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periodontist and sedation dentist Dr Boota Ubhi

Periodontist and sedation dentist Dr Boota Ubhi

Boota is an extremely skilled periodontist and sedation dentist. Leading a select team of experts devoted to delivering excellence in periodontics and implantology at the practice in Birmingham, he has a reputation for routinely surpassing patient’s expectations.

What is the definition of a periodontist dentist?

In order to define Periodontology or Periodontics (from Greek peri “around”  and odontos  “tooth”) is the speciality of dentistry that studies supporting structures of teeth, diseases, and conditions that affect them. The definition of the supporting tissues are the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament.

To define therefore; this is a professional who practises in this special field of dentistry who has additional training and qualifications. The British Society of periodontology exists to promote the art and science of periodontology. Their membership includes specialist practitioners, periodontists, general dentists, consultants and trainees in restorative dentistry, clinical academics, dental hygienists and therapists, specialist trainees in periodontology and many others.

Dr Boota S Ubhi

Qualifications and professional accreditations

BDS (Liverpool) MDentSci (Liverpool) MRD RCS (England)

  • 1992 University Of Liverpool – Bachelor of Dental Surgery
  • 1997 University Of Liverpool – Master Of Dental Science In Periodontology
  • 2000 Royal College of Surgeons (England) Restorative Dentistry (Periodontology)
  • 2000 Registered Specialist in Periodontics, UK

You are welcome to independently check my credentials.

A few words about my career as a periodontist

I qualified from Liverpool University in 1992 and worked in the Wirral area, Merseyside for 12 months as a vocational general dental practitioner.  Then I came back to my home city of Birmingham where I worked inner city area for a further 18 months in a large general dental practice. This exposed myelf to huge amount of dental disease and in particular gum disease.  I was astonished to find out that in UK’s second city with a population over 1 million that there was no Specialist Periodontist in Birmingham. The nearest practice offering this type of gum therapy and implants was in Leicester which is over 45 miles away.  Comparing this San Francisco which has a similar population,  there is over 200 Periodontists in that area alone.  This lead me to start a training programme in both dental implant implantology and also a Masters degree at Liverpool University.  After completing a Master’s degree in Periodontology in 1997, I then lectured in the periodontal department at Liverpool University from 1998 till 2000 part time.  In 2000 I was awarded membership of the Restorative Dentistry faculty of the Royal College of Surgeons (England) after passing the exams and in the same year was entered onto the General Dental Council’s Specialist Register in Periodontics. Since 1996 I have taking referrals for periodontal and implant therapy. I started in Harborne in 1997 and have been here since that date.

After almost 17 years since I started my training and I am still the only Full time Specialist Periodontist in the City of Birmingham and surrounding areas ! 

In addition to my role as Principal of Birmingham Peridontal and Implant Centre, I have also  taught part-time at the Birmingham University Dental School. Since then I  lectured extensively in the UK and Europe on Periodontology and Dental implantology.

External links to lectures and resources

Extracts of this text have been adapted under Creative Commons Attribution-ShareAlike 3.0. BPI Dental acknowledge and credit the author (s) of the original work which is used and / or appears in parts of this work. Link to source material http://en.wikipedia.org/wiki/Periodontology

Following tooth extraction which could be the result of periodontal disease, fracture roots, abscess formation etc. the bone and gum around the removed root starts to shrink away. Research has shown that up to 40-60% of the remaining bone shrinks away within 2-3years.
This leaves areas which areas which are unsightly because of the reduction of hard (bone) and soft tissue (gum) volume. This results in less than ideal final crown or bridgework in terms of size and shape compared to the adjacent natural teeth. We can offer rebuilding of this soft and hard tissue as we have had years of experience in providing these sorts of procedures.

gum grafting used to treat periodontal conditions

Gum grafting and bone graft treatment before dental implant placement

Should a patient request dental implants to replace these teeth than bone grafting may have to be done prior to any implants placed. The replaced teeth look odd as it maybe much longer and the gum around this tooth will also look sunken in. A procedure called ridge augmentation restores the natural hard and soft tissue profiles so that the replaced teeth look much more in harmony with the natural teeth. There are many different techniques of ridge augmentation and the actual procedure used will depend on the volume of tissue lost and also final restorative therapy to replace the missing teeth. This procedure can be carried out under local anaesthetic and depending on the size of the area to be filled can either be done with small bone graft or a soft tissue graft taken from the roof of mouth. You will be given a choice of materials to be used in the bone graft.

