In this post, we are going to answer the question “what is a periodontist” and discuss how a periodontist can help you.
Dentistry is a multifaceted field where professionals can not only practice general dentistry but also focus on specific areas of the mouth: gums, teeth, etc. In this post I will focus on periodontists, since I refer many of my patients who require more invasive gum and bone care to these colleagues. Some patients who have never seen or heard of a periodontist ask questions including what is a periodontist, what are signs of periodontal disease, what are the risk factors of periodontal disease, why they need to see a periodontist, what do periodontists do, etc.
What is a Periodontist and Who Should See One?
Many aspiring dentists choose to specialize while they attend dental school, and one option is to acquire additional education to become a periodontist. According to the American Academy of Periodontology (AAP), a periodontist is “a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease, and in the placement of dental implants.” They also have expertise in oral inflammation. In layman’s terms the answer to what is a periodontist is a dentist who concentrates specifically on the gums and the bones that support the teeth.
Periodontists receive three more years of specialty training after dental school, complete periodontal residency programs and continue with specialized education throughout their careers.
It may also be helpful to understand the etymology of periodontist, in other words not what does a periodontist do, but rather what is the meaning of periodontist, or periodontal. “Peri” means “around” in ancient Greek, and “odon” means “tooth.”
Signs of Periodontal Disease, or Periodontitis
Being an educated healthcare consumer is always helpful so you can more quickly determine when may be the right time to make an appointment with your dentist. The best defense is a good offense in order to prevent any periodontal disease from getting worse. At the first sign of any of these symptoms of periodontitis, or periodontal disease, it’s smart to schedule an appointment with your dentist:
- Bleeding gums
- Gingival recession
- Halitosis, or bad breath
- Mobile teeth
- Ill-fitting dentures
- Build-up of plaque and calculus
Risk Factors of Periodontal Disease
Some individuals may inherently have a higher rate of periodontal disease, so it’s helpful to know these risk factors of periodontal disease as well:
- Gender – periodontal disease is higher in men (56.4 percent) than in women (38.4 percent), according to the AAP.
- Alcohol consumption
- Genetic factors
- Oral hygiene
Some of these risk factors are within our control (smoking, stress) while others we have less control over (gender, genetics). Those of us who make the choice to live a healthy lifestyle can reap the benefits in a variety of ways. If you need help addressing any of the risk factors of periodontal disease, please let us know during your appointment and we can suggest resources to help you.
What Do Periodontists Do?
The goal of periodontists is to try and preserve as much of the patient’s bone and tissue as possible, as long as each are healthy. When the bone and tissue reach a point of no return, periodontists heal diseased tissue and bone through a variety of techniques that fall into six categories:
- Hard tissue procedures, which are also called osseous procedures, including bone grafting, bone recontouring, crown lengthening and tori removal.
- Soft tissue procedures include gum grafting, gingivoplasty (or gum recontouring), gingivectomy (or gum removal), root coverage procedures, pedicle flaps, frenectomies and biopsies.
- Dental Implants
- Combination, since some of the procedures can be completed simultaneously such as extractions and bone grafting.
I’ve gone into more detail for each of the categories and procedures below.
Hard Tissue Procedures or Osseous Procedures
As I mentioned above, hard tissue procedures, which are also called osseous procedures, include bone grafting, bone recontouring and tori removal.
Sometimes, the bone loss around a tooth is so great that it becomes unstable and has to be removed and an implant used in its place. In these cases, periodontists perform bone grafting procedures to create more stable bone with which to support the implant. By adding bone where people had previous extractions or injuries, there is available bone for future implant placement. A mixture of patient’s bone or synthetic bone that can be completed at the same time as an extraction. The bone will usually heal and mature over a three to six month period.
Bacteria love when a patient’s bone is jagged. Uneven bone allows bacteria to hide and multiply, which is bad for the patient and causes gum disease. With bone recontouring the periodontist will smooth the bone in order to limit any areas where bacteria could hide. This also improves the likelihood for the gum tissue to reattach to healthy bone.
What’s a tori? I’m so glad you asked! A tori is a bony growth on the top or bottom of a patient’s mouth. This is caused by a generally benign and painless condition called torus palatinus, if on the top of the mouth, or torus mandibularis, if found on the lower jaw. A tori removal simply reduces the incidences of excess bone. While tori usually don’t have to be removed, in some cases it may be suggested including to accommodate dentures, minimize food impaction, etc.
