Periodontal Therapy

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Periodontal Care

Periodontal treatment is necessary when various conditions affect the health of your gums and the regions of your jawbone which hold your teeth in place. Retaining your teeth is directly dependent on proper periodontal care and maintenance. Healthy gums enhance the appearance of your teeth, like a frame around a beautiful painting. When your gums become unhealthy, they can either recede or become swollen and red. In later stages, the supporting bone is destroyed and your teeth will shift, loosen, or fall out. These changes not only affect your ability to chew and speak; they also spoil your smile.

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Periodontal Disease

Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Bacteria found in plaque produce toxins or poisons, which irritate the gums. They may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. Plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss. However, don’t be fooled. With periodontal disease, bleeding, redness and swelling do not have to be present. Further, pain is usually not associated with periodontal disease. This disease damages the teeth, gum and jawbone of more than 80% of Americans by age 45.

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Preventing Gum Disease

Adults past the age of 35 lose more teeth to gum diseases than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and Periodontal Diseases is by good tooth brushing and flossing techniques, performed daily, and regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.

Other important factors affecting the health of your gums include:

• Tobacco Usage
• Diabetes
• Stress
• Clenching and grinding teeth
• Medication
• Poor nutrition

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Periodontal Disease and Tobacco

You are probably familiar with the links between tobacco use and lung disease, cancer and heart disease.

Current studies have now linked periodontal disease with tobacco usage. These cases may be even more severe than those of non-users of tobacco. There is a greater incidence of calculus formation on teeth, deeper pockets between gums and teeth as well as greater loss of the bone and fibers that hold teeth in your mouth. In addition, your chance of developing oral cancer increases with the use of smokeless tobacco.

Chemicals in tobacco such as nicotine and tar, slow down healing and the predictability of success following periodontal treatment.

Problems caused by tobacco include:

Lung disease, heart disease, cancer, mouth sores, gum recession, loss of bone and teeth, bad breath, tooth staining, less success with periodontal treatment and with dental implants.

Quitting tobacco will reduce the chance of developing the above problems.

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Diabetes and Oral Health

Individuals suffering from diabetes, especially uncontrolled diabetics, have a higher risk of developing bacterial infections of the mouth. These infections may impair your ability to process insulin, resulting in greater difficulty with controlling your diabetes. Periodontal diseases will be more severe than those of a non-diabetic and treatment more difficult. However, well-controlled diabetics have a lower incidence of cavities.

Steps to prevent periodontal disease include daily brushing and flossing to remove plaque from your teeth and gums, regular dental visits for professional cleaning and regular periodontal evaluation. Your health professional must also be told of your history and the current status of your condition. And finally, you can help resist periodontal infection by maintaining control of your blood sugar levels.

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Women and Periodontal Health

Throughout a woman’s life, hormonal changes affect tissue throughout the body.

Fluctuations in levels occur during puberty, pregnancy and menopause. At these times, the chance of periodontal disease may increase, requiring special care of your oral health.

Puberty

During puberty, there is increased production of sex hormones. These higher levels increase gum sensitivity and lead to greater irritations from plaque and food particles. The gums can become swollen, turn red and feel tender.

Menstruation

Similar symptoms occasionally appear several days before menstruation. There can be bleeding of the gums, bright red swelling between the teeth and gum, or sores on the inside of the cheek. The symptoms clear up once the period has started. As the amount of sex hormones decrease, so do these problems.

Pregnancy

Your gums and teeth are also affected during pregnancy. Between the second and eighth month, your gums may also swell, bleed and become red or tender. Large lumps may appear as a reaction to local irritants. However, these growths are generally painless and not cancerous. They may require professional removal, but usually disappear after pregnancy.

Periodontal health should be part of your prenatal care. Any infections during pregnancy, including periodontal infections, can place a baby’s health at risk.

The best way to prevent periodontic infections is to begin with healthy gums and continue to maintain your oral health with proper home care and careful periodontic monitoring.

Oral contraceptives

Swelling, bleeding and tenderness of the gums may also occur when you are taking oral contraceptives, which are synthetic hormones.

You must mention any prescriptions you are taking, including oral contraceptives, prior to medical or dental treatment. This will help eliminate risk of drug interactions, such as antibiotics with oral contraceptives – where the effectiveness of the contraceptive can be lessened.

Menopause

Changes in the look and feel of your mouth may occur if you are menopausal or post-menopausal. They include feeling pain and burning in your gum tissue and salty, peppery or sour tastes.

Careful oral hygiene at home and professional cleaning may relieve these symptoms. There are also saliva substitutes to treat the effects of “dry mouth.”

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Treatment Methods

There are a variety of surgical services. We pride ourselves on the fact that we are very conservative in our treatment recommendations and limit surgery to the areas where it is absolutely necessary.

Many times, the early stages of periodontal disease are best treated with non-surgical periodontal therapy. Even in severe cases, non-surgical periodontal therapy often precedes surgical therapy. This is done to improve the overall tissue quality prior to surgery and also to help limit the areas requiring surgery.

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Scaling and Root Planing

The initial stage of treatment is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line.

The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.

Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, dentist may place antibiotic fibers in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.

When deep pockets between teeth and gums are present, it is difficult for dentist to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.

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Bite Adjustment

A bite is considered to be healthy when all or most of the teeth are present and not destroyed by normal daily usage.

It is destructive when teeth show wear, looseness or when TMJ (jaw joint) damage is seen. Bite therapy helps restore a bite that can function without damage and destruction. The therapy may include:

Reshaping the biting surfaces of the teeth and eliminating spots of excessive pressures where the teeth are brought into contact. This is done by carefully dividing bite pressures evenly across all of the teeth.

Bite splint therapy using a custom fitted and adjusted plastic bite guard to keep the teeth apart, day, night or both.

• Braces, to reposition mal-aligned or drifted teeth.
• Replacement of old, worn out or damaged fillings.
• Reconstruction of badly worn and damaged teeth

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Cosmetic Periodontal Surgery

These procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of periodontal and cosmetic procedures.

Although your teeth appear short, they may actually be the proper length. The teeth may be covered with too much gum tissue. We can correct this by performing the periodontal plastic surgery procedure, crown lengthening.

During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to more than one tooth, to even your gum line, and to create a beautiful smile.

Another cosmetic procedure is the soft tissue graft. It is used to cover unattractive tooth roots, reduce gum recession and protect the roots from decay and eventual loss.

Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw, an appearance of a general aging. The original look of your mouth may not be recaptured because of spaces remaining under and between replacement teeth. They may appear too long compared to nearby teeth.

Bone grafting following tooth loss can preserve the socket/ridge and minimize gum and bone collapse. There is less shrinkage and a more esthetic tooth replacement for either an implant crown or fixed bridge around the replacement teeth.

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