The bone graft can either be taken from the patient (back of mouth) or usually from an either animal source (Bovine Bio-Oss) or synthetic material (Straumann bone ceramic. The bone graft helps to provide a stable base for the dental implants and gum tissue by bonding with the natural bone over a period of several months. After it has matured then the bridgework or implant therapy can be carried out. The healing period can vary and the success rates are very high but smokers are advised to refrain from smoking for at least 1 week prior to the procedure and for 3 weeks afterward for the best results. In some more advanced cases both hard and soft tissue grafts are used together.

bone and soft tissue grafts for treating gum disease

Non-surgical management of periodontal diseases

This could include any of the following, instruction in plaque control, scaling and root surface debridement, bacterial analysis and antimicrobial therapy, occlusal analysis and adjustment and splinting of teeth.
The patient’s response to non-surgical therapy is closely monitored; if periodontal problems persist further treatment may be required.

Non surgical treatment for severe periodontitis

Gum disease severe periodontitis before and after treatment

Gum disease severe periodontitis before and after treatment

BEFORE
This gentleman has severe gum problems caused by neglect and also medication for his high blood pressure. After undergoing a course of gum treatment, the swelling and bleeding was completely eliminated. His teeth were much more comfortable and felt his breath was much fresher. The long term outcome is very good with good flossing and brushing.
AFTER
After treatment the periodontal condition has been stabilised with just non-surgical therapy and has been maintained by excellent plaque control by the patient.

Periodontal plastic surgery.

Problems such as excessive recession around teeth that cause aesthetic and sensitivity problems can now be dealt with great success. The use of soft tissue grafts can increase the zone of keratinised tissue and cover exposed roots. They can also be used for ridge augmentation and papilla regeneration around implants. The use of microsurgical techniques has greatly enhanced the predictability and success rate whilst also minimising post-operative discomfort.

Surgical periodontal and regenerative therapy.

This is usually performed if there are still problem areas after non-surgical therapy. Various surgical techniques are used for pocket elimination and predictable regenerative therapy using the latest materials available.

Periodontal resective therapy

BEFORE
Non-responding sites that after root surface debridement still have deep pocketing and bleeding on deep probing.

AFTER
Pocket reduction periodontal surgery was carried out resulting in minimal probing depths and no bleeding on deep probing. This also provides the patient with proper access for plaque control in home maintenance.

Periodontal regenerative therapy

BEFORE
Advanced bone loss on the distal surface of the premolars. Surgical regenerative therapy was carried out using Emdogain bone regenerative material.

AFTER

Bone regenerative therapy establishes new tooth support through new bone growth thereby enhancing the long-term prognosis of the tooth.

Root resection : root hemisection surgical procedure

Often multi-rooted teeth have a localised infection around one root. This surgical procedure is used to remove an infected root or to divide a two rooted tooth. The tooth remains functional because the infection is eliminated making it possible to perform effective plaque control and keep the site healthy.

Root resection surgery before and after treatment

Root resection surgery before and after treatment

BEFORE
Extensive bone loss and failed root filling around the distal root of the molar. The mesial root was found to be sound.

AFTER
The distal root has been removed and the mesial root retained. The mesial root will be subsequently restored by the referring dentist.

Crown lengthening.

Short and inadequate tooth length prevents the placement and retention of a new crown or bridge. This procedure increases the amount of tooth structure to support a crown or bridge by contouring the gingiva and the underlying bone. In addition it can also be used to improve the appearance of the anterior teeth prior to any advanced dental treatment or by removing excess gum tissue in the case of a “gummy” smile.

