Course Subjects and Learning Objectives

Academic and Clinical Practices

The Department of Periodontology trains students for their professional lives with clinical training, instruction and research aiming at perfection through meticulous work highlighting the importance of science and art in the fields of education, treatment, periodontology, implantology and regenerative medicine.

This academic programme aims to educate prospective dentists who can change and adjust their treatment methods based on the latest findings of the controlled scientific studies. Planned academic studies to be carried out by the Department of Periodontology aim to contribute to the scientific literature.

Important topics and related clinical practices in the Department of Periodontology are as follows:

What is periodontium? What are its functions?

Periodontium consists of tissues that surround and support the teeth: gingiva, periodontal ligament, cementum, and alveolar bone. The main function of the periodontium is to attach the tooth to the bone tissue of the jaws and to maintain the integrity of the surface of the masticatory mucosa of the oral cavity. The periodontium also constitutes a developmental, biological, and functional unit which undergoes certain changes with age and is, in addition, subjected to morphological changes related to functional alterations and alterations in the oral environment.

What are the characteristics of healthy gums?

Healthy gums usually have a colour that has been described as coral pink. Although described as the colour coral pink, variation in colour is possible due to some factors such as blood flow to the gums, thickness and degree of keratinization of the epithelium, and pigmentation cells. Healthy gums are firm, resilient, and (except for mobile gingival margin) tightly bound to underlying bone. They have an orange-peel like texture and described as stippling. Healthy gums do not bleed.

What are the symptoms of Periodontal Disease (Gum Disease)?

Red, swollen or tender gums or other pain in your mouth; bleeding while brushing teeth, using dental floss or biting into hard food such as an apple; gingival recession, leading to apparent lengthening of teeth; loose or separating teeth; pus between teeth and gums; persistent bad breath; and changes in the positioning of the teeth in the jaws.

What are the causes of Periodontal Diseases?

Periodontal disease is caused by the build-up of bacteria in the dental plaque. Plaque is a sticky layer of bacteria and food debris that form on teeth due to poor oral hygiene. To eliminate bacteria, immune system cells release substances, which cause damage and inflammation in the periodontium. This may further cause gingivitis symptoms such as swelling, gingival bleeding (early stage of periodontal disease). In addition, progress of periodontal disease may result in tooth loss, which is a sign of advanced periodontal disease (advanced stage).

There are some factors that increase the risk of periodontal disease: genetics, smoking and tobacco use, poorly positioned braces or crowned teeth or bridges, teeth grinding or clenching, hormonal changes (especially in puberty and pregnancy), medications (e.g. phenytoin, cyclosporine, nifedipine), systemic diseases (diabetes, rheumatoid arthritis, HIV infection), and poor nutrition (e.g. vitamin C deficiency).

What is the difference between gingivitis and periodontitis?

Gingivitis is limited to gums and characterized by signs of inflammation of the gingiva without loss of dental attachment. In gingivitis, gums are red and swollen and bleed easily. This type of gum disease does not lead to destruction of the periodontal ligament or bone.

Periodontitis is defined as an inflammatory disease affecting the tissues surrounding the teeth. It is caused by certain microorganisms or groups of microorganisms and may result in increased probing pocket depth, gingival recession, or their combination along with destruction of periodontal ligament and alveolar bone. In periodontitis, the attachment of the gum to the root is disrupted and infected gaps (periodontal pockets) are formed. Release of bacterial toxins and the body’s natural reaction to the infection leads to the destruction of the periodontal ligament and bone.

What is non-surgical periodontal treatment (Phase I treatment)?

Non-surgical periodontal treatment is often used for patients with early stages of periodontal disease in order to avoid the development of advanced periodontal disease. Non-surgical treatment includes plaque control, patient education, diet control, scaling and root planing, correction of restorative and prosthetic irritation factors, excavation of cavities and restorations, antimicrobial treatment, occlusal treatment, small orthodontic movements, temporary splinting, and prosthetic practices. However, non-surgical periodontal treatment does have its limitations. When it fails to result in periodontal health, surgery may be indicated to restore periodontal health.

What is calculus (tartar)?

Calculus is hardened and mineralized dental plaque and commonly called tartar. It is caused by precipitation of minerals from saliva and gingival crevicular fluid in plaque on the teeth. Tartar results in further plaque formation since it has a rougher surface compared to the cementum covering the root surface of the tooth.

What is scaling and root planing?

Scaling means the process of removal of plaque and tartar from the root surfaces while root planing means the process of smoothing the root surfaces to remove any infected and necrotic tooth structure. A number of dental instruments including ultrasonic instruments and manual tools, such as curettes, may be used to perform those processes. The objective for periodontal scaling and root planing is to remove dental plaque and tartar, which house bacteria that release toxins which cause inflammation to the gum tissue and surrounding bone. Scaling and root planing are effective procedures to reduce the pocket depth, increase periodontal attachment level, and reduce the level of inflammation (bleeding on probing).

