What is Periodontal Therapy & Surgery?
Periodontal disease is an infection of the tissues and bone that support your teeth. Your gum tissue is not attached to the teeth as high as it may seem- there is a very shallow v-shaped crevice called a sulcus between the tooth and gums. Periodontal diseases attack just below the gum line in the sulcus, where they cause the attachment of the tooth and its supporting tissues to break down.
As the tissues are damaged, the sulcus develops into a pocket. Generally the more severe the disease, the greater the depth of the pocket, which leads to bone loss around the teeth.
What causes Periodontal Disease?
The sticky film that constantly forms on your teeth is called plaque, and is made mostly of bacteria. Some of these bacteria produce by-products that can irritate the tissues that support your teeth. These by-products can damage the attachment of the gums, periodontal ligament, and bone to your teeth.
You can remove plaque with good oral hygiene-brushing your teeth twice a day and cleaning between them once a day with floss or another interdental cleaner. When plaque is not removed through good oral hygiene, it builds up along the gum line and increases your risk of developing periodontal disease.
Plaque that is not removed regularly can harden into a rough porous deposit called calculus, or tartar. Tartar itself does not seem to cause disease, but it may make it more difficult for you to remove plaque so it should be removed regularly. Tartar only can be removed when your teeth are professionally cleaned in our dental office.
Do some factors increase the risk of developing Periodontal Disease?
Yes, some factors can increase the risk of developing periodontal disease. If one or more of the following apply you, it is especially important that you practice good oral hygiene and follow Dr. Alvarez’ advice to maintain healthy teeth and gums.
- People who smoke or chew tobacco
- Some systemic diseases, such as diabetes, can lower your body’s resistance to infection, making periodontal disease more severe.
- Many medications, such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers, and oral contraceptives can affect the gums. In addition, medications that reduce your salivary flow can result in a chronically dry mouth, which can irritate your oral soft tissues. Let Dr. Nejati know about your medications and update your medical history at the dental office when any changes occur.
- Crowns and Bridges that no longer fit properly, crooked teeth or fillings that have become defective can contribute to plaque retention and increase your risk or developing periodontal disease.
- Pregnancy or use of oral contraceptives increases hormone levels that can cause gum tissue to be more sensitive to the toxins and enzymes produced by plaque and can accelerate growth of some bacteria. The gums are more likely to become red, tender and swollen, and bleed easily.
How would I know if I have Periodontal Disease?
It is possible to have periodontal disease and have no warning signs. That is one reason why regular dental checkups and periodontal examinations are very important. However, several warning signs can signal that you have periodontal disease. If you notice any of the following, see Dr. Alvarez immediately:
- Gums that bleed easily
- Red, swollen, or tender gums
- Gums that have pulled away from the teeth
- Pus between the teeth when the gums are pressed
- Persistent bad breath or bad taste
- Permanent teeth that are loose or separating
- Any changes in the way your teeth fit together when you bite
- Any change in the fit of partial dentures
Types of Periodontal Diseases:
Periodontal diseases are classified according to severity of the disease. The two major stages of the disease are gingivitis and periodontitis.
Gingivitis is a milder and reversible form of periodontal disease that only affects the gums. It develops as toxins in plaque irritates gums, making them red, tender, swollen, and likely to bleed easily. It can usually be eliminated by daily brushing, cleaning between your teeth, and regular dental cleanings.
Gingivitis may lead to more serious, destructive forms of periodontal disease called periodontitis. There are several forms of periodontitis, with the most common being chronic adult periodontitis. Periodontitis occurs when toxins, enzymes, and other plaque by-products destroy the tissues that anchor teeth into the bone. The gum line recedes, which can expose the tooth’s root. Exposed roots can become susceptible to decay and sensitive to cold and touch.
As we mentioned earlier, the sulcus deepens into a pocket in the early stage of periodontal disease. Plaque that collects in these pockets can be difficult to remove during regular brushing and interdental cleaning. By-products from the plaque that collects in these pockets can continue to damage the gums, periodontal ligament, and bone. In some cases, so much ligament and bone are destroyed that the tooth becomes loose. Usually, Dr. Alvarez can still treat the disease at this point. In the worst of cases, a loose tooth may need to be extracted.