Periodontal surgery for tooth fracture

crown lengthening surgical procedure

crown lengthening surgical procedure

BEFORE
A tooth fracture with inadequate tooth structure for crown retention.

AFTER
After crown-lengthening procedure was carried out additional tooth is available to provide successful placement of a crown. After the procedure you can see a full coverage crown that is more retentive and natural looking.

Periodontal surgery for gummy smile

BEFORE
Short teeth and a gummy smile that compromises the aesthetic appearance of the smile.

AFTER
After aesthetic periodontal surgery the gums were positioned in a more pleasing position and contour. The beauty of this smile was completed with new porcelain veneers.

The casues of periodontitis

To understand this we must look at what causes gum disease in the first place. The cause of gum disease (gingivitis and periodontitis) is bacteria (bacterial plaque) inside your mouth which has overgrown. This is known as the indigenous bacteria i.e. it comes from own body. Just like the bacteria which we have inside our gut. The treatment for plaque induced gum diseases is all aimed at reducing the bacteria above and below the gum. However, we cannot get rid of indigenous bacteria, as this resides in our own body. That’s why antibiotics have only a limited effect in reducing the symptoms and the effect does not last more than a few weeks.

periodontitis cure before treatment

Treatment for periodontitis : Surgery and non-surgical management

All of periodontal treatments are aimed at reducing plaque bacteria to such a level that it does not become harmful and cause any further problems. First line of periodontal therapy is called non surgical treatment. Firstly we need to reduce the plaque build up above the gum by improving brushing & flossing techniques. Then any hardened deposits of plaque bacteria (called calculus or tartar) are removed both above and below the gum line by the use of both hand and ultrasonic instruments. Finally any fine deposits of bacteria and calculus are removed from the root surface with the use of specialised hand instruments called gracey curettes. In addition any teeth/tooth which have moved out of position and cause any problems with the bite may be adjusted (occlusal adjustment).

Management of periodontitis

Reducing periodontal pocket depths and bleeding

A reassessment is carried out approximately two months later to check the success of the treatment. The vast majority of cases we have treated at the Birmingham Periodontal & Implant Centre show at least 90% improvement in reduction of pocket depths. Almost all of the bleeding gums should be eliminated and in most mild to moderate cases this should be all the treatment that is needed. At this visit if we still find problems, then there is the option to have gum surgery. Gum surgery enables the periodontist to see the actual roots and bone surrounding the roots and also to remove any plaque/calculus deposits and any infection. Secondly the gum could be lowered to completely reduce the periodontal pockets also.

The final phase of any periodontal treatment is called maintenance therapy. Here 3 monthly hygiene appointments are arranged and professional cleaning above and below the gum line is carried out. Periodontitis needs to be treated like other chronic diseases such as diabetes and high blood pressure which cannot be cured but can be controlled by medication. The medication for periodontitis is good home care and regular professional hygiene visits. With this regime one can expect to keep their teeth for hopefully rest of their life.

aggressive periodontitis before treatment

BEFORE
Severe Chronic Periodontitis together with drug induced gingival hyperplasia (Nefidipine). After liasing with the General Medical Practitioner to change medication, the patient underwent a full course of non-surgical therapy.
AFTER
After treatment the periodontal condition has been stabilised with just non-surgical therapy and has been maintained by excellent plaque control by the patient.

