Periodontal

Periodontal Disease

Periodontal Disease

Periodontal simply means “the tissue around the teeth.” Periodontists specialize in the treatment of this area, which is often characterized by gum disease. Where the gum and the tooth meet, there is a “groove” or sulcus around the tooth. This sulcus usually measures three millimeters or less in depth. With disease, this sulcus develops into a pocket that is greater than three millimeters. These pockets trap harmful bacteria and make oral hygiene less effective.

Unfortunately, periodontal-related problems are often discovered after they have persisted for an extended period of time. Plaque (bacteria) is the most common element causing gum disease. The bacteria can lead to inflammation, which is often painless. The inflammation causes a breakdown of the attachment of the gum and bone to the teeth. Proper oral hygiene, daily dental care and regular dental checkups will minimize the risk of gum disease.

Gum disease ranges from gingivitis to mild, moderate or severe periodontitis. Generally, the more severe the gum disease, the deeper the pockets and the more bone loss there is. As bone loss continues, the teeth may become loose and develop painful swelling called abscesses. Treatments are available for every case of gum disease.

Common problems associated with gum disease:

• “Long” teeth (receding gum lines expose the root portions of your teeth)
• Discolored or deteriorating tooth structure
• Gum depressions (spaces in between the teeth in the gum tissue)
• Persistent bad breath
• Infected gum line (discoloration or inflammation of the gum tissue)
• Bleeding gums (either with brushing and flossing or spontaneously)
• Tooth loss or tooth movement
• Painful abscess formation

Systemic Health and Periodontal Disease

The effects of gum disease can be damaging to your dental health as well as your general health. The bacteria and toxins that are present in gum disease can enter the blood stream and have a negative effect on your overall health. Research suggests that there may be a link between oral health and diseases, such as bacterial pneumonia, stroke, diabetes, cardiovascular disease, increased risk for pre-term birth and low birth-weight babies.

Risk Factors

Several risk factors are associated with the development of gum disease. These would include:

• Smoking or chewing tobacco.
• Systemic diseases such as diabetes, HIV, blood disorders.
• Certain medications such as steroids, cancer medications, blood pressure medications, anti-epilepsy drugs, medications that cause dry mouth and oral contraceptives.
• Genetics can play a role.
• Poor fitting bridges, fillings, crowns or partial dentures.
• Fillings that have become defective.
• Pregnancy or puberty.

However, through proper preventive care and oral hygiene, you can avoid problems associated with gum disease.

Please contact our office for a periodontal evaluation.

Periodontal Treatments
Scaling and Root Planing

This is usually the first (non-surgical) approach to the treatment of periodontal disease. It involves a special cleaning calling scaling and root planing, often referred to as a “deep” cleaning. It is usually use when pocket depths are greater than 3 mm in depth. Scaling and root planing is the removal of tartar and plaque from below your gum line where regular home care cannot reach. Small instruments called scalers and/or ultrasonic cleaners are used to carefully remove the plaque and tartar down to the bottom of the pocket. This is often done with local anesthetic to reduce any discomfort during the procedure. This procedure is done in an effort to help the gums heal and the periodontal pockets to shrink.

Depending on the severity of the disease, the treatments may involve two or more visits that usually last about an hour. During this time, you will also be given instructions on how to care for your teeth and gums at home. We may also recommend medications to help aid in healing, to reduce infection or pain. This may involve a mouthrinse, pills or other medications that are placed directly in the periodontal pocket.

Once scaling and root planing has been completed, a re-evaluation appointment will be scheduled; this is usually 4 to 6 weeks later. At this appointment, we examine your gums for healing and pocket reduction. If further treatment is needed, it will be discussed at this time. A regular cleaning program will also be recommended to help maintain your periodontal health.

Periodontal Maintenance

After completion of your periodontal scaling and root planing and/or gum surgery, the doctor will recommend a regular cleaning schedule called periodontal maintenance therapy. Regular good home care and professional maintenance cleanings are the best way to help maintain a healthy mouth. Studies show that patients who are compliant with their periodontal maintenance care do better than those that do not. The compliant patient is less likely to need further treatments and is less likely to lose teeth.

Patients that have received periodontal treatment often need more frequent cleaning. Often it is recommended that patients get cleanings every three months. This is usually done on an alternating program with your general dentist. This keeps your general dentist on your dental team so they can examine and treat any of your other dental needs.

Maintenance procedures usually are about an hour in length and are similar to a regular cleaning but are designed to clean out any residual pockets that may be present. These procedures may also involve the use of local antibiotic therapy and treatment for root sensitivity. Along with regular professional maintenance, good and regular home care is needed to minimize the re-growth of disease-causing bacteria.

