Meet Your Periodontist
Dr Peter Apostolopoulos
BDSc (Melb), GradDipClinDent (Implants), DCD (Perio)
Dr Peter Apostolopoulos completed his undergraduate BDSc at the University of Melbourne in 2004. He then served as a Dental Officer in the Australian Army and Air Force at various locations around Australia, before returning to the University of Melbourne to complete postgraduate education in the GradDipClinDent (Implants) in 2010 and DCD (Periodontics) in 2015. His research thesis on Ridge Preservation has been published in the internationally renowned journal, Clinical Oral Implant Research.
What is a periodontist?
A periodontist is a registered dental specialist that has had additional postgraduate training in the field of periodontics, which involves the management of periodontal disease and dental implant surgery.
Why might I need to see a periodontist?
General dentists, dental therapists and hygienists are well-equipped to diagnose and manage most patients with periodontal disease. However, a small proportion of patients may not respond to conventional treatment methods or have quite severe or aggressive forms of periodontal disease. Patients are often referred to specialist periodontists to manage these more severe cases. A referral from your dentist is recommended, but is not necessary, to see a periodontist.
What is periodontal disease?
Periodontal (gum) disease is an infection of the gums that gradually destroy the hard and soft tissues that support your natural teeth. Patients with periodontal disease may exhibit some or all of the following symptoms: dark red, swollen and/or bleeding gums, loose teeth, bad breath (halitosis), receding gums, gum abscesses, pain.
Bacteria found in dental plaque is the primary cause of gum disease. Bacteria produce toxins that irritate the gums – this inflammation of the gums is referred to as gingivitis. Although some people are more at risk than others, it can affect anyone at any age. If this irritation is prolonged, the gums separate from the teeth and cause pockets to form. Plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
As periodontal disease progresses, the supporting gum tissue and bone that holds teeth in place deteriorate. The pockets increase in depth and harbour more destructive bacteria. This destruction of the tooth attachment and bone around the teeth is referred to as periodontitis. If left untreated, this leads to tooth loosening, abscesses and eventually tooth loss.
What is periodontal surgery?
Sometimes scaling and root planing alone is not successful at getting the gum disease under control. This is because the pockets in severe periodontitis cases are so deep that it is not possible to fully clean the roots without direct sight; therefore periodontal surgery may be recommended by Dr Apostolopoulos. This treatment is also routinely performed under local anaesthetic and involves a small incision of the gums to gently lift them away from the teeth, so that the roots can be directly visualised and cleaned below the gum line more effectively. The gums are then replaced in position via a small number of sutures and specific instructions provided to help manage the healing process.
Other forms of periodontal surgery that periodontists can perform include:
Periodontal regeneration (to replace the original hard and soft tissue support to the teeth)
Gingivectomy (removal of excess or overgrown gum tissue)
Crown lengthening (to improve the gum aesthetics and/or gain more structure for tooth restoration)
Gum grafting (to replace gum tissue around teeth lost due to recession)
Tooth exposure (of impacted or unerupted teeth)
Frenectomy (removal of irregular muscle attachments in the mouth)
Why is periodontal maintenance important?
Following the active phase of periodontal treatment, continuous monitoring of gum tissues and preventive periodontal care is vital to maintaining periodontal health. Significant time, effort and finances are invested in all forms of dental treatment. Commitment to periodontal maintenance is very important to prevent the risk of relapse into active periodontal disease.
Periodontal maintenance and good oral hygiene are imperative for good oral health. On completion of the active phase of periodontal treatment, a specific maintenance programme will be developed for you. Adherence to this maintenance programme as well as diligent home oral care will give you an excellent chance of keeping your gums healthy and extending the life of your teeth. Studies have shown that patients with a history of gum disease that do not adhere to good oral hygiene and periodontal maintenance tend to relapse and risk further bone and tooth loss.
Your periodontal maintenance visit may include the following:
Update of your medical and dental history
Assessment of your oral soft tissues
Clinical periodontal examination, which includes measurements of the depth of the pockets around your teeth
Clinical oral examination, including examination of teeth for decay and any other dental problems.
Update of your X-rays, where indicated
Review of your oral hygiene practice
Removal of bacterial plaque and calculus
Confirmation of recall frequency and scheduling of next appointment
The interval between your periodontal maintenance appointments is determined by the severity of your periodontal condition, your susceptibility to periodontal disease and your ability to perform adequate oral hygiene at home. Where appropriate and convenient, we may also recommend that your periodontal maintenance is shared between your dentist or hygienist and our practice. The ultimate aim of this treatment is to stabilise your periodontal condition so that you may return to your dentist or hygienist full time. You should be reassured that if there is ever any periodontal concern in the future, Dr Apostolopoulos will be available to re-evaluate and manage as necessary.
How do I prevent periodontal disease?
The saying “prevention is better than cure” certainly applies to periodontal disease. The best way to prevent periodontal disease is by twice-daily (morning and evening) thorough tooth brushing and cleaning between the teeth (flossing or other techniques), and regular professional examinations and cleaning with your dentist. Unfortunately, even with the most diligent home dental care, some people can still develop periodontal disease. Once this disease starts, professional intervention is necessary to prevent or minimise its progression.
Other important factors that can affect the health of your gums include:
Tobacco usage (smoking)
Diabetes mellitus (type 1 and 2)
Ill-fitting fixed or removable prostheses (e.g. dentures, bridges, implants)
Clenching and grinding teeth
What periodontal treatment is available?
Following a thorough examination and diagnosis of the gum condition, periodontal treatment can be performed. The initial stage of treatment is often a non-surgical periodontal therapy called scaling and root debridement (or colloquially as a “deep clean”). This deep cleaning procedure involves removal of plaque and calculus deposits from above and beneath the gum line, to allow the gum tissue to heal and reattach to the tooth surface. Anti-microbial adjuncts (systemic antibiotics or oral mouthrinses) may also be recommended in specific cases to help control the growth of bacteria that create toxins and cause periodontitis.
This treatment is routinely performed in the dental chair and local anaesthetic is readily available to numb the gums and teeth, and minimise any discomfort during and after the procedure. Due to the thoroughness and labour-intensiveness involved, this treatment is often completed over multiple appointments and can be customised to individual patient preferences. Please remember to inform Dr Apostolopoulos of any concerns you may have about your periodontal treatment, so that they can be addressed efficiently and effectively.
In the early stages of periodontal disease, scaling and root planing may be all that is needed to get the condition under control. However, in a small proportion of patients, periodontal surgery may be necessary to manage advanced and/or unresponsive sites to restore periodontal health.