Periodontal Dentistry

Periodontal means around the tooth. Periodontal disease attacks the supporting gums and bone around the teeth. Plaque is the first to form and it is a sticky film consisting of food particles, bacteria and saliva. If plaque is not removed it calcifies and turns in to calculus (tartar) build up. When plaque and calculus are not removed form the teeth they start to destroy the gum and bone.

Periodontal disease is not only the number one cause of tooth loss it is also linked to a number of systemic diseases. Research suggests the there may be a link between periodontal disease and cardiovascular disease, diabetes, increased risk for pre term babies, strokes, and bacterial pneumonia. Researchers are looking into the links that associate the inflammation and bacteria associated with periodontal disease to these systemic diseases and conditions. Smoking also increases the risk of periodontal disease.

Some signs and symptoms of periodontal disease are bleeding gums, loose teeth, new spacing between teeth, constant bad breath, pus coming from gums, red and swollen gums, receding gums, and tenderness of the gums.

What is Periodontal (Gum) Disease?

Periodontal disease is an inflammation and infection of the gums and bone that support the teeth.

It is estimated that 61% of adults 25 and older and 86% of adults 45 years and older have at least one site of periodontal disease in their mouths. Gum disease (Periodontal disease) is one of the leading causes of tooth loss.

Recent research shows that periodontal disease affects the general health of a person. The same bacteria found in the mouth and the inflammation they cause have been linked to diabetes, heart disease, stroke, low birth-weight babies, and even arthritis and other immune system related disorders. With the new research now more than ever our concern is not just for your teeth but for your over all health.

The word periodontal means around the tooth. Therefore it means that periodontal disease is an infection and inflammation of the supporting structures around the teeth.

Warning signs of periodontal disease include:

• Bleeding gums
• Red, swollen or tender gums
• Gums that have receded or pulled away from the teeth
• Bad breath or a bad taste in the mouth
• Teeth that appear to be shifting or loose
• Changes in your bite

Periodontal disease is also known as the silent disease because a person may have periodontal disease without noticing any of these symptoms. Bone may be quietly eroding without producing noticeable changes until it is to late. That is why regular dental evaluations are so important.

Diagnosis

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination. During this examination measurements are taken around each tooth to detect bone loss and inflammation. This exam should be done at every dental re-care appointment. A healthy measurement is 3mm or less with no bleeding. A periodontal probe helps to determine if the pockets are greater than 3mm. As periodontal disease progresses the pockets usually get larger.

Your dentist or dental hygienist will use the measurements depths, amount of bleeding, inflammation, recession and tooth mobility to put you into one of these categories.

Healthy

Healthy which means no bleeding while probing, probe readings 3mm or less and no evident bone loss on the x-rays.

Gingivitis

Gingivitis one of the first stages of periodontal disease plaque and its bacteria toxins irritate the gums making them red, tender, inflamed and bleeding.

Periodontitis

Periodontitis the plaque hardens into calculus build up. As calculus and plaque continue to build up, the gums begin to recede from the teeth. The pockets become deeper between the gums and the teeth and fill with bacteria and pus. The gums become very inflamed, irritated and bleed easily. Slight to moderate bone loss may be present.

Advanced Periodontitis

With advanced periodontitis the teeth lose more bone support as the gum, bone and periodontal ligament continue to be destroyed. With out treatment the teeth will be come very loose and may be lost. Generalized moderate to severe bone loss may be detected.

 

 

Treatment

Your dentist and dental hygienist will set up a plan just for you. Periodontal treatment methods depend upon the type and severity of the disease. Periodontal disease progresses as the pocket between the tooth and the gums fill with bacteria, plaque and tarter causing the tissue around the tooth to become irritated. When the irritants remain in the pockets they cause damage to the gum and eventually the supporting bone.

If the disease is caught in the early stage of gingivitis, and no damage has been done to the bone one or two regular cleanings may be recommended. Also your dentist and dental hygienist will give you tips and tools to help you improve your home care and regular cleanings will be very important.

If the disease has progressed to more advanced stages a periodontal cleaning called scaling and root planning (deep cleaning) will be recommended. It is usually done in sections with the area being numb so that we can clean deep under the gums. During this procedure plaque, calculus and toxins are removed from above and below the gums and rough surfaces of the root are smoothed. This allows for the gum tissues to heal and shrink.

Your dentist and dental hygienist may also recommended fighting the infection with a locally administered antibiotic. Periodontal disease is a chronic bacterial infection and, as with any infection, treatment with an antibiotic is common. Dental professionals often add a locally administered antibiotic directly to the site of infection where bacteria hide.

For home care a special medicated mouth rinse is recommended and also an electric tooth brush to help control infection and healing.

If the pockets do not heal after scaling and root planing your dentist may recommended you to see a periodontist for periodontal surgery options to reduce the pockets so that you can keep them clean.

Maintenance

Once you have completed your periodontal cleanings your dentist and dental hygienist will recommend a maintenance cleaning schedule for you (usually four times a year). At each appointment the pocket depths will be checked to ensure that things are healthy. The plaque and calculus that builds up in the hard to reach pockets will be removed from above and below the gums.

In addition to your periodontal maintenance cleaning your visits will include:

• An update of your medical and dental history
• X-ray review
• Oral Cancer screening
• Tooth examination by the dentist
• Gum and bone examination
• Review of home care
• Scaling and root planning, as needed
• Polishing the teeth
• Gums and pockets irrigated with medicine or antibiotics

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control. As in many other chronic conditions, successful long-term control of the disease and prevention of tooth loss depends on continual, and possibly lifetime maintenance.