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What is periodontics?

Periodontics is the specialty of dentistry that studies the prevention, diagnosis and treatment of diseases or abnormalities that affect the tissues that support the teeth. The main periodontal diseases are gingivitis and periodontitis.

What is the Periodontal disease?

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss.  Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed. Dr. Jose Nart is a US trained periodontist in Barcelona who can treat succesfully periodontal dieases.

Gingivitis

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Periodontitis

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

There are many forms of periodontitis. The most common ones include the following.

• Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
• Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
• Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
• Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Symptoms of Gum Disease
Periodontal disease is often silent, meaning symptoms may not appear until an advanced stage of the disease. However, warning signs of periodontal disease include the following:

• Red, swollen or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or eating hard food
• Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
• Loose or separating teeth
• Pus between your gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

Following are some of the procedures that periodontists use to treat patients diagnosed with a periodontal (gum) disease. The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth; however, many other factors can cause periodontal (gum) disease or influence its progression.

Non-Surgical Treatments

The least invasive includes scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis.

Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Periodontal Surgery

If you're diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:

 

Pocket reduction procedure

When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth.
Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

Your periodontist has measured the depth of your pocket(s). A pocket reduction procedure has been recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine.
During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

Regenerative procedure

Your periodontist may recommend a regenerative procedure when the bone supporting your teeth has been destroyed. These procedures can reverse some of the damage by regenerating lost bone and tissue.
During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.
There are many options to enhance support for your teeth and to restore your bone to a healthy level. Your periodontist will discuss your best options with you.

Cosmetic Procedures

In addition to procedures to treat periodontal disease, we also perform cosmetic procedures to enhance your smile. Oftentimes, patients who pursue cosmetic procedures notice improved function as well. Cosmetic procedures include:
 

Crown Lengthening

To improve a "gummy" smile because your teeth appear short. Your teeth may actually be the proper lengths, but they're covered with too much gum tissue. To correct this, your periodontist performs crown lengthening. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.

Soft Tissue Grafts

Periodontal procedures are available to stop further dental problems and gum recession, and/or to improve the esthetics of your gum line.

Exposed tooth roots are the result of gum recession. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or, maybe you're not bothered by the appearance of these areas, but you cringe because the exposed roots are sensitive to hot or cold foods and liquids.

Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. You may not be in control of what caused the recession, but prior to treatment your periodontist can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss.

CONNECTIONS BETWEEN PERIODONTAL DISEASE AND OTHER SERIOUS HEALTH RISKS:

Research has shown, and experts agree, that there is an association between periodontal diseases and other chronic inflammatory conditions, such as diabetes, cardiovascular disease and Alzheimer’s disease. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.
When an inflammatory condition is suspected or diagnosed, it is important to consult with both a general physician and a dental health professional, such as a periodontist. Sometimes the only way to detect periodontal diseases is through a periodontal evaluation. A periodontal evaluation may be especially important if you:

• Have a high risk for periodontal diseases.
• Have heart disease, diabetes, respiratory disease or osteoporosis, or are thinking of becoming pregnant.
• Have a family member with periodontal disease. Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.
• Have a sore or irritation in your mouth that does not get better within two weeks.

Heart Disease

Diagram Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.

Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

Pregnancy Problems

For a long time we've known that risk factors such as smoking, alcohol use, and drug use contribute to mothers having babies that are born prematurely at a low birth weight.
Now evidence is mounting that suggests a new risk factor – periodontal disease.

Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. More research is needed to confirm how periodontal disease may affect pregnancy outcomes. It appears that periodontal disease triggers increased levels of biological fluids that induce labor. Furthermore, data suggests that women whose periodontal condition worsens during pregnancy have an even higher risk of having a premature baby.

All infections are cause for concern among pregnant women because they pose a risk to the health of the baby. The Academy recommends that women considering pregnancy have a periodontal examination.

Diabetes

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

A study in the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are. Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection. This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.

