Periodontics is a complex field. This Glossary should help fill some of the gaps in your knowledge base. If you don't find a term defined and think it should be added, please contact us and we can add it for you!
Terms:
Abscess
Abscesses are localized collections of pus. Pus is dead bacteria and the debris from an infection. Swelling, redness, pain, funny tastes, basically the symptoms of the classic toothache. They are caused by bacteria finding a good home. They particularly like dark, warm, wet, quiet locations that are not being cleaned. A piece of food or a small cut or the advancement of gum disease can spark them off. It is often said that the patients who get these are lucky. Since gum disease is normally silent, it may be an advantage for the abscess to bring the advancing gum disease to the patient's attention so they may seek treatment.
Bacterial Testing
A sample of the bacteria living under the gums can be collected and sent to a lab for testing to determine what kinds of bacteria are present. Culturing and antibiotic testing can be done to determine the most effective antibiotic. A helpful tool in hard to treat conditions. The antibiotic therapy that may result from this testing will not fix the damage to bone and gum that already has occurred. Some of the bacteria that live in the gums do not like the air and die on the way to the lab, so a DNA test is also performed to catch to attempt to catch them too. The testing is often done in several steps, including prior to antibiotic usage, after and later on to see how effective it was long term.
Bone Grafting
Bone is lost during the process of gum disease similar to the battlefield in a war. Here the bacteria and its products battle with the cells of the body and the bone tissue is destroyed in the process. If conditions are correct, the periodontist can place a bone grafting material into a defect in the bone caused by gum disease. There is some unpredictability and the techniques are improving constantly. Bone grafting is also used in implant dentistry to build up the jaw bone to later accept implants.
Calculus(tartar) forms on teeth. It is the hard deposit that is removed in the dental cleaning process. It is not the soft deposit(dental plaque) but not brushing the plaque daily will result in increased calculus. Calculus can be a problem since it is hard, irritating the tissue, and since it is porous, collecting toxic products from the bacteria that can more easily live in it.
Chemotherapy
Periodontists use chemistry in many ways. Antibiotics are used the the traditional oral method to treat acute infections and abscesses as well as in treating certain chronic periodontal diseases. Newer chemical delivery systems are available that can deliver medications into the pockets found in periodontal disease. See our chemotherapy section of the new therapy page to learn more.
Furcations are the spaces between the roots of our teeth. Normally, furcations are buried under the gum and bone just like the roots of a tree are buried under the ground. As gum disease progresses, these furcations become exposed. Mainly found on back teeth with disease, these areas are easy places for bacteria and tartar to collect and are difficult areas for patients to clean and for therapists to treat.
Gingivitis
Usually involving red, puffy, bleeding gums, this initial stage of gum disease can lead to the loss of bone and periodontitis. Its most common cause is bacterial plaque and is most times preventable and reversible.
Gum Graft(gingival graft)
Gums recede for a variety of reasons. Periodontists have techniques to replace this receded gum. To view examples of these procedures, click to the gingival grafting page.
Gum surgery(flap surgery, gingivectomy, periodontal surgery). This procedure is normally done to reduce the pocket depth allowing patients and their dental team to clean the deposits on the teeth better. It is normally performed in the periodontal office, with local anesthetic("novacaine"), usually in sections and sounds like a dental cleaning is being performed. Patients can be sedated for the procedure if the anxiety or medical condition warrants this. After an incision is made at the gumline, the gum is reflected back to allow the periodontist to clean the inside of the gum, the bone and the exposed portion of the roots of the teeth. Often the bone needs to be sculpted to allow the gum to sit over it in health. The periodontist may attempt regeneration therapy at this point. The gum tissue is replaced and sutured into position. Occasionally, a periodontal dressing similar to "silly putty" is placed over the gum as a bandage to protect it. Pain medication similar to ibuprofen is often given to the patient following the procedure and will probably be needed for a few days. Eating should be done on areas not treated and should be softer than normal.
Implants(Dental Implants, that is!)
These are artificial teeth that are implanted into the jaw bone. They are generally made of titanium and appear similar to a thick screw or cylinder. There is also implants that are similar in appearance to the blades of ice skates the size of a doll's skates. They are placed in areas only where the bone is thick enough to accept them. Similar to hanging a heavy picture where you need a good thick stud in the wall to accept the screw, with implants you need a thick jaw bone to accept the implant. Periodontists now have techniques to graft bone to thicken it to allow many patients to be able to have implants who were not able to years ago. Visit the Implant Pages for more information.
Irrigants are chemicals in liquid form that are placed under the gum with a thin hose or nozzle. It is a method of delivering medicine to the place where the bacterial are hiding.
Keratinized tissue is a thicker layer of gum that surrounds teeth. The roof of the mouth is all keratinized tissue, thick, tough and it adheres to what it is near. The thickness is similar to a callous on the hand. This tissue is used as donor tissue for much of the gingival grafting performed today. The rest of the gum is called mucosa which is like the inside of the lip or cheek, very thin and not adhering to the underlying bone or tooth.
