Periodontology
Periodontology or periodontics (from Ancient Greek περί, perí – 'around'; and ὀδούς, odoús – 'tooth', genitive ὀδόντος, odóntos) is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them.
The soft tissues and connective fibres that cover and protect the underlying cementum, periodontal ligament and alveolar bone are known as the gingivae.
In healthy periodontium, the gingival margin is the fibrous tissue that encompasses the cemento-enamel junction, a line around the circumference of the tooth where the enamel surface of the crown meets the outer cementum layer of the root.
[4] The junctional epithelium is a collar-like band that lies at the base of the gingival sulcus and surrounds the tooth; it demarcates the areas of separation between the free and attached gingiva.
[4] Collagen fibres bind the attached gingiva tightly to the underlying periodontium including the cementum and alveolar bone and vary in length and width,[4] depending on the location in the oral cavity and on the individual.
The attached gingiva dissipates functional and masticatory stresses placed on the gingival tissues during common activities such as mastication, tooth brushing and speaking.
[7][page needed] The interdental gingiva takes up the space beneath a tooth contact point, between two adjacent teeth.
[8] The periodontal ligament is the connective tissue that joins the outer layer of the tooth root, being the cementum, to the surrounding alveolar bone.
[7][page needed] In periodontal health, the alveolar bone surrounds the teeth and forms the bony socket that supports each tooth.
Gingivitis is typically painless and is most commonly a result of plaque biofilm accumulation, in association with reduced or poor oral hygiene.
Other factors may increase a person's risk of gingivitis, including but not limited to systemic conditions such as uncontrolled diabetes mellitus and some medications.
[16] Signs and symptoms of periodontal disease: bleeding gums, gingival recession, halitosis (bad breath), mobile teeth, ill-fitting dentures and buildup of plaque and calculus.
[17] Along with specialist periodontist treatment, a general dentist or dental hygienist can perform routine scale and cleans using either hand instruments or an ultrasonic scaler (or a combination of both).
The most effective way to control the plaque biofilm is via mechanical removal such as toothbrushing, interdental cleaning or periodontal debridement performed by a dental professional.
The balance between normal cell responses and the beginning of gingival disease is when there is too much plaque bacteria for the neutrophils to phagocytose and they degranulate, releasing toxic enzymes that cause tissue damage.
When gingival disease remains established and the aetiology is not removed, there is further recruitment of cells such as macrophages, which assist with the phagocytic digestion of bacteria, and lymphocytes, which begin to initiate an immune response.
Numerous studies show that age, gender, race, socioeconomic status, education and genetics also have strong relationships on influencing periodontal disease.
[citation needed] Periodontitis and associated conditions are recognised as a wide range of inflammatory diseases that have unique symptoms and varying consequences.
A diagnosis is reached by firstly undertaking thorough examination of the patient's medical, dental and social histories, to note any predisposing risk factors (see above) or underlying systemic conditions.
[39] If disease is identified through this process, then a full periodontal analysis is performed, often by dental hygienists, oral health therapists, or specialist periodontists.
This involves full mouth periodontal probing and taking measurements of pocket depths, clinical attachment loss and recession.
These phases are structured to ensure that periodontal therapy is conducted in a logical sequence, consequently improving the prognosis of the patient, in comparison to indecisive treatment plan without a clear goal.
[41] Phase I consists of treatment of emergencies, antimicrobial therapy, diet control, patient education and motivation, correction of iatrogenic factors, deep caries, hopeless teeth, preliminary scaling, temporary splinting, occlusal adjustment, minor orthodontic tooth movement and debridement.
[42] Factors identifying if the surgical phase is required are: periodontal pocket management in specific situations, irregular bony contours or deep craters, areas of suspected incomplete removal of local deposits, degree II and III furcation involvements, distal areas of last molars with expected mucogingival junction problems, persistent inflammation, root coverage and removal of gingival enlargement.
[42] The maintenance phase constitutes the long-term success for periodontal treatment, thus contributing to a long relationship between the oral health therapist, dentist, or periodontist and the patient.
It mainly focuses on the elimination and reduction of putative pathogens and shifting the microbial flora to a favourable environment to stabilize periodontal disease.
[45] It requires a few appointments, depending on time and clinician skills, for effective removal of supragingival and subgingival calculus, when periodontal pockets are involved.
This allows the dental team to work more competently and effectively as dentists can manage more complex treatments or significantly medically compromised patients.
[49] List of procedures performed by a periodontist:[49] Before applying to any postgraduate training program in periodontology, one must first complete a dental degree.
According to the American Academy of Periodontology, U.S.-trained periodontists are specialists in the prevention, diagnosis and treatment of periodontal diseases and oral inflammation, and in the placement and maintenance of dental implants.
