Q&A with Dr. Jaffer Kermalli Periodontist at GTA North Periodontics
Periodontists are dentistry’s experts in treating periodontal (gum) disease. They receive several years of additional specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. Periodontists are also experts in replacing missing teeth with dental implants. Here are some treatments you might see a periodontist for when you are referred by your General Dentist.
• Non-surgical Treatments for treatment of periodontal disease which were non-responsive to the treatment done in the general dental office.
• Gum Graft Surgery for areas of root exposure and hypersensitivity of the teeth
• Laser Treatment for the elimination of things like deep periodontal pockets.
• Regenerative Procedures to help grow the backbone and supporting tissue in areas of bone loss due to periodontal disease
• Dental Crown Lengthening prior to crown work to be done by your general dentist
• Dental Implants
• Pocket Reduction procedures and surgeries
• Plastic surgery procedures such as correcting a gummy smile.
So let’s start the Q&A
1. What does a periodontist do to treat gum disease?
A periodontist diagnoses the cause of gum disease and provides treatment to arrest it and where possible reverse the destruction from it. Our strategies range from deep cleanings and teaching patients how to target susceptible areas on their, to gum surgery that removes diseased areas of gum.
2. Explain what a Gum graft is. Where is the “Gum“ grafted from and is it painful because I’ve heard it can be. How long will my discomfort last? Will my tooth finally be less sensitive to cold and sweets after this?
A gum graft is a procedure that corrects areas where the gum has receded or thinned. This involves moving a small piece of gum tissue from the roof of the mouth to an area where the gums are deficient. Alternative donor tissues from cadaver or animal sources are possible. I have personally had two gum grafts. I took 1 Advil that night and woke up the next morning with some soreness that I would rate as 2/10. I went to work, did 6 surgeries and life went on. Talking a lot did make my mouth feel sore. The biggest inconvenience was not being able to work out hard for about a week and the soft diet. I was really craving some burgers and pizza!
3. My dentist sent me to have a procedure called crown lengthening. Is this really necessary? What is it’s done why do I need it?
I personally feel that crown lengthening is such an important procedure. A crown is generally needed when a tooth is very broken down. For a crown to be successful the dentist must bond the crown to as much solid tooth structure as possible. Often the tooth is broken down below the gums and the crown procedure for the dentist becomes difficult due to working under bleeding gums. Crown lengthening moves the gums down so that more solid tooth is visible for the dentist to work with. This allows for a crown that connects to solid tooth structure without the dentist having to battle with bleeding gums that can make the cementation process compromised. Gluing a crown in the presence of fluids like blood compromises the seal of the crown to the tooth. Also, if a crown is pushed down very deep under the gums, it will constantly irritate that area and lead to persistent inflammation, bleeding, soreness. When I see a patient who comes in for crown lengthening, I praise the dentist for insisting on doing the job right.
4. I was born with what my dentist says is a gummy smile. I show a lot more of my gums than my teeth and it affects the appearance of my smile negatively. How can you correct this?
Gummy smiles can occur for several reasons. A common situation is when teeth look square shape and there is excessive gum tissue. A simple procedure that adjusts the gums and bone can instantly improve the smile. This does not damage the teeth, gum, or bone and keeps your smile naturally beautiful. I often do this on teenagers after their braces come off and they recover fast with minimal downtime.
5. I need dental implants however first I may need what’s called a sinus lift. Please explain what that is and why I need it. My dentist sent me to you to have that done.
A sinus lift can be needed to help build bone for a dental implant. They are typically required for upper molar implants. There are two types of sinus lifts. One that can be done at the time of implant surgery when about half the bone needed is already there, the other is a separate procedure that is typically done prior and builds up a large volume of bone. Both procedures involve pushing the sinus floor up and adding bone. This procedure has been routinely done for more than 25 years and has very good success rates.
6. I need a bone graft before a dental implant. Explain what that procedure is and where is this bone coming from?
A bone graft can be required to increase bone volume prior to an implant. The analogy I like to use comes from carpentry. If your bone is like wood and is too thin for a screw, we need to thicken it up before placing the screw. The procedure requires bone to be added and this bone can come from a different area of your mouth, a cadaver tissue bank, or animal bone products. The donor’s bone is placed in the area needed and typically covered with a membrane and allowed to heal for 3-6 months. During that time, your body converts those bone products into your natural bone. I still find it amazing that we can grow bone in the human body so predictably and every time I open up an area that I grafted to place an implant I am in awe.
7. I have deep dental pockets around certain teeth that have progressively been getting worse at each check-up appointment. What can be done to fix this I don’t want to lose my teeth.
There are several options to correct progressively deep pockets. First is to look at factors your body may have that could be contributing, such as smoking, diabetes, or not brushing/flossing well. The second is keeping consistent with cleanings every 3 months. The reason why 3-month cleanings are so important is that it takes approximately 100 days for bacteria in your mouth to grow to a point where it causes destruction to gum and bone. Cleaning every 3m stops that growth and prevents future breakdown. Finally if needed, gum surgery or certain medications can be prescribed to help manage the area.
8. Other than periodontal disease are there any other diseases of the mouth that you treat?
I also treat gingival post-traumatic distress 🙂 On a serious note, approximately half of my workload is reconstructing people’s mouth to improve their chewing and esthetics with dental implants.
9. What procedures do you use a laser for?
We typically use a laser for small gum procedures like frenectomies, and to trim excessive gum tissue.
10. What is gingival hyperplasia? What causes it and how do you treat it?
Gingival hyperplasia is a form of gum enlargement. This can be due to genetics, hormonal, poor hygiene, or a combination. It’s a fun procedure to treat where the gum tissue is trimmed and the teeth are cleaned really well.