Maintenance therapy
see supportive periodontal therapy
Osseointegration
This is the process of attachment of a dental implant to the bone. It is different from the attachment of a tooth in that no periodontal ligament space exists. Therefore, implants have no movement when shaken, yet natural teeth have a slight amount of "give" or movement. This is why it is difficult to attach dental work to implants and natural teeth at the same time.
Osseous
Referring to bone; osseous tissue is bone. Often used to describe pocket reduction surgery, as osseous surgery.
Periodontal Ligament(PDL)
There is a space between natural teeth and the bone. Special fibers live in this space that attach the tooth to the bone. Many people think the teeth are in the jaw like a fence post in concrete. But teeth are actually slung in the socket similar to a hammock is slung from a tree, only there are thousands of fibers doing the slinging. This PDL is important as it is destroyed in the process of gum disease and it is very difficult, almost impossible, to get back. Check out the new therapies page for Emdogain, designed to supplement the body's attempt to replace the PDL following therapy.
Periodontics is the field of dentistry concerning treatment of the supporting structures of the teeth including gums, bone and the placement and care of dental implants.
Periodontist
Periodontists are dentists who received additional training in periodontics. Accredited programs are normally require 2-4 years (after 4 years of college and 4 mores years of dental school) of specialized training and education in periodontics and implant dentistry. That is why there are so many initials after our names!! Periodontists treat the supporting structures of the teeth including the gums, bone and replacement of teeth with dental implants.
Plaque
This the soft film of debris that forms on your teeth if you don't brush regularly. It contains bacteria, food debris and toxic chemicals that allow gingivitis to develop. If left on the teeth, it can begin to develop into calculus.
Pockets develop along with gum disease. The depth of the space between the gum and tooth are measured with a small ruler called a probe. Normal is not zero but rather 2-3 millimeters. Usually, 6 points on each tooth are measured. This will sound like some kind of a code. As gum disease damages the bone or inflames the gum tissue, the pockets increase in size. The problem with pockets is they are hard to clean and allow bacteria and tartar too nice a home. The photo shows the probe in a normal sized pocket in a healthy mouth. For more on your first visit, go to the Consultation page.
Recession is the shrinking of gum away from the tooth surface. This occurs for many reasons and is prevented by good oral hygiene and avoiding hard brushing. Learn more about recession on the why you were referred page or view a gingival graft which is often used to repair areas of recession.
Regeneration Barriers
In an attempt to allow the bone around teeth to rebuild itself or to assist a bone graft heal and incorporate into an area, barriers are placed over the healing area. They are generally placed over the bone and under the gum. The basic purpose is to exclude the gum from growing down into the are of the healing bone and interfering with re-establishment of the delicate process of bone attaching to the tooth. Gum heals very quickly compared to bone, you know that, and here the gum wants to grow toward the root blocking the slower bone from healing properly. There are many varieties of these barriers, from Gore-tex to bovine collagen to plaster of paris to synthetic materials. This area of periodontics is changing rapidly.
Regeneration Therapy
It is the dream of periodontists everywhere to have their therapy end in a situation of perfect health. But nothing will ever be as it was when you were seventeen, and I am not the first to tell you this. Regeneration is therapy attempting to put something back that was not there before, normally referring to replacing the supporting bone and the delicate and complex attachment of the bone to the tooth. Bone grafts are used as well as regeneration barriers. View the radiographic changes of this therapy on our regeneration page.
Scaling and root planing is the cleaning of tartar from the roots and the smoothing of the surface of the root. Just like a piece of sand in your eye will irritate the eye tissue, so too will rough roots irritate the gum tissue. This is normally performed one side at a time with local anesthetic and will take about twice as long as a normal cleaning for one side of the mouth. To view the results of this procedure visit the scaling and root planing page.
Subgingival describes the area under the gumline. All pockets are subgingival. It is difficult subgingivally, yet is a beautiful condominium for bacteria.
Sulcus describes a "pocket" that has a measurement in the normal range(2-3 mm.). We use the term sulcus when this distance measured is in the normal range as opposed to using the term pocket which implies trouble. The work "pocket" is often used to talk about both.
Supportive periodontal therapy
This is the new fancy term for periodontal maintenance therapy. This is a plan to prevent the return of periodontal disease in patients who have had it. It involves oral hygiene instructions and a dental cleaning program that alternates between the general dentist and the periodontist. If recurrent disease is detected, several therapies are available including scaling and root planing, bacterialogic testing, chemotherapy, further surgical care.
Supragingival describes the area above the gumline. This is what we clean well with a toothbrush.
Xerostomia- is the medical term for dry mouth. It can be caused by medications and is normally seen with maturity. It can lead to an increase in oral organisms and subsequently more decay and gum disease.
