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Andrew Sullivan, DDS & Joel Pascuzzi, DMD, LLC
Specializing in Periodontics
Oral Medicine and Implant Surgery
Call: (201) 437-9098

When to See a Periodontist

A periodontist is a dentist specializing in the prevention, diagnosis and treatment of infections and diseases in the soft tissues surrounding the teeth, and the jawbone to which the teeth are anchored.  Periodontists have to train an additional three years beyond the four years of regular dental school, and are familiar with the most advanced techniques necessary to treat periodontal disease and place dental implants.  Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.

Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth.  This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection.  As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums.  The response of the body is to destroy the infected tissue, which is why the gums appear to recede.  The resulting pockets between the teeth deepen and if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.

Referrals from General Dentists and Self Referral

There are several ways treatment from a periodontist may be sought.   In the course of a regular dental check up, if the general dentist or hygienist finds symptoms of gingivitis or rapidly progressing periodontal disease, a consultation with a periodontist may be recommended.  However, a referral is not necessary for a periodontal consultation.

If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:

  • Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.
  • Bad breath – Continued halitosis (bad breath) which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis or the beginnings of an infection in the gum tissues.
  • Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease.  As this disease progresses and attacks the jawbone, (the anchor holding the teeth in place) the teeth may become loose or be lost altogether.
  • Ulcerations in the gum tissues – The periodontist will check these ulcerations and determine their cause along with the diagnosis. A treatment modality will be suggested to treat these ulcerations. 
  • Related health conditions – Heart disease, diabetes, osteopenia and osteoporosis are highly correlated with periodontitis and periodontal infections.  The bacteria infection can spread through the blood stream and affect other parts of the body.

Diagnosis and Treatment

Before initiating any dental treatment, the periodontist will examine the gums, jawbone and general condition of the teeth.  When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non surgical options available to treat the underlying infection, halt the recession of the soft tissue, and preserve the bone, which support the teeth.

  • Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal.  Education and advice will be provided on an effective cleaning regime thereafter.
  • Moderate periodontal disease – If the gum pockets reach 4-6mm in length and their is supporting bone loss of 3-4 mm , a more extensive scaling and root planing cleaning might be required.  This cleaning is usually performed under local anesthetic, followed  by an evaluation for more comprehensive treatment.
  • Advanced periodontal disease – Gum pockets in excess of 5-6 mm and there is supporting bone loss of 5 mm or more, indicates need for more extensive treatment. Scaling and root planing will always be performed as the initial non-surgical treatment.  In addition, the periodontist may recommend surgical treatment to reduce pocket depth. There are a number of surgical therapies that may be indicated. The recommendation is based on the findings for each clinical case. 
  • Tooth loss – Where one or several teeth are missing due to periodontal disease, dental implants are an effective option.  If the remaining bone is available to support an implant, implant surgery will be recommended. However, if the bone is severely eroded and resorbed, bone grafts may be performed by the periodontist to provide a suitable anchor for the new tooth/teeth. This is performed by a procedure called Guided Bone Regeneration, whereby bone grafts, bio-mediators and membranes are used to regenerate the jaw bone to accommodate the implant. 

Ask your periodontist if you have questions about periodontal disease, periodontal treatment or dental implants.