Dental Implants | Esthetic Dentistry
Periodontology | Dr. George Makris & Co.

Periodontology is the branch of dentistry that deals with the health of the gums and the tissues that support the teeth. It examines and treats problems such as gingivitis and periodontitis, which, if not treated, can lead to tooth loss. Its purpose is to keep the gums and teeth healthy.

What is microbial plaque?

Microbial plaque is an organized mass of microorganisms originating from the normal flora of the mouth that has the ability to adhere to the surface of the tooth. As the plaque matures, its infectious action increases. It is the characteristic off-white coating that forms around the tooth, particularly at the “junction” of the gum-tooth interface when left unbrushed. Microbial plaque has strong adhesive properties, so it can only be removed by the mechanical action of the toothbrush.

What is “tartar”?

Tartar, or calculus as it is the correct term, is the late and calcified form of microbial plaque. It forms when microbial plaque is not removed in time, starting the process of calcification. It is more commonly found where the salivary glands discharge (e.g., the posterior surfaces of lower teeth). Tartar has a rough surface, a property that facilitates the attachment of new microbial plaque. It is mainly found at the tooth-gum junction, both above the gums (visible tartar) and below them.

What is gingivitis?

Gingivitis is an infection that causes inflammation with bleeding in the gums. At times, it can be very intense (blood on the pillow), while at other times, the symptoms subside. These conditions are reversible, meaning that with treatment, full restoration of periodontal health can be achieved. The symptoms of gingivitis may worsen under certain conditions, such as hormonal changes (puberty, pregnancy, menopause, etc.), the use of medication (specific categories of antihypertensives, contraceptives, etc.), and the presence of systemic diseases (diabetes mellitus).

What is the treatment for gingivitis?

The treatment for gingivitis is based on controlling the microbial factor, i.e., the removal of microbial plaque and tartar. This is the well-known “cleaning.”
Depending on the severity of the disease, it is performed with or without local anesthesia on the gums, usually in one or two sessions.

What is periodontitis?

Periodontitis is an infection that, in addition to the soft tissues (gums), extends to the underlying hard supporting tissues of the tooth (bone). As a result, there is gradual loss of the supporting bone surrounding the tooth, leading to gum recession and the formation of a periodontal pocket. Periodontitis, depending on its chronicity, the bone destruction it has caused, and the speed of its progression, is classified as early, moderate, advanced, and aggressive.

Unlike gingivitis, the treatment of periodontitis cannot restore the damaged tissues, but it can stop the progression of the disease.

What are the symptoms?

Periodontitis is a “sneaky” disease. It does not cause pain like a decayed tooth, and it is not easily noticeable. The symptoms come and go. It can only be detected by the patient in the final stage, when teeth begin to become loose, move to other positions, abscesses form, etc. In the early stage, only the dentist can diagnose it.

What is the cause of these diseases?

Periodontal diseases are infections, caused by the action of specific pathogenic microorganisms that live in anaerobic conditions (without oxygen). There is also a predispositional family factor, and of course, neglect in maintaining oral hygiene. However, the main factor remains the microbial infection.

What is the treatment?

Since periodontal diseases are infections, their treatment is “antimicrobial.” This does not mean taking antibiotics (which is done only in acute situations), but that the teeth must be “cleaned” beneath the gums, and the patient must then maintain oral hygiene and, consequently, the results of the treatment. The treatment is performed per quadrant and always under local anesthesia. It includes root scaling to remove subgingival tartar and plaque, and where necessary, surgical intervention to reduce pockets and create a healthy oral environment.

Does periodontitis hurt?

Very rarely. Only when an acute condition develops with the accumulation of pus (abscess). Patients usually complain of a “prickling” sensation and report, “I want to make my gums bleed to feel better.”

Why does my mouth smell?

Periodontal diseases present with gum bleeding and swelling. Inflammation is a process of tissue destruction and breakdown. Among the products of this ongoing destruction are methane and sulfur compounds, which have a strong and characteristic odor that cannot be masked with mouthwashes.

What are the pockets?

In cases of advanced periodontitis, pockets are formed. These are gum crypts around the teeth. Due to the destruction of the bone that supports the teeth, and if the gums do not recede, a crypt (pocket) forms between the bone and the gum margin. This creates ideal conditions for the proliferation of bacteria responsible for periodontal diseases, as removing them from deep pockets is difficult or impossible for the patient. When the bacteria reach a critical mass of pathogenic activity, a localized micro-abscess forms, destroying part of the tooth’s support, leading to bone recession. This process repeats, ultimately resulting in tooth loss.

What does surgical treatment mean for periodontitis?

If the depth of the pockets is significant, they should be reduced. It is estimated that in advanced periodontitis, the total area of the pockets corresponds to the area of our palm, covered with millions of bacteria. Surgical treatment achieves three goals: First, it provides direct visual access for cleaning the teeth; second, it reduces the depth of the gum crypts, and thus the conditions for the growth of pathogenic bacteria; and third, it facilitates the patient’s ability to clean the teeth. In a scaling (conservative treatment), this cleaning is done without visibility.

