The periodontium designates all the tissues surrounding the tooth and constituting its supporting structures (bone, periodontal ligament and cementum).

According to most recent studies, 50 to 70% of the North American population suffers from some form of periodontal disease.

Periodontal disease is an infectious disease initiated by pathogenic bacteria present in dental plaque. These bacteria release toxins and cause a state of chronic inflammation that will lead to the destruction of the tissues supporting the tooth.

Gingivitis

• Consists of inflammation of the gums.
• Over 90% of the adult population suffers from it to varying degrees.
• The main cause is build-up of bacterial plaque around the neck of the teeth.
• The gums are red, swollen and bleed.
• Gingivitis is reversible with adequate intervention consisting of a professional cleaning and good oral hygiene measures.
• It can progress to periodontitis if left untreated.

Periodontitis

• More advanced stage of the disease.
• This state of hyperinflammation causes the destruction of bone and of all the supporting structures of the tooth.
• A space, called a periodontal pocket, is created between the gum and the tooth, making a gateway to more bacteria.
• If left untreated, bone loss progresses, pockets become deeper and in severe cases it can lead to tooth loss.

BACTERIAL PLAQUE IS THE PRINCIPAL CAUSE OF PERIODONTAL DISEASE.

However, contributing factors exist such as:

Smoking

• Smoking is considered to be one of the most significant risk factors in the development and progression of periodontal disease.
• Smokers will experience more severe periodontal disease and more bone loss. They will have a higher risk of losing their teeth and a poorer response to periodontal treatments.

Genetics

• Certain individuals have poorer resistance to periodontal pathogens and are therefore predisposed to developing periodontitis.
• If the disease is detected in time and appropriate treatments are carried out, tooth loss can be prevented even in highly susceptible individuals.

Stress

• Stress weakens the immune system and reduces resistance to periodontal pathogens.

Diabetes

• Periodontitis is now considered a complication of diabetes.
• Diseases that affect the immune system such as diabetes make the body more vulnerable to infections in general, including to periodontal disease.
• Studies have shown that there is a bidirectional relationship between diabetes and periodontal disease.
• Patients with uncontrolled diabetes will have more severe periodontal involvement.
• Diabetic patients with untreated periodontal disease will show higher blood glucose levels. Following periodontal treatment diabetes control is often improved.

Other systemic diseases

• Systemic diseases that interfere with the body’s inflammatory system may worsen a pre-existing periodontal involvement. These include cardiovascular disease and rheumatoid arthritis.

Only a thorough periodontal examination including measurements taken at the gums and appropriate radiographs can help diagnose this often painless and silent disease.

Periodontal disease is in most cases silent and painless unless it reaches a more advanced stage. Here are some signs and symptoms:

• Bad breath
• Bad taste in the mouth
• Bleeding gums
• Redness, swelling, inflammation, and gum tenderness
• Progressive recession
• Sensitivity to cold or hot
• Tooth mobility
• Teeth spacing

Note that you can have periodontal disease without experiencing any of the above-mentioned symptoms.

The mouth is not separated from the rest of the body. Bacteria and inflammation in the mouth can spread throughout the body and cause constant irritation to the immune system.
Links are now well established between uncontrolled periodontal disease and chronic inflammatory diseases such as:

• Cardiovascular diseases
• Cerebrovascular accidents
• Diabetes
• Lung diseases
• Certain cancers (pancreatic cancer, oral cancer, gastrointestinal cancers)
• Alzheimer’s disease
• Premature and low birth weight infants

Treating your periodontal condition can not only improve your oral health, but will also improve your general health.

• Although it is very difficult to predict how quickly the disease will progress in each individual patient, it is known that the condition will in most cases worsen over time. In addition, management of less advanced involvements are usually easier and require less invasive treatments.
• Untreated periodontal disease can lead to tooth loss and systemic diseases. Maintaining good oral health is essential to your overall health.

• Its management starts with a professional cleaning.
• Maintaining good dental hygiene is essential. We make sure to provide you with oral hygiene instructions with tools and techniques adapted to your specific needs.
• Full resolution is expected within 3-4 weeks of proper plaque control.

1 – Control of risk factors

• Establish good oral hygiene practices.
• Smoking cessation.
• Control any contributing factors such as grinding teeth or other para-functional habits.
• Make sure that all systemic diseases present are well controlled.

Without control of risk factors, we cannot expect a good response to treatment.

2 – Root planing (deep cleaning)

• Non-invasive procedure.
• Consists of thorough sub-gingival cleaning of the surfaces of the roots of teeth in order to remove all the plaque and calculus that cover them.
• Performed under local anesthesia in 2 to 4 sessions.
• Patients experience little discomfort following this procedure, apart from some sensitivity to cold.

3 – Re-evaluation

• Between 8 to 12 weeks following the root planing procedure, an appointment is planned to assess the response to treatment, perform a good cleaning and determine the appropriate frequency of maintenance care to minimize recurrences.

4 – Maintenance phase

• Long-term follow-up by your periodontist and good oral hygiene habits are essential for the maintenance of your oral health.
• These appointments consist of an evaluation of the state of your gums and a thorough cleaning adapted to your specific needs, alternating between our office and that of your dentist.
• This preventive approach allows us to detect any reactivation of periodontal disease and if needed to intervene quickly with simple measures.
• A maintenance appointment consists of :
  
  1. Updating your medical and dental history.
  2. Assessing your periodontal health.
  3. Removing all plaque and calculus build-up both above and below the gum and in hard to reach areas.
  4. Assessing your ability to remove plaque and, if necessary, revising oral hygiene techniques.

In certain situations, we need to resort to surgical approaches in order to achieve periodontal health.

Pocket reduction surgery

• Treatment of choice in more severe cases or when deep residual pockets persist following root planing.
• Allows better access to reach calculus which is lodged far under the gum.
• Provides access to correct bone defects caused by periodontal disease and to reposition the gum closer to the actual bone level in order to reduce pockets depth and create an environment that will be easier to clean and maintain.
• Following this procedure, the teeth will temporarily become more sensitive to cold and heat.

Guided tissue regeneration

• In certain situations, you can regenerate the bone that has been destroyed by periodontal disease. To achieve this, bone grafts or proteins having the capacity to stimulate bone formation can be used.