What are the differences between the signs and symptoms of gingivitis

Gingivitis is an infection caused by bacteria. In approximately 24 hours the natural bacteria in the mouth will multiply and form a sticky, almost invisible, film on the teeth called plaque. If this plaque (biofilm) is not removed by brushing and an effective oral hygiene regime at home then it will develop into calculus (tartar). As the disease progresses various signs and symptoms will begin to become obvious, however some indicators are not so evident to the patient. For this reason it is important to distinguish the difference between signs and symptoms. Periodontal disease that is left untreated can result in the loss of teeth and often the symptoms are painless until the disease has progressed so far and little can be done to save the affected teeth. If you have missing teeth already you can get affordable dental implants in birmingham

SIGNSSYMPTOMS
Altered gingival appearanceGums bleeding while brushing
Gums pulling away from the teeth Red and swollen gums
Exposed roots and recessionsRed and swollen gums
Periodontal pocketsTender and sore gums
Pus between teeth and gums.Loose teeth, spaces appearing between teeth
Change in the way teeth fit together / a different bite
Halitosis – Bad breath
table showing the signs and symptoms of gingivitis

Both signs and symptoms are actually something that is abnormal to a healthy person and usually indicate that there is a medical condition developing. The difference between a sign and a symptom however is that a symptom is usually something that a patient experiences and can describe, for example; my gums bleed when I brush my teeth. A sign on the other hand is an observation a periodontist makes upon an examination, a clinical discovery that proves that there is indeed gum disease present. For example a periodontist would notice gingival recession or periodontal pockets.

Do you have gingivitis? This is what you should look for!

It is important to note you may have periodontal disease and not experience any of these symptoms. Periodontal disease is silent and chronic, rarely giving an advanced warning that tissue destruction is taking place. That is why it is important to have regular dental checkups.

SIGN – 1 – Altered gingival appearance

Changes in appearance are usually described according to colour, shape, size, consistency and surface characteristics. Healthy gingivae are pale pink and the edges of the gum line tightly hug the shape of the tooth. Gingival inflammation usually starts between the teeth and gradually spreads around the tooth margin. The infection causes the tissues to become red and swollen and the fine definition and tone of the gingivae is lost, they eventually become smooth and glossy.

SIGN – 2 – Gingival bleeding

Gingival bleeding is probably the most frequent patient complaint. Unfortunately, bleeding is so common that some people may not take it seriously and even believe it to be normal. Bleeding is usually evidence that bacteria is present and an infection has begun. It occurs most frequently while brushing the teeth. Bleeding may also be provoked on eating certain hard foods such as apples. Patients can taste blood and it may even be smelt on the patients breath.

SIGN – 3 – Halitosis – Bad breath and an unpleasant taste

Halitosis is a word that describes bad breath, and it often accompanies gingival disease. Halitosis is a common reason people visit the dentist. The smell originates from blood and poor oral hygiene, and should be distinguished from odours from other sources. Halitosis has a number of causes:

    • Residual food deposits especially such things as garlic, curry, onion etc….represent the most common cause of halitosis. For example garlic that is absorbed in the intestines is then taken into the bloodstream and finally exhaled by the lungs, so the odour can be smelt long after the food has been consumed.

 

    • Bacterial infections in the respiratory tract, nose, sinuses, tonsils and lungs can cause an embarrassing smell as can diseases of the digestive tract.

 

    • Mouth odour is common upon waking up and between meals and is associated with food stagnation and reduced salivary slow.

 

  • Metabolic diseases such as uraemia and diabetes give characteristic smells, such as the odour as acetone in the case of diabetics with an increase in blood sugar levels.
florida probe is a periodontal probe used to diagnose gum disease

periodontal probe used to diagnose gum disease

 

How is periodontal disease diagnosed? What are gum pockets?

During a consultation or routine check up the dentist inspects the colour and firmness of the gums. Teeth are tested for looseness. The bite is checked. At some point, a small measuring instrument the periodontal probe – is gently inserted between the tooth and gum to measure the depth of the gum pockets. Periodontal Pockets are spaces between the tooth and gum, the deeper the gum pocket the worse the problem. This “periodontal” exam should be done at frequent intervals for all adults, especially when there is a history of periodontal disease in the immediate family. X-rays should be taken at appropriate times to evaluate changes in the bone supporting the teeth

Broad definition of the stages of periodontal disease
*Warning Signs*

There are few if any early warning signs, but as the disease progresses, the signs and symptoms become more obvious.