Periodontal Surgical Procedures
Pocket Reduction

This procedure may be indicated if the remaining pockets after scaling and root planing remain too deep to clean with daily home care. The gums should fit snugly around your teeth like a gasket. With gum disease, the bone and tissues around the teeth are destroyed, forming spaces or “pockets” around the teeth. These pockets trap even more tartar and plaque (bacteria), resulting in further inflammation and tissue destruction.

This procedure is done under local anesthetic and can be done with the aid of sedation. With this procedure, the gums are folded back and the disease-causing tartar and bacteria are removed. In some cases, the irregular bony surfaces are smoothed to reduce areas where bacteria can hide. The gums are then closed tight against the teeth. Often times, there is a “band aid” type material called a dressing that is placed over the area to protect the site during healing.

Regeneration

These procedures are designed to reverse some of the damage caused by periodontal disease by regenerating lost bone and tissue. In this procedure, the doctor folds back the tissue and removes the disease-causing bacteria and tartar. Then certain materials are used alone or in combination to promote your body’s regenerative potential. These are typically bone grafts, membranes or stimulating proteins. This procedure helps to eliminate the pockets around the teeth by improving bone support and reducing the pockets from the “bottom up.” This is an attempt to repair the damage that has been done by the disease.

Soft Tissue Grafts

These procedures are designed to stop certain dental problems and gum recession, as well as to improve the esthetics of your gum line. Exposed roots can happen for a variety of reasons. Often they are related to gum disease or aggressive tooth brushing. These areas can be an esthetic concern as well as cause hot and cold sensitivity. During this procedure, gum tissue is taken from your palate or other donor site and placed over the areas of recession. This can be done for one or several teeth. Sometimes a substitute gum tissue can be used rather than taking the graft from a donor site.

Crown Lengthening

Sometimes a tooth needs to have a filling or crown because of disease (decay) or injury (fracture). When the damage extends too far under the gum, this can cause a problem for the restorative dentist. Crown lengthening is often done to expose more of the damaged tooth to allow access for the restorative dentist to repair it. Sometimes crown lengthening is done for esthetic reasons to reduce a “gummy smile” or to even out a gum line that is not pleasing.

These procedures usually involve the removal or repositioning of gum tissue and the removal of bone around the “neck” of the tooth. The gums are then secured in the proper position and allowed to heal. The time needed before the final restoration is placed may vary from 6 weeks to 6 months depending on the situation and final treatment needs.

Socket Preservation

The bone or “socket” that holds the tooth in place is often damaged by disease or infection and will result in jaw deformity when the tooth is extracted. These deformities can cause a significant problem for the replacement of the missing tooth. This can be a concern with any replacement option but is especially true for an implant or bridge. These jaw deformities can be prevented or minimized with socket preservation. Socket preservation can greatly improve your chance of successful implant placement and other restorative treatments.

This procedure involves the extraction of a tooth and the placement of a bone graft material into the socket. Sometimes the graft is covered by a membrane and then the gums are closed over the top. The bone will be allowed to develop for usually four to six months before an implant can be placed or a final bridge done. Usually some form of a temporary replacement is done to maintain function and esthetics during the healing period. Be sure to ask if socket preservation is needed before any tooth is extracted.

Sinus Lift

The upper back teeth have been traditionally harder to replace with implants due to insufficient bone quality and quantity. If you have lost upper back teeth, you may be left with insufficient bone to place implants. Sinus augmentation is designed to help this problem.

In this procedure, the sinus floor is raised by one of several techniques. The most common technique is when an incision is made to expose the bone on the side of the sinus. Then a small circle is cut into the bone and gently lifted into the sinus space, like a trap door. The space created under the “skin” lining of the sinus is filled with a bone graft material. The incision is then closed and allowed to heal. Depending on the individual needs, the healing time will vary from 6 to 12 months. The implants are then placed and allowed to heal. Sometime the implants can be placed at the same time the sinus lift is done.

Although it sounds like a difficult procedure, most patients experience minimal pain and discomfort. This procedure has allowed dentistry to replace teeth with implants where before, this was not an option.

Ridge Augmentation

Defects in the upper or lower jaw can be present that limit the ability to secure implants. These deformities can be the result of periodontal disease, trauma, developmental defects or long-term denture wearing. Ridge augmentation is designed to build up the ridge to allow for implant placement.

There are several ways that this can be done depending on the individual needs. Generally, the gum is lifted away from the ridge to expose the defect. Then a combination of bone graft material, small tack-like pins and a membrane is placed. The incision is closed and allowed to heal. Usually this healing takes place over a period of 6 to 12 months before implants can be placed.

This procedure has been shown to improve the look and placement of dental implants, the end result being better function and esthetics.