Overview

Periodontics is a specialized field of dentistry focused on the prevention, diagnosis, and treatment of diseases affecting the supporting structures of the teeth, including the gums, alveolar bone, cementum, and periodontal ligament. It plays a crucial role in maintaining oral health, function, and aesthetics.

Anatomy of the Periodontium

  • Gingiva: The gum tissue surrounding the teeth.
  • Periodontal Ligament (PDL): Connective tissue fibers anchoring the tooth to the alveolar bone.
  • Alveolar Bone: The part of the jawbone that contains the tooth sockets.
  • Cementum: Calcified layer covering the tooth root.

Periodontal Anatomy

Common Periodontal Diseases

1. Gingivitis

  • Inflammation of the gingiva without loss of attachment.
  • Symptoms: Redness, swelling, bleeding on probing.

2. Periodontitis

  • Progression from untreated gingivitis.
  • Characterized by loss of connective tissue attachment and alveolar bone.
  • Can lead to tooth mobility and eventual tooth loss.

Types of Periodontitis

  • Chronic Periodontitis
  • Aggressive Periodontitis
  • Necrotizing Periodontal Diseases

Etiology and Risk Factors

  • Microbial Plaque: Main causative agent; biofilm of bacteria.
  • Host Factors: Genetics, immune response, systemic diseases (e.g., diabetes).
  • Environmental Factors: Smoking, stress, poor nutrition.
  • Iatrogenic Factors: Overhanging restorations, faulty dental work.

Diagnostic Methods

  • Clinical Examination: Probing depths, bleeding on probing, mobility.
  • Radiographic Analysis: Assessment of bone loss.
  • Microbiological Testing: Identification of pathogenic bacteria.
  • Biomarkers: Analysis of inflammatory mediators in gingival crevicular fluid.

Treatment Modalities

Non-Surgical Therapy

  • Scaling and Root Planing (SRP)
  • Local delivery of antimicrobials

Surgical Therapy

  • Flap surgery
  • Bone grafting and guided tissue regeneration
  • Crown lengthening

Adjunctive Therapies

  • Laser therapy
  • Host modulation (e.g., subantimicrobial dose doxycycline)

Recent Advances

  • Use of biomaterials for regeneration (e.g., growth factors, stem cells)
  • Digital Periodontics: 3D imaging, computer-assisted surgery
  • Microbiome research: Exploring the oral microbiomeโ€™s role in systemic health

Citation:
Tonetti, M.S., Greenwell, H., Kornman, K.S. (2022). Staging and grading of periodontitis: Framework and proposal of a new classification. Journal of Clinical Periodontology, 49(Suppl 22), 6-36.

Surprising Facts

  1. Periodontal Disease and Systemic Health: Periodontal disease is linked to cardiovascular disease, adverse pregnancy outcomes, and diabetes mellitus.
  2. Plastic Pollution Impact: Microplastics have been detected in human oral tissues, raising concerns about their role in oral and periodontal diseases (see: Cox et al., 2021, Science of the Total Environment).
  3. Deep Ocean Connection: Plastic pollution has been found in the deepest parts of the ocean, and emerging research suggests that microplastics can enter the human body through the oral cavity and potentially affect oral health.

Ethical Considerations

  • Access to Care: Disparities exist in periodontal treatment availability, especially in underserved populations.
  • Informed Consent: Patients must be fully informed about risks, benefits, and alternatives to periodontal therapies.
  • Environmental Responsibility: Dental professionals should minimize plastic waste and promote sustainable practices, given the link between plastic pollution and oral health.
  • Research Ethics: Use of human subjects in periodontal research must adhere to ethical guidelines, ensuring privacy and safety.

Famous Scientist Highlight

Dr. Sigmund S. Socransky
Pioneered research on the microbial composition of periodontal pockets, identifying key bacterial complexes associated with disease progression. His work laid the foundation for targeted antimicrobial therapies and modern periodontal diagnostics.

How Periodontics Is Taught in Schools

  • Preclinical Training: Simulated exercises on models to master scaling, root planing, and surgical techniques.
  • Clinical Rotations: Direct patient care under supervision, focusing on diagnosis, treatment planning, and execution.
  • Interdisciplinary Approach: Collaboration with other dental specialties (prosthodontics, endodontics, oral surgery).
  • Evidence-Based Curriculum: Incorporation of current research, case studies, and critical appraisal skills.
  • Community Outreach: Programs emphasizing prevention and public health, often addressing underserved populations.

Reference

  • Tonetti, M.S., Greenwell, H., Kornman, K.S. (2022). Staging and grading of periodontitis: Framework and proposal of a new classification. Journal of Clinical Periodontology, 49(Suppl 22), 6-36.
  • Cox, K.D., et al. (2021). Microplastics in human tissues: A review. Science of the Total Environment, 755, 142518.

Diagram: Periodontal Disease Progression

Periodontal Disease Progression

Summary Table

Structure Function Disease Impact
Gingiva Protective barrier Inflammation
Periodontal Ligament Tooth anchorage Loss of attachment
Alveolar Bone Supports teeth Bone resorption
Cementum Covers tooth root Exposure, sensitivity

Key Takeaways

  • Periodontics integrates clinical practice, research, and ethics.
  • The field is rapidly evolving with advances in biomaterials and microbiome science.
  • Environmental issues such as plastic pollution are emerging as significant factors in oral health.
  • Education in periodontics is comprehensive, blending theory, practical skills, and community engagement.