Soft Tissue Procedures
Soft tissue procedures include gum grafting, gingivoplasty (or gum recontouring), gingivectomy (or gum removal), root coverage procedures, pedicle flaps, frenectomies and biopsies
A gum graft is another common procedure performed by periodontists. A patient requires a gum graft when he or she has so much recession that there’s no or little attached gingiva, or gums, around a tooth.
Little fibers from the gum attach to the tooth and create a seal around the tooth to prevent bacteria from going down near the bone. When the gums wear away from heavy brushing or the use of heavy bristles, having braces, gingivitis, poor dental hygiene, periodontal disease or other reasons, the gums become unstable, causing the teeth to move around. When so much gingival recession occurs, a periodontist has to perform a gum graft to protect the teeth from decay and stabilize the teeth and mouth.
Gum grafts cover a spectrum, although three common methods of gum graft include:
- Connective Tissue Graft. After the periodontist cuts a flap in the top of the patient’s mouth, or palate, he or she then takes a piece of tissue under the flap and attaches it to the root in question.
- Free Gingival Graft. This is similar to the connective tissue graft, although the main difference is that the flap of tissue from the palate is used, rather than taking tissue from under the flap.
- Pedicle (Lateral) Grafts. In a pedicle, or lateral, graft, tissue from around the gum is used, rather than tissue from the roof of the mouth.
You’ll notice that all of the above gum graft methods require the patient to provide the tissue. Thanks to technology, another option is a synthetic graft, or utilizing tissue from a tissue bank, rather than harvesting the tissue from the patient’s mouth.
Gingivoplasty or Gum Recontouring
Gingivoplasty, or gum recontouring (also sometimes seen as gum contouring), involves surgically reshaping a patient’s gums surrounding a tooth. In most cases a gingivoplasty is done not for medically necessary reasons, but rather for cosmetic reasons.
Gingivectomy or Gum Removal
Periodontists perform a gingivectomy, or gum removal, on patient’s whose gums have separated from the teeth and now have deep pockets between the tooth and the gums. As we know, deep pockets are bad because bacteria thrive in this environment, as it’s difficult for home care to effectively remove plaque.
If needed, the periodontist can cover the exposed root of a tooth that has a lot of recession. This procedure is done primarily for aesthetics or sensitivity to cold or heat.
Before I go too deep into the procedure, first I want to educate you about frenums. Frenums are bands of tissue that connect the teeth and gums. You’ll find your lingual frenum on the bottom part of your jaw between the floor of your mouth and the base of your tongue. Your labial frenum is on the top of your mouth connecting your gum to your lip. If either of the frenums is too large, a periodontist will perform a frenectomy to reduce the size. A frenectomy helps to give the tongue more movement to allow for easier speech, swallowing or other movement, or to help close space between the front teeth.
Anyone who has visited a dermatologist in South Florida is likely familiar with biopsies on the skin. It’s very similar in dentistry with gingival biopsies, in that periodontists will take a sample of a patient’s gum if they see any suspicious areas of oral pathology, including oral cancers.
A periodontist performs dental extractions when he or she removes teeth. A common extraction is wisdom teeth, which many of us experienced when we were kids. Other reasons teeth need to be extracted include when teeth are decayed and unable to be healed.
When a tooth is lost to trauma or periodontal disease – or in some cases the tooth never grew in – a great option to replace a missing tooth is a dental implant. Fortunately, the technology has changed quite a bit over the years – long gone are the days of ill-fitting dentures.
Today’s dental implant is a root shaped, highly engineered piece of titanium, since titanium is one of the few materials that bone will actually grow on to. The implant is put directly into the available bone. Periodontists measure the size of the bone with dental 3D imaging to determine the exact site of optimal placement of the implant of the correct size. Depending on the quality and quantity of bone, as well as the overall general health of the patient, the implant will take from three to six months to integrate with the bone. Only then will a general dentist start procedures to build a tooth or a bridge on top of the implant.
A common dental implant procedure is an All-on-4 implant procedure, and I’ll discuss that in more detail in a future blog post.
