Periodontal Evaluation

A periodontist is a dentist specializing in the prevention, diagnosis, and treatment of infections and diseases of the soft tissues surrounding the teeth and the jawbone to which the teeth are anchored.  Periodontists have to train an additional three years beyond the four years of regular dental school, and are familiar with the most advanced techniques necessary to treat periodontal disease and place dental implants.  Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.

Periodontal disease begins when plaque (bacterium) builds up on the tooth surface. If this plaque is left over a period of time, the gum tissues become inflamed.  As plaque accumulates over time it will set up an environment for more toxic plaque to grow below the gums that can lead to bone loss.  As the infection progresses, increased inflammation or irritation between the teeth and gums occur. The response of the body is to destroy the infected tissue, which can lead to increased swelling, resulting in pockets between the teeth and gum tissue.  If left untreated, the pockets get deeper with further bone loss that can lead to loss of teeth.

Referrals from General Dentists and Self-Referral

There are several ways treatment from a periodontist may be sought. In the course of a regular dental check up, if the general dentist or hygienist finds symptoms of gingivitis or rapidly progressing periodontal disease, a consultation with a periodontist may be recommended. However, a referral is not necessary for a periodontal consultation.

If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:

  • Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.
  • Bad breath – Continued halitosis (bad breath), which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis, or the beginnings of an infection in the gum tissues.
  • Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease.  As this disease progresses and attacks the jawbone (the anchor holding the teeth in place), the teeth may become loose or be lost altogether.
  • Separation of teeth 
  • Related health conditions – Heart disease, diabetes, osteopenia, and osteoporosis are highly correlated with periodontitis and periodontal infections.  The bacterial infection can spread through the blood stream and affect other parts of the body.

Diagnosis and Treatment

Before initiating any dental treatment, the periodontist must extensively examine the gums, jawbone, and general condition of the teeth.  When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non-surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth which may be missing.

  • Gingivitis/mild periodontal disease – When the gum pockets exceed 4mms in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal.  Education and advice will be provided on an effective cleaning regime thereafter.
  • Moderate periodontal disease – If the gum pockets reach 4-6mms in length, a more extensive scaling and root planing cleaning might be required.  This cleaning is usually performed under local anesthetic.
  • Advanced periodontal disease – Gum pockets in excess of 6-7mms are usually accompanied by bone loss and gum recession.  Scaling and root planing will always be performed as the initial non-surgical treatment.  In addition to those non-surgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.

Ask your periodontist if you have questions about periodontal disease, periodontal treatment, or dental implants.