Does the “laser” method outperform surgery?

Lasers operate with high-energy radiation. There are various types of lasers with many different properties, which makes selecting the right laser difficult. Additionally, they have been implicated in causing tissue burns. Finally, regarding the disinfection of the tooth surface, it has been proven that lasers do not outperform conventional disinfection methods. Therefore, their use carries risks without offering any advantage.

Is the surgical approach painful?

It depends on the surgical procedures. It is related to whether there is a real need for surgery, how extensive the surgical opening is, and how careful the overall approach to the area is.

Is it possible for the surgery to be limited to just one area?

Of course. If there is a single large pocket, the treatment can be very localized. However, surgical intervention in small pockets can cause bothersome recessions and should be avoided.

Does gum recession automatically mean periodontitis?

No, not necessarily! Often, the recession may be due to traumatic brushing in combination with anatomically thin gums.

Why do gums recede?

Periodontal disease, as mentioned, is characterized by the destruction of the bone that supports the teeth. This process also causes destruction of the gums, which gradually recede. The extent of recession depends on anatomical factors. That is, with the same degree of bone destruction, one person may have significant gum recession and small pockets, while another person may have less gum recession but larger pockets.

After treatment, will the gum and bone recession be restored?

The answer is no! The goal of treatment is to stop further progression of the disease. It is not possible to restore lost tissues, except in very localized and specific cases.

Will the gaps between the teeth close with treatment?

No. The gaps have been created because the inflammation and swelling have subsided after treatment. The gums regain their normal color and texture and shrink to approach the underlying bone. This is the natural healing process!

If the gaps are in the front teeth, can any aesthetic intervention be done?

Yes! Not with plastic surgery, but with small bonding fillings on the adjacent dental surfaces between the teeth. However, there must always be a gap to allow cleaning with an interdental brush.

What should the patient expect after periodontal disease treatment?

The bone destruction caused by periodontal disease is unfortunately an irreversible result. The goal of the treatment is to halt the disease progression and create conditions for health. Therefore, the effects of periodontitis, such as gaps between the teeth or gum recession, do not return after treatment, as the lost bone cannot regenerate. In many cases, the patient may feel that the gaps between their teeth are even larger after treatment because the inflammation subsides, along with the swelling of the gums.

Is it true that periodontitis affects our general health?

There are studies supporting a close relationship between heart disease and periodontitis, as well as between periodontitis and diabetes. It is known that the pathogenic bacteria of periodontitis may contribute to the formation of atherosclerotic plaques. It is understood that these pathogenic bacteria from the mouth can be swallowed and thus enter the bloodstream. The effects may manifest in distant parts of the body. Imagine the consequences of chronic and continuous irritation.

What can I do about tooth mobility?

First, treatment should be performed. Reducing inflammation will reduce tooth mobility! In addition, based on an empirical rule, if this tooth mobility does not affect daily function (mainly chewing), there is no need for intervention. In the opposite case, there are various methods for stabilizing several teeth together to reduce mobility. Additionally, adjustments are made to fit them into the occlusal system of the mouth to avoid excessive chewing forces. These methods are usually non-invasive, meaning no teeth need to be ground down!

How are aesthetic or functional problems caused by periodontitis addressed?

The main problem for periodontal patients is the gaps that form between the teeth. This aesthetic issue is addressed by “closing” these spaces, mainly with resin veneers (bonding). When these gaps are located in the posterior teeth and other factors are present (poor fillings, extensive cavities), it is often decided to proceed with prosthetic restoration. However, it should be emphasized that especially for the posterior areas, if these gaps do not interfere with chewing and mouth function, they are necessary for the easy removal of microbial agents by the patient.

What is the maintenance of the therapeutic result?

The patient is educated on proper oral hygiene from the start of the treatment. In addition to the correct brushing technique, interdental brushes play a dominant role in maintaining the result and preventing the recurrence of the disease. Interdental brushes can access surfaces that a toothbrush cannot reach with traditional brushing. These are the surfaces between adjacent teeth. Throughout the treatment, advice is given on the proper adherence to oral hygiene measures. Finally, a follow-up program is designed at regular intervals to evaluate the progress or lack thereof of the periodontitis.

If I undergo the treatment, will the result be permanent?

Unfortunately, no. The treatment halts the progression of the disease, but for the results to be permanent, each individual must realize the importance of oral hygiene (brushing – interdental brushes), the effects of smoking, and the need for regular check-ups and cleanings. It should be a continuous effort, with a large part of the responsibility lying with the patient.

Can periodontitis be transmitted from my husband, wife, etc.?

No, these infections are not transmitted. However, it is not pleasant to live with someone who has bad breath, and certainly, it is not a good lesson for our children to have an indifferent approach to personal cleanliness and, consequently, the health of our mouth!