Periodontics is that branch of dentistry pertaining to the diagnosis and treatment of the supporting and surrounding tissues of the teeth and their substitutes. It also includes the implantation or transplantation of teeth and their substitutes. The goal of modern periodontal therapy is to preserve and maintain periodontal health, aesthetics, and function of natural dentition and implanted tooth replacements.
The supportive structures, collectively termed the periodontium, consist of the gingiva, periodontal ligaments, and alveolar bone. Diseases that damage the periodontium are called periodontal diseases.
To prepare for this chapter, review chapters 5, 6, and 8 of
Dental Technician, Volume 1, NAVEDTRA 12572, and chapter 3 of this manual. In chapter 5, "Oral Pathology," we discuss pathology of the periodontium. In chapter 6, "Emergency Treatment of Oral Diseases and Injuries," we discuss diseases of the periodontal tissues. In chapter 8, "Nutrition and Diet," we discuss preventive dentistry and nutrition. In chapter 3, "Preventive Dentistry," we discuss oral hygiene and supragingival scaling. In this chapter, we will cover the functions and indications of periodontics.
The treatment of periodontal diseases may encompass both the dental and medical professions. When the cause of a patient's periodontal disturbance is diagnosed as systemic (affecting the body as a whole), the patient should be referred to the medical facility for diagnosis and treatment of the medical condition.
The dental treatment of a periodontal patient may require coordinated treatment from other specialty areas. Often, patients needing periodontal treatment are referred from specialty areas where they were seeking treatment for other related dental problems. For example, the patient may need a prosthetic appliance to replace some missing teeth. However, the patient's periodontal condition may require periodontal treatment before the appliance can be made. In evaluating and treating the patients periodontal disease, the periodontist may decide to eliminate periodontal pockets surrounding some teeth and determine other teeth are nonrestorable. The patient is referred to the oral surgeon for removal of these nonrestorable teeth. The periodontist may determine that other periodontal problems can be alleviated by having a general dentist remove and replace faulty restorations. In some situations, the services of the orthodontist may be required to reposition malposed teeth.
Since periodontal disease affects the supportive structures of the teeth, the primary function of periodontal treatment is (a) to eliminate the inflammation and arrest the progress of the disease and (b) perform periodontal treatment. Several reasons to eliminate pockets are as follows:
Food, bacterial accumulation, and infection can exist in pockets that form around the teeth.
Conditions, such as loss of gingival covering, can lead to exposure of the root and caries can occur.
Inflammatory changes in the gingiva may increase the susceptibility to necrotizing ulcerative gingivitis (NUG). Note: NUG is caused by bacteria usually in the presence of secondary factors such as stress, smoking, and or lack of rest.
Inflammation from the pocket walls can cause bone loss.
Discomfort can occur during mastication.
Most periodontal diseases are characterized by inflammation that initially affects the gingiva. Advancement of the inflammatory process, if not stopped, may proceed to cause damage to periodontal ligament tissue and alveolar bone. Inflammatory diseases confined to the gingiva are termed gingivitis, whereas those that cause damage in the deeper supporting structures are classified as periodontitis.Continue Reading