Periodontal disease (or commonly known as gum disease) is an inflammatory disease of the support structures of teeth. These structures include gingiva (gum), periodontal ligament and alveolar bone (part of the jaw bone). The gingiva, being the most superficial tissue, provides most of the signs and symptoms of periodontal disease, such as swelling, redness, bleeding, recession etc. When inflammation is confined ONLY to the superficial layer (the gingiva), the condition is known as Gingivitis. This is a very common condition affecting adults and children alike. When inflammation is spread to and involving deeper structures (such as bone) the condition is known as Periodontitis (or Periodontal Disease). It is usually characterized by the irreversible loss of alveolar bone. This bone loss feature can be seen on radiographs (x-ray). About 30% of the adult population can have limited periodontitis during their lifetime. Generalised and severe periodontitis only affects 10-15% of the adult population.

Bacteria in the mouth are usually responsible for causing Gingivitis and Periodontitis. It is unclear at this stage if this is a mono-infection (caused by more than one type of bacteria). Poor personal oral hygiene (tooth cleaning) allows bacteria to accumulate around the neck of teeth and gum margins. This build-up of bacterial moss is known as dental plague. The prolonged retention of plaque at these locations will cause gum inflammation (gingivitis). If gingivitis is allowed to go on for a long time, some gingivitis progress to the next stage of disease - periodontitis, where there is a progressive loss of bone and tooth attachment to bone. The reason (and mechanism) for the transformation from gingivitis to periodontitis is not clearly understood at present.

In advanced cases, the excessive loss of tooth support structure can result in the loss of this tooth. Therefore, segmental and progressive tooth loss is a common feature of advanced periodontal disease.

Gingivitis, being a reversible condition, will restore quickly once dental plaque is removed and prevented from returning (by regular tooth brushing and flossing). Periodontitis unfortunately is NOT reversible. The loss of support structures (including bone) around teeth is usually a permanent feature. At best it can only be halted by appropriate treatment and satisfactory personal oral hygiene. In severe cases, a permanent disfigurement (such as gum recession and elongation of teeth) remains and the patient has to accept these limitations. Plastic and reconstructive surgery can correct some of these disfigurements sometimes but not in all cases.

A Periodontist is a specialist dentist who specializes in the management of periodontal disease. These days, Periodontists also involve themselves in the correction and rebuilding of dentition after the destructive affects of periodontal disease. They provide service in plastic and reconstructive periodontal surgery and implant surgery etc. Which provides the foundation for the restorative dentists to replace missing teeth or restore broken down teeth.

The first step is to eliminate gum inflammation through a series of debridement procedures as well as enlisting the patient's cooperation in self-care (daily oral hygiene) to ensure a satisfactory healing outcome.

The second step is to make changes around and between teeth to allow access for oral hygiene. This may involve surgery to the gum and bone structure, replacing or modifying restorations on teeth.

Finally if the patient can achieve a stable condition he/she will then be placed on a maintenance routine where professional checks and treatment are given at regular intervals.

Halitosis is a clinical term used to describe oral malodour or bad breath, as it is commonly known.

There are many causes of halitosis. However over 80% of cases are caused by oral bacteria giving out sulphur-containing gases (volatile compounds). Typically these bacteria's reside on the upper surface of the tongue and in periodontal pockets (the separation between gum and teeth).

The second most common source of bad breath comes from decaying food debris in the mouth and around teeth. Both these conditions can be resolved by a thorough debridement by your dental hygienist, dentists or periodontists for improved oral hygiene.

The Periodontist will take a detailed history and carry out a thorough examination and assessment. They will also record an oral odour reading for future comparison purpose. Depending on the findings of the examinations, appropriate treatment will be given. Repeated measurements of the oral odour will be done from time to time to monitor any changes. In most cases, oral malodour will not be detectable if the patient follows instructions closely and adhere to a strict regimen of oral hygiene.

Halitosis from other causes will also be treated accordingly.

Dental implants are usually made of Titanium metal of various sizes and shapes, and are placed in the jawbone following tooth/teeth loss. After successful healing (osseointergration) dental restorations (crowns and/or bridges) are then to be placed on these implant supports.

Provided straight criteria of case selection and clinical protocols are adhered to, dental implants claim to have a success rate of 80%. In some cases, such as in the anterior mandible, the success rate is close to 99%. Your dentist will assess you and advise you if you are a suitable candidate for dental implants.

Yes, complications for dental implants can occur. This is why it is important that you consult your dentist prior to agreeing to treatment. You need to give 'informed consent', preferably in writing when accepting any specific treatment plan.

Successful dental implants are based on the maintenance of a 'satisfactory' osseointergration between the implant and the surrounding bone. Osseointergration is a dynamic state of the union between bone and titanium surface. As such, it relies on a healthy bony metabolism throughout life. Within certain limit, osseointergration should last for the duration of the natural life span of the individual.

Risk factors known to destroy osseointergation are:

1.Infection (bacterial or deep gingival infection)

2.'Overloading' (such as to-and-fro movements on implants generated by teeth clenching or grinding habits).

On the other hand, restorations (crowns and other connection compounds (screws) are subject to wear and tear processes in the mouth. They will also be subject to accidental breakage. Therefore, replacement or repair is expected from time to time.

They will depend on a large number of factors the most important factors are the amount of tissue loss after the extraction and the feasibility of replacing the lost tissue by plastic and reconstructive surgery. If the lost tissue can be successfully restored, then it is usually a simple matter of fabricating a crown with satisfactory esthetics. This part of the dental work relies on the skill of the restorative dentist and his technician.

Not at all. Local anesthetics are usually used for simple cases. In complex and extensive cases, intravenous sedation or general anesthetic can be used. The amount of post-operative discomfort varies from case to case according to situation. For simple cases such as a simple implant, the post-operative discomfort is usually minimal. Most patients can return to normal activity the following day.