Periodontics, as the name implies, deals with those parts of the mouth that lie around the teeth. It is important that the gums and bone are kept healthy to avoid periodontal disease. Dental decay is not the only cause of tooth loss. Periodontal disease causes enormous tooth loss, especially in later years. It is an insidious disease, for the most part painless, and often not recognised until it is too late. Like dental decay, it is preventable in most people.
Periodontal disease is really a series of different but related diseases, and is caused in the first instance by the accumulation of dental plaque around the teeth. Plaque is a soft deposit around the teeth caused by bacteria in the mouth. The mouth contains enormous numbers and varieties of bacteria, and each person has a different collection. Dental plaque can and should be constantly removed as it forms. Some of it is removed naturally. At one time when diets were more natural, a good deal was removed by the action of tough and fibrous foods. Wild animals and native tribes use this method, but modern man and domesticated animals need some further assistance. A professional mechanical removal with a sealer can be maintained by constant polishing with a very soft toothbrush, dental floss and soft wooden stimulators.
If plaque is left to accumulate, it causes irritation to the gums and bone. In many cases it is converted by other bacteria into a hard deposit called tartar or calculus, which no amount of brushing will remove. It must be scaled off with a sharp instrument by a dental hygienist, dentist, or periodontist (a dental specialist in this field). If left, tartar or calculus traps more plaque which is harder to remove and in turn becomes more calculus. Some people can build up enormous deposits in a very short time. Hard calculus deposits can trap not only plaque but food debris which can putrefy and cause bad breath or halitosis. Regular professional removal of calculus enables most people to keep their teeth clean, polished and healthy.
Gums that are irritated by plaque or calculus become inflamed and suffer from gingivitis. The gums look red and swollen, and bleed easily when touched. The bone underneath retreats towards the tip of the root. A pocket is formed between the gum and the tooth, which is impossible to keep clean and may become infected. The gingivitis turns into periodontal disease and causes pus and pain. If left untreated, the infection often becomes much worse and spreads over the whole of the mouth. The so-called trench mouth of the First World War, accelerated by the appalling hygiene conditions, was of this type. It is now known as Vincent's infection.
Apart from meticulous scaling and cleaning, the periodontist at times performs surgery to correct defects or prevent an ongoing problem. Pockets remaining after treatment can be surgically removed. The procedure is called gingivectomy.
While periodontal disease is seen less often in children, it is the lesson learnt in childhood that meticulous tooth cleaning is a part of civilised life that will help minimise the risk of trouble later in life.