Combination of Hard and Soft Tissue Procedures
One common combination procedure that periodontists perform is pocket elimination, traditionally known as gum surgery. Pocketing occurs when the bone recedes around a tooth and the gum stays in the same place, resulting in air between the tooth and the gum. Bacteria loves this space! Periodontists measure the size of the pocket by a small ruler called a periodontal probe. This tiny instrument has marks that measure the amount of recession around the tooth. A general rule of thumb is that a healthy area measures one to three millimeters without bleeding. But when people don’t floss, the bacteria on the tooth and around the gums builds up. This bacteria produces acid that dissolves the bone and supporting structures, like the periodontal ligaments, and the gums become inflamed. This is similar to having a splinter in your finger. Ouch!
Let me give you another analogy. Whether you’re a Miami native like me or if you relocated recently and are looking for the best dentist in Miami, you likely have seen some strong winds either during a hurricane, tropical storm or simply a famous Florida summer afternoon rain shower. Due to Florida’s storms and high wind, fence posts around your house need to extend a number of feet into the ground. Indeed, the larger percentage of the post that’s in the ground compared to above ground, the more stable that fence will be during a windstorm. The same goes for your teeth – the post – and your gums – the ground. The larger percentage of your tooth that is below your gums, the more stable that tooth will be. Conversely, the more of your tooth that exists above the gum, the more mobile that tooth becomes. A tooth becomes also increasingly mobile the more you push your tongue against it or chew, and then it can become infected.
Periodontists remove the disease gum but then more of the tooth is exposed and teeth look longer. People who have longer pockets – longer than the ideal one to three millimeters – have more issues with flossing. The floss generally can’t effectively clean the tooth if pockets are larger than three millimeters, so bacteria stays in the gums and continues to build up.
This procedure has not only saved millions of teeth over the years, but also relieved patients of much pain and discomfort.
Another combination procedure, dental crown lengthening helps people who may have a “gummy” smile, or whose teeth appear short. In actuality, the teeth may be of normal length, but the gums may protrude too far down the tooth. During crown lengthening, the periodontist reshapes excess gum and bone tissue to expose more of the patient’s natural tooth.
Cosmetic Periodontal Procedures
Sometimes, while a procedure isn’t medically necessary, cosmetic contouring of the gums is performed. Think of it like plastic surgery of the gum. Many people choose to have cosmetic periodontal procedures to have an even smile, to better like the smile of person they see in the mirror.
Success of Periodontal Procedures
Like with any medical surgery, it’s vital that patients follow their doctor’s pre- and post-operative instructions for any periodontal surgery or periodontal procedure. Common post-operative instructions include not using a straw, not brushing the area for a certain amount of time, no vigorous rinsing. Part of the natural healing includes build-up of a clot that allows the gum to heal underneath, so it’s vital that the patient doesn’t do anything that removes the clot.
How to Avoid Going to a Periodontist
Not all patients need to see a periodontist, and in most cases seeing a periodontist can be avoided by maintaining healthy dental hygiene. Each time you’ve visited your dentist over the years you’ve likely heard the same instructions: brush and floss after meals, each and every day. While you may groan inwardly – or outwardly! – maintaining dental health on a daily basis is the best long-term strategy for keeping a healthy mouth, and avoiding the periodontist. It’s a marathon, not a sprint – we know if you only floss the night before your dental visit!
Sometimes, it can’t be helped, no matter how diligently you adhere to your at home care regimen. People who have a temporomandibular joint (TMJ) disorder or temporomandibular disorder (TMD) or grind their teeth can have periodontal issues. It’s a slippery slope, which is yet another excellent reason why people should floss daily.
Some people also have periodontal disease due to genetics. This is unfortunate but true. If you’re one of those who have periodontal disease in your family, it’s still vital to maintain good dental hygiene.
See One of the Best Periodontists in Coral Gables, FL
During your regular visits to South Gables Dental, we thoroughly inspect your teeth and gums for any issues, and we fortunately have a top Coral Gables periodontist, Dr. Robert Kaufman, right here at our practice. Learn more about Dr. Kaufman here.
Thank you for reading our blog that answers what is a periodontist. If you have additional questions about the information provided or you have questions about what is a periodontist that weren’t addressed, please feel free to contact us at email@example.com.
You can contact us to schedule an appointment for all of your Coral Gables or Miami dentist needs.
I’m Dr. Lawrence Lesperance, a Coral Gables dentist who specializes in preventative dentistry, general dentistry services, and cosmetic dentistry services. My team and I provide personalized dental services for the whole family and offer orthodontic treatments, implant dentistry, periodontic services and botox treatments (for TMJ and migraines and cosmetic botox) and much more. Contact us to experience the South Gables Dental difference today!
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