  • Red swollen gums that may bleed easily
  • Persistent bad breath
  • Tall looking teeth (Recession)
  • Loose teeth (Mobility)

 

HEALTHY GUMS AND TEETH

periodontal chart healthy gumsimage of healthy gum diagnosis

  1. Coral pink gums
  2. Gums hug teeth tightly
  3. No bleeding
  4. Periodontal Pockets 1-3mm deep

FIRST STAGE DIAGNOSIS: GINGIVITIS

periodontal chart gingivitisimage of gingivitis diagnosis

  1. Gums become red/swollen that may bleed easily
  2. Warning – This stage is not always obvious
  3. Periodontal Pockets 1-4mm deep

SECOND STAGE DIAGNOSIS : EARLY PERIODONTITIS

periodontal chart early periodontitisimage of early periodontitis diagnosis

  1. Periodontal Pockets form as gums separate from teeth
  2. Periodontal Pockets 4-5mm deep

THIRD STAGE DIAGNOSIS : MODERATE PERIODONTITIS

periodontal chart moderate periodontitisimage of moderate periodontitis diagnosis

  1. Periodontal Pockets deepen as more bone supporting the tooth is lost
  2. Periodontal Pockets become difficult to clean as they deepen
  3. Periodontal Pockets 5-6mm deep

FOURTH STAGE DIAGNOSIS : SEVERE PERIODONTITIS

periodontal chart severe periodontitisimage of severe periodontitis diagnosis

  1. More than 50% of the bone supporting the tooth has been lost
  2. Teeth loosen or may need to be extracted
  3. Periodontal Pockets 6-10mm deep

patient education stages of gum disease

BPI Dental use the leading high tech Florida Probe system for diagnosis of gum disease and periodontal pocket depth

Dental research continues to solidify the link between periodontal (gum) disease and your overall health. Although periodontal disease is often difficult to detect in the early stages without a periodontal exam, it can be very easy and painless to treat. If not treated in a timely manner, periodontal disease has been associated with an increased risk of heart disease, stroke, diabetes, and low birth-weight babies.
We are excited to let our patients know that we utilize the Florida Probe® System as an advanced diagnostic tool for the tracking and monitoring of this disease. This system, which utilizes an automated, computerized probe, has proven to be more accurate and consistent than traditional methods of assessing periodontal disease and provides both you and the dental team with advanced information.

Software automatically tracks good and bad changes in your periodontal health over time and creates a printable periodontal chart that visually illustrates these changes to enhance understanding.

 

Florida Probe system also calculates your risk of periodontal infection

Their new Risk Assessment Screening tool calculates your risk of periodontal infection or re-infection based upon your specific risk factors, which include smoking habits, systemic health, oral hygiene, medications you may be taking, genetics, age and other contributing factors. You are assigned a high, medium, or low risk score based on combining these risk factors and your periodontal exam data to date.

You will leave with a clear picture of your gum health and a better understanding of your treatment options. Florida Probe®, helping to protect your beautiful smile for a lifetime!

sample image of periodontal chart

Do you have periodontal disease? The diagnosis?

If left untreated, periodontal disease can lead to bleeding, discomfort, receding gums and tooth loss. More that 50% of Americans over 30 have some gingivitis and more than 33% (35 million) have periodontitis. Periodontal disease affects 3 out of 4 people at some point in life. Dental research had linked periodontal disease to and increase rate of heart disease, stroke, diabetes, respiratory disease and pre-term and low birth weight babies. The Florida Probe has been designed has a high tech instrument used in the war against periodontal disease. Speak with your dentist about routine periodontal probing, maintenance of deep pockets and ways to improve your home care. Remember that early diagnosis is the key to maintaining your oral health and preventing serious systemic problems.

Extracts of this text have been adapted and used under copyright of Florida Probe Corporation. BPI Dental acknowledge and credit the author (s) of the original work which is used and / or appears in parts of this work. Link to source material http://www.floridaprobe.com