Curriculum JOSE NART

• Doctor in Dental Surgery (DDS).
  Universitat Internacional de Catalunya, Barcelona.
• Certificate in Periodontology and Implants.
  Tufts University, Boston, USA.
• Diplomate, American Board of Periodontology.
• Associate Professor.
  Universitat Internacional de Catalunya, Barcelona.
• Invited Professor, Advanced Oral Implantology Master,
  Universidad Europea de Madrid (UEM).
• PhD candidate.
• Private practice limited to Periodontology and Implants.
  Barcelona.
• International and national scientific publications.
• International and national lecturer.
• Specialist member of the Spanish Society of Periodontology (SEPA).
• Active member of the American Academy of Periodontology (AAP).
• Active member of the Catalan Society of Dentistry (SCOE-ACM).

News

March 2010

Dr Jose Nart defended succesfully his PhD Thesis last January the 20th and obtained his PhD in Dentistry with the highest degree.

Dr Jose Nart introduced Dr Fabio Vignoletti in his lecture in Barcelona about Inmediate Implant Placement.

Dr Jose Nart has been invited to the `Speakers Development´ event by Straumann which will take place in Paris the 26th and 27th of March. 

January 2010

January 20th 2010, UIC, Barcelona. Doctoral Thesis (PhD): Prospective evaluation of the use of Motorized Ridge Expander in Guided Bone Regeneration for future Implant sites.

January 15th 2010, UIC, Barcelona. Dr Jose Nart will introduce and moderate the conference and live surgery of Dr. Fabio Mazzocco, Padova, Italy.

November 2009

November 12-15th 2009, SEPA, Las Palmas. Dr. Jose Nart, along with Drs Conchita Curull and Leopoldo Mateos, were jury of Clinical Posters and Associate member Posters at the Annual Meeting of the Spanish Society of Periodontology (SEPA) in Las Palmas, Canary Islands.

October 2009

October 14th 2009, UIC, Barcelona. Dr. Jose Nart introduced Dr. Paul Levi Jr. (Past President, American Academy of Periodontology Foundation) in his lectures to Postgraduate Periodontology students.

October 9th 2009, Barcelona. During the Annual Meeting of SEPES (Spanish Society for Prosthetic Dentistry) it was announced that Dr. Jose Nart will be a speaker at the next annual meeting to be held in Santander, Cantabria, on October 10 to12, 2010.

September 2009

September 29th 2009, Madrid. Dr. Jose Nart and other Spanish and Portuguese renowned periodontists join Professors Jan Lindhe and Mariano Sanz, in the 1st Iberian roundtable in Ridge Preservation Techniques.

Dr. José Nart Molina will be attending the 95th Annual Meeting of the American Academy of Periodontology in Boston the next 11 to 15 September. On September 11th he will participate in the Tufts Periodontal Alumni Reunion at Tufts University, School of Dental Medicine.

Dr. José Nart Molina has become Visiting Professor of the Official Master in Advanced Implantology at Universidad Europea de Madrid (UEM), directed by Drs. Jaime Jiménez y Vicente Jiménez López, for this 2009-2010.

Press release, November 2008

Dr. Jose Nart Molina received the award `Best Clinical Poster´ at the SEPA-joven (Spanish Society of Periodontology) meeting, celebrated in Barcelona last November 14-15th. The poster´s title was `Subepithelial connective tissue graft to enhance implants esthetics´, and the authors were Jose Nart, Fabio Mazzocco, Mario Gatti and Maria Nart. 

Press Release (The American Board of Periodontology)

Jose Nart, D.D.S. of Barcelona, Spain was awarded Diplomate status by the American Board of Periodontology at its recent meeting in Dallas on May 8, 2008. The American Board of Periodontology is recognized by the American Dental Association as the national certifying board for the dental specialty of Periodontics. The Board awards Diplomate status upon those who, after two to three years of postdoctoral advaced specialty training at an accredited institution, succesfully complete a two part examination which consists of a comprehensive written examination and an oral examination.

Dr. Nart received his dental degree in 2001 from Universitat Internacional de Catalunya. He received his advanced certificate in Periodontics in 2007 from Tufts University. Currently, he is in full time private practice in Barcelona and is a part time Associate Professor- Department of Periodontology at Universitat Internacional de Catalunya. Dr. Nart is an active member of the American Academy of Periodontology, Spanish Society of Periodontology and Catalan Society of Dentistry.

