Periodontal Treatment

 

Diagnosing periodontal disease

What is periodontal disease?

Periodontal disease is an infection of the teeth, gums, and the bone that surrounds the teeth, and it's the leading cause of adult tooth loss. Stopping this condition begins with a thorough diagnosis.

What causes periodontal disease?

The main cause of periodontal disease is the accumulation of plaque, the sticky film of food and bacteria that forms constantly on your teeth.  If plaque isn't removed each day, the bacteria in plaque invade the spaces between the teeth and gums and begin producing toxins. These toxins, combined with your body's reaction to them, destroy the bone around your teeth. And once bone has been lost, it never grows back on its own.  When too much bone is lost, there's so little support for the teeth, they get loose and must be removed.

The warning signs

If you have periodontal disease, you may be experiencing persistant bad breath, bleeding of the gums when brushing or flossing, soft, swollen, or tender gums, gums pulling away from the teeth, or loose teeth. You may also notice inflammation of the gums between the teeth. This is where periodontal disease usually starts.  It is also possible to have no noticeable problems. In fact, most people who have periodontal disease aren't even aware of it.

Diagnosis and treatment

x-rays tell us a lot about periodontal disease. As periodontal disease progresses, x-rays will show that jawbone levels have become uneven, and that bone has receded away from the necks of the teeth.  Once we've found periodontal disease, we'll talk wTo find periodontal disease, we perform a thorough examination with a periodontal probe and x-rays. Periodontal probing measures the depth of the space between your teeth and gums. When you have periodontal disease, these space are called pockets, we measure the pocket from the bottom of the pocket, where its attached to the tooth, to the top of the gums. A probe reading of more than three millimeters is a sign of periodontal disease. In general, the deeper the pockets, the greater the spread of periodontal disease.  Gums sometimes bleed during probing. This is also a sign of infection.ith you about the treatment options and proper homecare to minimize bone loss and restore the health of your gums.

Scaling and root planning

Why do I need scaling and root planning?

The goal of scaling and root planting is to eliminate the source of periodontal infection by removing the plaque, tartar, and bacterial toxins from the root surfaces of the teeth below the gum line.  When you have active periodontal disease, routine cleaning are not enough because they generally remove plaque and tartar from above the gumline only.

The procedure

To keep you comfortable, we usually numb the area before root planning begins.  Using specialized instruments, we carefully and meticulously remove the plaque and tartar around and beneath the gumline, and then smooth the root surfaces. This removes the source of infection and helps your gums heal. As they heal, your gums will tighten around your teeth.

We may schedule scaling and root planning over several appointments. This way we can promote your comfort, check the help, and help you fine-tune your homecare efforts.

Ultrasonic scaling

What is ultrasonic scaling?

Ultrasonic scaling is one of the most effective procedures for treating periodontal disease.  An ultrasonic scaler consists of a wand with a small scalping tip that produces a soft ultrasonic vibration. The small quick vibrations, in combination with a gentle water flow, thoroughly remove tartar, while decreasing the number of destructive bacteria below the gumline.  Removing tartar and bacteria are crucial to controlling periodontal disease.

The benefits of ultrasonic scaling

Ultrasonic scaling has many benefits over using hand scaling alone. These include:

  •       More efficient removal of plaque and tartar

  •       Less need for hand removal of stubborn deposits

  •       Greater comfort for you

 

Homecare for periodontal disease

When you've lost bone due to periodontal disease, it takes new tools and techniques to clean the plaque off of your teeth.  In a healthy mouth the space between the tooth and gums, called the sulcus, is normally two to three millimeters deep. And that's how far below the gums you can effectively clean without a toothbrush and floss. With periodontal disease, the sulcus deepens. It's now greater that three millimeters, and we call it a pocket.

Another problem in periodontal disease has to do with the shape of the tooth roots. If there is no periodontal disease, the bone level is high and the gums attach at the necks of the teeth.  You can wrap floss around this surface and do a thorough job of keeping plaque off your teeth. But in periodontal disease, the attachment shifts and you lose bone. This exposes the root surfaces, which have indentations. Floss stretches across these indentations and can't remove the plaque.

Special cleaning tools

Special tools are necessary to reach down beyond the normal three millimeters to thoroughly clean the indentation in the sides of the roots in a pocket. Each tool is useful in different areas of your mouth.  We'll be happy to work with you to custom tailor a plaque-removal program using these special tools and techniques.

Arestin

As part of our therapy for periodontal disease, we have an effective treatment called arestin that helps us control the infection in your mouth.

How is arestin used?

Arestin is used together with scaling and root planting to significantly reduse the depth of the infected pockets and prevent the progression of the disease.

Arestin is an antibiotic in powder form. After scaling and root planting, we apply the powder to your periodontal pockets, where it combines with moisture in your mouth and adheres immediately to the infected gum tissue.  The individual powder particles release a controlled, steady flow of the active ingredient, minocycline, a potential antibiotic. The medication helps fight your periodontal infection for at least 21 days.

Arestin and periodontal therapy

In certain conditions, arestin may not be the right treatment for you. The active ingredient in arestin is in the tetracycline family, so we don't use it for patients who are allergic to tetracycline, pregnant or nursing, or under the age of eight.  You should also know that arestin is not a cure for periodontal disease. Once bone is lost, no medication will bring it back. For periodontal therapy to be successful, you'll still need to be very thorough with your daily oral hygiene and come see us regularly for exams.

Arestin is an important part of the overall periodontal therapy program that we have designed for you to restore health to your gums.

 

Considering extraction due to periodontitis

When too much bone around a tooth has been lost due to severe periodontal disease (also called periodontitis), sometimes the best treatment is to remove the tooth to maintain the health of your mouth.

Periodontal disease causes bone loss

Teeth are held in place by the height and shape of the jawbone, but then teeth and gums and infected by the bacteria that cause periodontal disease, the disease process begins to destroy the bone that surrounds the teeth.  Left untreated, periodontal disease destroys so much bone that there's not enough support for the teeth. In severe cases, the teeth become very loose and cannot be saved.

Diagnosis and treatment

To determine if an extraction is right for your situation, we'll do a thorough examination, which typically includes x-rays. In advanced gum disease, sometimes called periodontitis, x-rays show us low and uneven bone levels around the teeth. The condition is especially obvious when compared to x-rays of a healthy mouth, in which the bone comes up high around the necks of the teeth.

Many times we can save teeth. Aggressive periodontal therapy, frequent periodontal maintenance appointments in our office, and a consistent home care can halt the progression of periodontal disease and stop the bone loss. Sometimes we also recommend periodontal surgery to save teeth.  However, if your teeth continue to loosen and the destruction persists, our only option will be to remove the affected tooth. It's important to extract a tooth that cannot be saved as soon as possible to prevent the spread of infection.

We often recommend replacing an extracted tooth to preserve remaining jawbone and stabilize your bite, so weÕll talk with you about your replacement options.