Dr. Rima Abdallah is a Diplomate of the American Board of Periodontology. She joins Dr. Michael’s Dental Clinic with a decade of evidence-based approach in Periodontology and Implantology.
What inspired you to pursue a career in periodontics?
I have always loved the link between oral health and systemic health. Knowing that gum disease is closely related to general systemic diseases in the body and being an academic at heart, I wanted a platform to educate and share this knowledge with my patients. I want to spread awareness about prevention and oral health and I also love that periodontics is a speciality that uses minimally invasive techniques to provide a healthy and esthetic housing for the teeth.
What types of procedures does a periodontist do?
Non-surgical treatments including:
- Scaling and root planing - Cleaning the surface of the roots of teeth to remove plaque, tartar and bacteria from periodontal pockets. Additionally, systemic antibiotics may be prescribed to assist in treatment
- Antimicrobial medications - For some cases, local antibiotics can be applied beneath the gums to suppress or kill the bacteria
- Soft tissue lasers can be applied in adjunct to scaling and root planing to disinfect the pocket from bacteria
Surgical treatments for advanced cases including:
- Periodontal pocket reduction - folding back the affected gum tissue, removing the bacteria and securing the gums back in place
- Gum graft surgery - transferring tissue from the roof of the mouth to the exposed root of the tooth. This procedure reduces gum recession and temperature sensitivity.
- Regenerative procedures - regenerating lost bone and tissue can reverse some of the damage caused by periodontal disease
Esthetic surgical treatments including:
- Gummy smile treatment - If you feel your teeth look too short or your gums cover too much of some teeth while leaving the others the right length, then dental crown lengthening might be the solution for you. During this procedure, excess gum tissue is removed to expose more of the crown of the tooth. During the dental crown lengthening 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.
- Gingival depigmentation - Heavy smokers might get dark pigments in their gums, this can be removed by a noninvasive peeling of the pigmented gums using a soft tissue laser beam
- Piezocision - a minimally invasive surgery to accelerate your orthodontic treatment by stimulating the bone around the teeth to regenerate faster than usual, decreasing your treatment time by one third to half of treatment time
What happens during a patient’s first periodontal consultation?
During a patient’s first visit I would like to take as much data as possible, medical history as well as dental history. Gum disease is an inflammatory disease so any medical conditions that are inflammatory in origin like atherosclerosis or diabetes will increase the level of gum disease and gum disease will increase the level of those systemic diseases as well.
Then we would go over the full mouth radiographs to asses bone levels supporting the teeth as well as conduct a visual intra oral clinical exam to look for the signs of gingivitis or periodontitis (redness of the gums, bleeding, foul odor, swelling of the gums, gum recession, etc.)
The third and final step before diagnosis and treatment planning would be the periodontal charting, which is like a map of the gum level and extent of gum support around the teeth, this will allow us to classify and diagnose the level of gum deterioration and will allow us to give you the prognosis of the treatment.
Proper oral hygiene instructions and specific oral hygiene regimen will also be customized and demonstrated for each patient.
What do you want patients to understand about gum health?
Gingivitis is the mildest form of gum disease. Symptoms include red swollen gums that bleed easily. Little or no discomfort is noted at this phase. Bad oral hygiene is the main cause of gingivitis. Gingivitis is reversible with professional treatment and good oral hygiene.
Periodontitis is the second phase of the disease that is always proceeded by untreated gingivitis. With time, plaque can spread and grow below the gum line. The release of toxins by the bacteria in dental 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 more than 500 species of bacteria in the oral cavity, some of them good and others harmful. I want my patients to know that gum and oral health are synonymous with balancing the good and bad. The more regular you are with your hygiene and dental visits the better you are equipped at keeping these bacteria at bay. I also need to emphasize that gum disease starts off as bacterial in origin but continues as an inflammatory disease, so it will be important to have a diet high in fatty acids and omega 3 as well as making sure any systemic disease like diabetes are kept under control. Smoking and obesity will be very harmful as they will exacerbate the inflammatory component.
What advice do you have for patients with gum disease?
Gum disease is something you have to learn to live with. Once it progresses to periodontitis it becomes irreversible. That does not mean that it cannot be managed. Constant monitoring by your Periodontist and regular hygiene visits are a must, as well as proper oral hygiene regimen at home.
Periodontal treatment and maintenance rely on decreasing the levels of bacterial plaque as well as reducing the external factors that might increase the intensity of the disease such as smoking, obesity, diabetes and heart disease. By controlling and or eliminating those external factors you will put yourself on the road to healthier gums free from bleeding and bad odor.
What would you say to patients who are hesitant to see their dentist/dental specialist because they’re worried about pain?
I always recommend prevention and early intervention. The more regular you are with your dental visits the less pain or discomfort you will have to endure. During your dental procedure we will go over your concerns and tailor your treatment to fit your level of comfort. I always want my patient to feel in control of his appointment. You will be made at ease by being aware of the treatment procedure, length of procedure and level of discomfort that you might face so once you are in the know I am sure your worries will disappear.
When should dentists or specialists refer patients to a Periodontist?
A dentist or dental specialist may recommend dental crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps the tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.
An orthodontist might refer for assessment of health and stability of attachment apparatus prior to orthodontic treatment, to asses if a frenectomy or soft tissue procedure is needed before or after treatment or for a Piezocision procedure to decrease treatment time. as well as constant monitoring and maintenance all throughout the orthodontic treatment.
A general dentist or dental specialist might refer for a bone graft and or sinus lift to rehabilitate the area of a lost tooth and to follow that by a dental implant to replace that missing tooth.
Dr. Rima is now seeing patients at Dr. Michael’s Dental Clinic in Umm Suqeim. For appointments and referrals, please call +971 4 394 9433.