Periodontal disease is more commonly known as gum disease and was referred to as pyorrhea in the old days. It is a progressive inflammatory disease of the gingival and the surrounding tissue (bone) around the teeth. Periodontal disease is the number one cause of tooth loss after the age of 30 and it is believed that around 80% of the population above the age of 30 may suffer from this disease, with varying degrees of severity. It is usually painless and is mainly caused by plaque although pregnancy, diabetes, epilepsy, and such medications as chemotherapy, medication prescribed for heart problems, birth control pills, and antidepressants can all make you more susceptible to gingivitis, which is one of the more common forms of periodontal disease.

The disease is of a progressive nature and in several stages.

Gingivitis
The first stage of periodontal disease, gingivitis, is the mild inflammation of the gingival caused by plaque build up. Your gingival will be red, swollen, and tender. You may also notice bleeding while you brush and floss. This stage of periodontitis is reversible.

Mild Periodontitis
Inflammation will spread to the supporting alveolar bone. Minor bone loss and the formation of periodontal pockets, or food traps, may occur.

Moderate Periodontitis
In this stage, there will be increased gingival recession, moderate to deep pockets, moderate to severe bone loss, and mobility of teeth due to the bone loss.

Severe Periodontitis
This is the most serious stage of periodontitis. Deep pockets, increased mobility of teeth, movement of teeth out of position, and visible fistulas (boils) will be present in this stage. Pus may develop; bone loss continues, and your teeth may loosen or fall out

In order to diagnose periodontal disease, the doctor will evaluate the following :

These findings determine the periodontal stage and therefore determine the appropriate treatment plans. Treatment will depend upon the type of periodontal disease and how far the condition has progressed.

If the disease is still in the first stage (gingivitis) your dentist may prescribe an anti-microbial mouthrinse and advise you to brush and floss on a regular basis.

Scaling, deep scaling and root planning as opposed to prophylatic

Periodontal scaling is a treatment procedure, which involves the instrumentation of the crown and root surfaces of the teeth. Plaque, calculus, and stains will be removed from these surfaces. It is performed on patients with periodontal disease and is therapeutic, as apposed to prophylactic in those without disease and may precede root planning. It is a definitive, meticulous treatment procedure aimed at the removal of cementum and/or dentin that is rough and is possibly permeated by calculus, or even contaminated with toxins or microorganisms. When carried out thoroughly, some unavoidable soft tissue removal occurs. Debriding the root surface is a critical element in establishing periodontal health. Root planing involves scaling the deep areas of the roots of teeth with special instruments called curettes. In some patients, there may be a need for your dentist to give local anaesthesia on the teeth involved so as to prevent and remove any pain from occurring.

The best way to prevent periodontal disease and tooth decay is to maintain good oral health care. Daily brushing will remove a thin sticky film of bacteria, called plaque that grows on your teeth. Cleaning between the teeth once a day with floss removes plaque from between the teeth - areas where the toothbrush can't reach but constitutes 40% of the teeth surface area.. Brushing and flossing are essential in preventing gum disease. Brush your teeth twice a day, with a soft-bristled brush and use a formula of toothpaste that contains fluoride, which helps protect your teeth from decay. It is also advisable to seek regular dental visits that include a periodontal evaluation.

In most cases, the gums are too tender to brush post-operatively. We will provide you with an antibacterial rinse called chlorhexidine, which will chemically reach those areas that the toothbrush will be too sensitive to debride or unable to reach. Warm salt water will help to reduce gum inflammation and an antibiotic is usually prescribed to prevent infection. Analgesics (pain killers) can be used if the pain becomes severe.

Your dentist will probably recommend regular fluoride treatments that will strengthen enamel and help your teeth resist decay. You should drink fluoridated water and always use fluoridated toothpaste.

It is essential for your dentist to monitor your progress and a series of appointments will be scheduled at three month intervals if the condition is severe.

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