What can I do to prevent periodontal disease?

The development of gingivitis and periodontitis can be prevented by adopting thorough oral hygiene habits, alongside regular professional examinations and support. The aim of the oral hygiene phase of treatment is to reduce the number of bacteria in the mouth, and thus reduce the level of inflammation.

The main steps of a good oral hygiene regime are:

Brushing all surfaces and sides of the teeth twice daily, with a toothbrush and toothpaste,
Cleaning once a day the spaces between the teeth where the toothbrush bristles cannot reach, using either dental floss or an interdental brush, depending on the size of the space.

The next step would be removal of all bacterial deposits and tartar from the root surfaces and gingival pockets by the dentist. Following that treatment, your dentist or periodontist will make a full assessment of your gums to check the progress of your treatment. If periodontal pockets are still present, further treatment options may be suggested, including surgical corrective therapy.

What is surgical periodontal treatment (Phase II treatment)?

This phase includes periodontal surgery to treat and improve the condition of periodontal and surrounding tissues. The treatment also includes gum graft surgery, laser treatment, regenerative procedures, dental crown lengthening, dental implants, and pocket reduction, and plastic surgery procedures.

What are the causes of gingival enlargement and what is its treatment?

Gingival enlargement is a common feature of gingival disease. Causes include inflammation, side effects of certain medication (anticonvulsants, immunosuppresants, calcium channel blockers), and association with systemic diseases or conditions (pregnancy, puberty, leukemia, and vitamin C deficiency). The dentist should emphasize plaque control as the first step in the treatment of gingival enlargement. Despite diligent care, in some patients the enlargement is persistent. Gingivectomy or flap surgery may be performed in those patients.

What are the causes of gingival recession?

Common causes of gingival recession are as follows: abrasive and traumatic tooth brushing habits, periodontal disease and chronic marginal inflammation, aggressive periodontal therapy, frenulum and muscle attachments, orthodontic tooth movement in thin buccal bone layer.

Gingival graft can be used to cover root surfaces and increase keratinized gingival tissue that was lost due to extreme gingival gum recession. During gingival graft surgery, the periodontist takes gingival tissue from the palate or another site in order to cover the exposed root surface. Some patients may have worries about the possibility of wounds that may occur in those sites. Tissue engineering methods can be a perfect alternative for those patients.

Is there any association between periodontal diseases and systemic diseases?

Studies show association between periodontal diseases and other diseases. It was believed that bacteria were the cause of association between periodontal diseases and other diseases in the body; however, recent studies have shown that inflammation could be the cause of this association. Therefore, treatment of the inflammation would result in not only the cure of periodontal diseases, but also the cure of chronic inflammatory diseases. It is now understood that untreated periodontal disease can have effects on general health. For example, it poses an increased risk for complications during pregnancy (pre-eclampsia, premature birth and low birth weight) and also an increased risk for heart disease and diabetes.

What is Periodontal Maintenance and Supportive Periodontal Therapy?

The long-term success of periodontal treatment depends on both patients’ own efforts with oral hygiene and regular dental inspection. Following the first phase of treatment, the dentist will need to review the condition of the patient’s gum at regular intervals to check if the inflammation has been halted. The frequency of the follow-up appointments depends on the severity of disease and the patient’s individual risk of disease progression. Regular follow-up appointments are vitally important to ensure early diagnosis of the disease and avoid destruction of the gums and supporting bone.

What are dental implants? What are their indications?

Dental implants are metal posts or frames that are surgically positioned into the jawbone to replace a missing tooth or teeth. Dental implants can restore partial or total edentulism. Dental implant-supported restorations aim to properly replace missing teeth.

What are peri-implant diseases and their treatment?

Peri-implant diseases are inflammatory conditions affecting the soft and hard gum tissues around dental implants. Peri-implant diseases are classified into two categories:

In peri-implant mucositis, gingival inflammation is found only around the soft tissues of the dental implant, with no signs of bone loss. Generally peri-implant mucositis is a precursor to peri-implantitis. It is shown that peri-implant mucositis may be successfully treated and is reversible if caught early.

In peri-implantitis, gingival inflammation is found around the soft tissue and there is deterioration in the bone supporting the dental implant.

Just like your natural teeth, implants require regular tooth brushing and flossing and regular check-ups from a dental professional. With a proper oral health routine, your dental implant can last a lifetime.

Many methods of treating peri-implantitis have been documented in the literature and most focus on removal of the contaminating agents from the implant surface. These treatments include mechanical debridement, systemic or local antibiotic administration, antimicrobial treatment, laser decontamination, surgical debridement, and a combination of these methods.