A periodontal specialist is a dentist who has undergone further training and qualifications in the field of gum disease and have limited their practice to the provision of this work. The Periodontal specialist at StoneRock is Arwa Al-Khaburi.
Gum disease (also known as periodontal disease) affects 20% of the adult population and is the commonest cause of tooth loss in the world today. The disease destroys the attachment between the gum and the tooth, destroying the underlying bone as it does so. This break down in attachment leads to the development of deep pockets which are inaccessible to daily cleaning and eventually harbour chronic infection causing abscesses and increased mobility of the teeth. This process is usually painless in the early stages and, without careful assessment, can go undetected for many years. By the time symptoms develop it is often too late to save all the teeth so early detection and treatment are the key to long-term success.
The treatment of gum disease depends on the severity of the disease along with the susceptibility of the individual to the disease and their age at the time of diagnosis. The treatment can vary from simple oral hygiene instruction through to surgical procedures aimed at the eradication of deep pockets that have not responded to normal treatment. Gum disease is usually much worse in patients who smoke and is also strongly affected by the presence of diabetes. Current research is looking at the links between gum disease and coronary artery disease and diabetes and it seems that active untreated gum disease can have a negative impact on both of these conditions. It is worth noting that smokers, on average lose three times as many teeth as non-smokers, which highlights just how damaging this habit is to the health of the mouth (see smoking section for more information).
Often the first sign of gum disease is the much more common and completely reversible condition known as gingivitis. All of us will develop some level of gingivitis at some point in our lives. Bleeding from swollen gums is the body’s response to a build up of plaque on the teeth. If we then clean our teeth better so that there is no build-up of plaque on the teeth then the gums return to normal health with no lasting damage. In some patients, however, the body’s response to the plaque is more prolonged and never fully settles which means it has the capacity to develop into the much more destructive and irreversible process of gum disease. It is very difficult to tell who is going to progress from gingivitis to gum disease so we treat everyone with gingivitis the same; we show them how to clean their teeth better so that it goes away. We can think of gingivitis as being the body’s way of telling us to do a better job with our cleaning! Patients who smoke, have poorly controlled diabetes or who have a family history of gum disease are much more likely to progress from gingivitis to gum disease so we are much more watchful of these individuals.
There are two broad types of gum disease: chronic and aggressive with chronic being by far the commonest type. Aggressive gum disease usually presents at an early age (late teens or early 20s) and has a strong family history. Early detection and swift referral to a specialist known as a Periodontist are essential for successful management. Treatment for aggressive periodontal disease will always involve the use of antibiotics as an adjunct to extensive cleaning by the periodontist and scrupulous daily home care. Chronic gum disease usually presents in mid-adulthood and is often picked up through the dentist noticing changes in the regular chartings that we carry out to assess gum health at each examination. Treatment rarely involves antibiotics other than in the very advanced cases but always involves a great deal of work and attention to daily home cleaning as mastering this is the key to all periodontal success. It is normal for patients at StoneRock who have been diagnosed as having chronic gum disease to receive three short oral hygiene instruction appointments at which they are shown how to clean their teeth to a level sufficient to maintain healthy gums. Once they are able to do this then we will carry out extensive, full-mouth ultrasonic debridement (FMUSD) to help bring the disease under control.
If the disease is detected at an early, moderate stage then the hygienist is often best suited to provide most, if not all of the treatment. Once the disease is more advanced (pockets deeper than 6 mm that bleed when probed) then treatment with a periodontal specialist is indicated. Patients with higher than expected probing depths and bleeding scores often require a specialist assessment even if there is no advanced disease evident. This is because certain individuals are more susceptible to gum disease than others and early treatment will benefit them greatly.
We do not think in terms of curing gum disease but with appropriate treatment and maintenance, we can control it make sure it does not worsen. The most important factor for success long term is patient compliance. Any individual who wants to treat their gum disease needs to be able to clean their teeth on a daily basis to a much higher than normal standard. Teaching these techniques and reviewing their success is a vital part of the treatment and they need to be mastered before active treatment can begin. Regular review visits will be required throughout life to ensure that these cleaning techniques are maintained to prevent recurrence of the disease.
- Consultation fee (for new and referral patients). A written report and accurate assessment of fees will be provided following this visit £140 (including radiographs, photographs and oral hygiene instruction)
- Periodontal specialist non-surgical fees. The amount of time required to treat an individual will be based on the number and severity of sites that need treating and the patients ability to master the home care techniques required £350-£900
- Periodontal specialist surgical fees. Surgery is used to eradicate pockets that have not responded to non- surgical techniques. It is only ever used where there is a very high compliance in home care and where there is evidence of healing elsewhere £400 per site
- Crown lengthening procedures. Occasionally it is necessary to lengthen a tooth to either expose enough root to allow a crown to be fitted to it or to match the length of an existing natural crown to the adjacent teeth on aesthetic grounds. This work is carried out surgically under local anaesthetic £400 per site
- Review visits. These visits happen at 3 and 6 months post treatment, although for more routine cases they can be carried out in conjunction with the hygienist as part of the routine maintenance £100
Please note: Both non-surgical and surgical treatments require local anaesthetic to complete and both will result in a short period of post operative discomfort. All patients undergoing treatment will be expected to carry out a scheduled maintenance program with a hygienist following treatment with the specialist.
If you would like more information or to make an appointment with Arwa at our Dental Practice in Hawkhurst, Kent please contact our Reception Team on 01580 752202 or firstname.lastname@example.org who will be more than happy to help with any matter.