Next courses and lectures:

• September 29th, Madrid. Presentation of clinical cases of ridge preservation using Bio-Oss Collagen, Geistlich, in the1st Iberian roundtable in Ridge Preservation Techniques.
• September 30th, UIC, Barcelona. 1st Seminar for students of Postgraduate Aesthetics and Aesthetics On-line 2009-11: Basic periodontal principles and periodontal surgery.
• October 22nd, UEM, Madrid. Diagnosis, Prognosis and Periodontal Treatment Planning.
• October 23rd, AHIADEC, Barcelona. Theoretical & Practical instrumentation in phase I periodontal treatment in live patients.
  
• October 27th, ISIDN, Barcelona. Healing and Bexident Post clinical applications.
• November 26th, UEM, Madrid. Periodontal Surgery, Regeneration and Mucogingival therapy.
• December 16th, UIC, Barcelona. 2nd Seminar for students of Postgraduate Aesthetics and Aesthetics On-line 2009-11: Functional and Aesthetic Crown Lengthening.
• January 20th, UIC, Barcelona. Doctoral Thesis (PhD): Prospective evaluation of the use of Motorized Ridge Expander in Guided Bone Regeneration for future Implant sites.
• January 21st, UEM, Madrid. Materials in bone regeneration and reidge preservation. Implant positioning and distances.

Contact/Links

Contact

• by email:
  info@nartperiodoncia.com
  
  
• Nart Clínica Dental
  C/ Padilla, 368 T 934 567 003
  Barcelona.
  www.nartclinicadental.com
  
  
• Advanced Perio-Implant Clinic
  C/ Aribau, 326 2º 2ª T 93 414 23 48
  Barcelona.

Links

• Sociedad Española de Periodoncia y Osteointegración
  www.sepaos.es
• American Academy of Periodontology
  www.perio.org
• Societat Catalana d’Odontoestomatologia
  www.scoe.cat
  
• Nart periodoncia
  www.nartperiodoncia.com
  
• American Board of Periodontology:
  www.perio.org/amboard
• Nart implantes dentales
  www.implantesdentalesbarcelona.es

FAQ’S

- What are periodontal diseases?

The word periodontal literally means "around the tooth." Periodontal diseases are serious bacterial infections that destroy the attachment fibers and supporting bone that hold your teeth in your mouth. Left untreated, these diseases can lead to tooth loss. There are many forms of periodontal diseases

- Who is a periodontist?

A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire. Often, dentists refer their patients to a periodontist when their periodontal disease is advanced. However, you don't need a referral to see a periodontist. In fact, there are occasions when you may choose to go directly to a periodontist or to refer a family member or friend to your own periodontist.

- Is it normal for my gums to bleed when I brush my teeth?

Bleeding gums are one of the signs of gum disease. Think of gum tissue as the skin on your hand. If your hands bled every time you washed them, you would know something was wrong. There are a number of other warning signs of gum disease.

- When should I see a periodontist?

If you value your oral as well as overall health, anytime is a good time to see a periodontist for an evaluation. Sometimes the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation may be especially important in the following situations:

• If you notice any symptoms of periodontal disease, including:
  • gums that bleed easily, such as during brushing or flossing.
  • red, swollen or tender gums.
  • gums that have pulled away from the teeth.
  • persistent bad breath.
  • pus between the teeth and gums.
  • loose or separating teeth.
  • a change in the way your teeth fit together when you bite.
  • a sore or irritation in your mouth that does not get better within two weeks.
• If you are thinking of becoming pregnant. Pregnant women who have periodontal disease may be seven times more likely to have a baby born too early and too small. In addition, about half of women experience "pregnancy gingivitis." However, women who have good oral hygiene and have no gingivitis before pregnancy are very unlikely to experience this condition.
• If you have a family member with periodontal disease. Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.
• If you have heart disease, diabetes, respiratory disease or osteoporosis. Ongoing research is showing that periodontal disease may be linked to these conditions. The bacteria associated with periodontal disease can travel into the blood stream and pose a threat to other parts of the body. Healthy gums may lead to a healthier body.
• If you feel that your teeth are too short or that your smile is too "gummy." Or, if you are missing one or more of your teeth and are interested in a long-lasting replacement option.
• If you are not satisfied with your current tooth replacement option, such as a bridge or dentures, and may be interested in dental implant.