The periodontal condition of the mouth involves the surrounding and supporting structures of teeth such as the Gums, Periodontal ligaments and the Alveolar bone.
A dentist will examine these tissues when they are giving a patient a check up. A dentist will not only look for signs of healthy gums and the presence of plaque and calculus (tartar), but will also assess the periodontal health by using a special probe (a WHO or CPITN probe or a pocket measuring probe) to physically check the health of gums and periodontal ligaments, they will also check that bone levels are healthy by observing dental radiographs. A dentist must update each patient’s medical history at each appointment, and this too is relevant to some periodontal conditions, for example smoking can mask some of the signs of gingivitis and hormonal changes e.g. in pregnancy, can also affect the health of periodontal tissues.
If a hygienist or therapist is available within the practice the dentist may refer a patient to them for a more thorough periodontal examination and to provide appropriate treatment for periodontal conditions.
Healthy gums are the first indication to a dental care professional that a patient does not have a periodontal condition. Healthy gums;
- Have a pink stippled appearance
- Form a tight cuff around individual teeth (pockets around teeth are 3mm in depth or less)
- Have sharp, pointed, defined papilla (the pointed part of the gum between teeth)
- Do not bleed on probing (or when brushing)
- Are held in place with a reasonable amount of alveolar bone
Periodontal conditions which require treatment from a dentist, therapist or hygienist include;
- Chronic gingivitis
- Acute herpetic gingivitis
- Acute necrotising gingivitis (ANUG)
- Chronic periodontitis
- Acute lateral periodontal abscess
- Pericoronitis
Most periodontal diseases are caused by,
- Certain medical conditions and treatment drugs, such as diabetes, epilepsy, vitamin C deficiency, the use of immuno-suppressant drugs
- Poor oral hygiene
- The presence of food stagnation areas due to badly aligned teeth , or due to irregularly formed teeth (causing areas where oral hygiene is difficult to maintain)
- Poor dentistry – i.e. fillings with overhangs or ill fitting crowns, bridges and partial dentures (causing areas where oral hygiene is difficult to maintain)
- A combination of all of the above
- There is also a large school of thought that believes periodontal diseases are hereditary to some extent, so genetics may also play a part in an individual’s susceptibility to periodontal disease
Periodontal diseases are the main cause of tooth loss in adults, and caries the main cause of tooth loss in children. A huge percentage of the population suffer from some sort of periodontal condition at some point in life, gingivitis is a reversible condition, but most other periodontal conditions are irreversible, they may be managed and treated regularly to reduce their ongoing effects but at present it is not possible to undo all of the damage that may have already occurred for example to periodontal ligaments and alveolar bone. Therefore it is essential for good oral hygiene techniques to be taught to patients and also for individuals to maintain good oral hygiene at home.
