localised areas which may trap plaque and are difficult to keep clean.

7. Stress - Scientific evidence suggests that stress can be associated with rapidly progressive bone loss and aggressive periodontal disease.

8. Other factors such as obesity and grinding of the teeth have been identified as risk indicators of periodontal disease. Unfortunately the available evidence can be inconclusive.

Why do I need to see a Periodontist?

If you have been asked to see a Periodontist, this is because it is felt your particular gum problem needs the attention of an expert. He is the best person to make an accurate assessment of the level of disease in your mouth, discuss the most appropriate treatment and either carry out the treatment himself or make a treatment plan for the dental hygienist to follow.

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