How Can I prevent Periodontal Diseases?
Daily good oral hygiene can help reduce your risk of developing periodontal diseases. Proper daily hygiene involves brushing your teeth twice a day and flossing at least once a day. With proper brushing, you can remove plaque from the inner, outer and chewing surfaces of each tooth. Dr. Alvarez can show you the proper brushing technique. Using a fluoride-containing toothpaste also will help protect your teeth against cavities. Carefully clean between your teeth once a day with dental floss or another interdental cleaner to remove plaque from areas your toothbrush can’t reach. It only takes a few minutes each day and is just as important in maintaining oral health as brushing your teeth. If you need extra help controlling gingivitis and plaque that forms above the gum line, Dr. Alvarez may recommend using an ADA- accepted antimicrobial mouth rinse or other oral hygiene aids as an effective addition to your daily oral hygiene routine. When choosing dental care products, look for those that display the American Dental Association’s seal of Acceptance-your assurance that they have the ADA standards of safety and effectiveness.
Checking for Periodontal Diseases:
During your checkups, Dr. Alvarez will examine your gums. This is called a periodontal examination. An instrument called a periodontal probe gently measures the depth of the sulcus surrounding each tooth. The healthy sulcus depth is usually three millimeters or less.
Periodontal diseases cause the sulcus (the shallow v-shaped crevice between your teeth and gums) to deepen into a pocket. A periodontal probe can determine whether you have developed any pockets and the depth of those pockets. Generally, the more severe the disease, the deeper the pocket.
Dental x-rays, or radiographs, also may be taken to evaluate the amount of bone supporting the teeth and to detect other problems not visible during the clinical examination. If periodontal disease is diagnosed, Dr. Alvarez will provide treatment or may need to refer you to a periodontist, a dentist who specialized in the treatment of periodontal disease.
How are Periodontal Diseases treated?
Treatment methods depend upon the type of disease and how far the condition has progressed. The first step usually is a thorough deep cleaning that includes scaling to remove plaque and tartar deposits. The tooth roots also may be planned to smooth the root surface, allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion, or bite, may require adjustment.
Dr. Alvarez may also recommend local delivery of antibiotics to help control infection, pain, and to promote healing. This medication is placed directly in the periodontal pocket after scaling and root planning.
Is surgery sometimes needed?
When very deep pockets between teeth and gums are present, it is difficult to thoroughly remove the plaque and tartar even with dental instruments. Likewise, you may have trouble keeping these pockets clean.
If the pockets do no heal after scaling and root planning, periodontal surgery may be needed. One of the goals of periodontal surgery is to reduce the depth of the periodontal pockets to make them easier to keep clean.
With surgery, we can access hard to reach areas that require the removal of tartar and plaque. The tooth root is cleaned and smoothed. Sometimes the bone around the tooth also is smoothed to help remove these pockets. The gums then are sutured back into place or into a new position that will be easier to keep clean at home.
Bone surgery may be used to rebuild or reshape bone that has been destroyed. Grafts of the patient’s bone or artificial bone may be used, as well as special membranes. Splints, bite guards, or other appliances are used to stabilize loose teeth and to aid the regeneration of tissue during healing. If excessive gum tissue has been lost from the tooth root (gum recession), a gum graft may be performed. After surgery, a protective dressing over teeth and gums is usually applied. An antibiotic and mild pain reliever may be prescribed.
How do I prevent periodontal disease from recurring?
Good oral hygiene at home is essential to help keep periodontal disease from becoming more serious or recurring. Dr. Alvarez also will want to see you at regular intervals. You may need to schedule more frequent visits then you have in the past. You don’t have to loose teeth to periodontal disease. Brush, clean between your teeth, eat a balanced diet, and schedule regular dental visits for a lifetime of healthy smiles.