Periodontics (Gums, Teeth Mobility, Bad Breath)

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What is Periodontics?
Who is a Periodontist?

Periodontics is the specialty of dentistry that studies the supporting structures of teeth, diseases, and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament.
A periodontist is a fully qualified dentist who has undergone additional University postgraduate training enabling him/her to register as a Specialist in the field. Their level of expertise allows them to provide a higher level of care in treatment of gum diseases, placement and maintenance of dental implants, and associated surgical procedures. Periodontists are also trained in performing cosmetic periodontal procedures.

What is Periodontal (Gum) Disease?

Periodontal disease is an infection of the tissues that hold your teeth in place (gingiva, alveolar bone, cementum, and the periodontal ligament)

What causes Gum Disease?

The mouth is full of bacteria. These bacteria, along with mucus, food remains and other particles, constantly form a sticky, colorless biofilm on teeth surface called plaque. Adequate tooth brushing and flossing help in getting rid of plaque. If not removed, plaque hardens and forms calculus (tartar) that cannot be eliminated by brushing.


Untreated gingivitis advances to periodontitis. Toxins produced by the bacteria in plaque irritate the gums and stimulate a chronic inflammatory response. The body in essence turns on itself. The tissues that support teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, teeth become loose and fall off/may have to be removed.


Prolonged exposure of the gum to plaque/calculus is harmful since bacteria in plaque causes inflammation of the gums (gingivitis).”In gingivitis, the gums become reddish and swollen with easy bleeding. It is the mildest form of gum disease and is reversible with professional cleaning and good oral home care.

How do I know if I have gum disease?

However, warning signs of gum disease include the following:

Who is at risk of developing gum disease?



Prevalence and severity of periodontal disease increase with age. Over 70% of adults aged 65 and above have one form of periodontal disease or another. This is related to the length of time an individual has been exposed to bacterial plaque and other risk factors.


Tobacco use is linked with many illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease and lower chances of successful periodontal treatment.


People with diabetes are at higher risk for developing periodontal disease. Periodontal disease on the other hand complicates the control of blood sugar levels in diabetics


Drugs such as anticonvulsants (phenytoin), calcium channel blocking antihypertensives (Nifedipine, Amlodipine), Immunosuppressants (Cyclosporin) induces gingival overgrowth. Others such as narcotic analgesics, antihistamines, sedatives significantly decrease saliva flow. It is important to inform your dentist/periodontist about your medical history.

Genetic susceptibility.

Some people are more prone to developing severe form of gum disease than others despite aggressive oral care habits

Hormonal Fluctuations

Hormonal fluctuations alters the status of periodontal health. Such changes may occur during puberty, menstrual cycle, pregnancy, menopause or oral contraceptives use or hormone replacement therapy


During pregnancy, the probability of developing gum disease increases. Gum disease may in turn impact on the foetus and the pregnancy outcome. It’s vital to prevent the disease to avoid pregnancy complications (regular dental visits before and during pregnancy)


Altered local or systemic immune response contributes to the pathogenesis of periodontal diseases. It also predisposes to less common types of severe gingival & periodontal destruction.

Other factors

Include osteoporosis, stress, rheumatoid arthritis and poor nutrition

How is gum disease treated?

Treatment of gum disease is tailor-made for each individual with the sole aim of controlling the infection. For any treatment to succeed, the patient must keep good oral hygiene and adopt a behavior change (e.g. quitting smoking)

Largely, treatment is done via non-surgical means (scaling/root planing, medications, tray delivery systems, occlusal adjustments, periodontal splints among others)

Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.
Teeth with hopeless prognosis may be extracted and replaced with dental implants after healing

Scaling and Root Planing

Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Scaling and root planing is sometimes followed by adjunctive therapy such as local delivery antimicrobials, tray delivery systems, systemic antibiotics, and host modulation, as needed on a case-by-case basis.
A tray delivery system consists of a custom-fit tray made from impressions of the patient’s mouth. Patients use the tray at home to deliver medications that have been prescribed by their dentist

The outcome is usually good with ongoing maintenance therapy to sustain health

Periodontal Surgery

What causes bad breath?

Bad breath (halitosis) is a general term used to define unpleasant odour emanating from the breath of an individual.

Estimated to be the 3rd most common reason for seeking dental treatment after tooth decay and periodontal disease (1 in every 4 people affected).
90% of all cases are caused by oral conditions (bacterial breakdown of food remains into sulfur compounds). 10% extra oral causes

Majority of patients consider bad breath serious enough to cause embarrassment and affect interpersonal social communication

Causes : Tobacco products, Food (e.g garlic), dry mouth, poor oral hygiene, fasting, some drugs, diseases (e.g some cancers, liver failure, gastroesophageal reflux), nose and throat consitions

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