To provide you with a better understanding of periodontics, we have provided the following multimedia presentation. Many common questions pertaining to periodontics are discussed.
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Dolson Avenue Dental provides a variety of services for the treatment of periodontal issues. 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.
A dental prophylaxis is a cleaning treatment performed to thoroughly clean the teeth and gums. Prophylaxis is an important dental treatment for stopping the progression of gingivitis and periodontal disease.
Prophylaxis is an effective procedure in keeping the oral cavity in proper health and halting the progression of gum disease. The benefits include:
Prophylaxis can be performed at our office by our hygienists, periodontist or your general dentist. It may be beneficial to have your regular cleanings done by our hygienists, periodontist or general dentist, who are more familiar with the full scope of your periodontal disease. We recommend that prophylaxis be performed twice annually as a preventative measure, but should be completed every 3-4 months for periodontitis sufferers. It should be noted that gum disease cannot be completely reversed, but prophylaxis is one of the tools our hygienists, periodontist or general dentist can use to effectively halt its progress.
The initial stage of treatment for periodontal disease is usually a thorough cleaning that may include scaling or root planing. The objective of these non-surgical procedures is to remove etiologic agents such as dental plaque and tartar, or calculus, which cause gingival inflammation and disease. Scaling and root planing can be used as a stand-alone treatment, or a preventative measure. They are commonly preformed on cases of gingivitis and moderate to severe periodontal disease.
What do the procedures entail?
Our hygienists, periodontist or general dentist will only perform scaling and root planing after a thorough examination of the mouth, which may include taking X-rays and visually examining the mouth. Depending on the condition of the gums, the amount of tartar present, the depth of the pockets, and the progression of periodontitis, our hygienists, periodontist or general dentist may recommend scaling and root planing. In some cases, a local anesthesia may be used during the procedure.
When scaling is performed, calculus and plaque that attaches to the tooth surfaces is removed. The process especially targets the area below the gum line, along the root. Scaling is performed with a special dental tool called an ultrasonic scaling tool. The scaling tool usually includes an irrigation process that can be used to deliver an antimicrobial agent below the gums to help reduce oral bacteria.
Root planing is performed in order to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed, which promotes healing, and also helps prevent bacteria from easily colonizing in the future.
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, our hygienists, periodontist or general 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 our hygienists, periodontist or general 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.
Benefits of Treatment
If treatment is successful, scaling and planing may have many periodontal benefits. One is that it can help prevent disease. Research has proven that bacteria from periodontal infections can travel through the blood stream and affect other areas of the body, sometimes causing heart and respiratory diseases. Scaling and root planing removes bacteria that causes these conditions.
Another benefit of treatment is protecting teeth against tooth loss. When gum pockets exceed 3mm in depth, the risk for periodontal disease increases. As pockets deepen, more bacteria are able to colonize, eventually causing a chronic inflammatory response by the body to destroy gingival and bone tissue. This leads to tooth loss.
Finally, scaling and root planing may make the mouth more aesthetically pleasing, and should reduce bad breath caused from food particles and bacteria in the oral cavity. Superficial stains on the teeth will be removed during scaling and planing, adding an extra bonus to the procedures.
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:
Osseous surgery, sometimes referred to as pocket reduction surgery or gingivectomy, refers to a number of different surgeries aimed at gaining access to the tooth roots to remove tartar and disease-causing bacteria.
Goals of Osseous Surgery
Osseous Surgery is used to reshape deformities and remove pockets in the alveolar bone surrounding the teeth. It is a common necessity in effective treatment of more advanced periodontal diseases. The ultimate goal of osseous surgery is to reduce or eliminate the periodontal pockets that cause periodontal disease. Despite the word “surgery” the procedure is reported to feel more like a thorough cleaning. The specific goals of surgery include:
Reducing Bacterial Spread:
Bacteria from the mouth can spread throughout the body and cause other life-threatening conditions such as heart disease and respiratory disease. Removing deep tartar and thereby bacteria can help reduce the risk of bacteria spreading.
Preventing Bone Loss:
The immune system’s inflammatory response prompted by periodontal bacteria can lead to bone loss in the jaw region, and cause teeth to fall out. Osseous surgery seeks to stop periodontal disease before it progresses to this level.
Enhancing the Smile:
Mouths plagued with periodontal disease are often unsightly. Brown gums, rotting teeth, and ridge indentations can leave a person feeling depressed and too self-conscious to smile. Fortunately, osseous surgery can help reduce bacteria and disease and thereby restore your mouth to its former radiance, while restoring confidence at the same time.
Facilitating Home Care:
As the gum pocket become deepens, it can become nearly impossible to brush and floss adequately. Osseous surgery reduces pocket size, making it easier to brush and floss, and thereby prevent further periodontal disease.
What does the procedure entail?
A local anesthetic will be used to numb the area prior to surgery. First, our hygienists, periodontist or general dentist will cut around each tooth of the affected area to release the gum tissue from the bone. This allows access to the bone and roots of the teeth. After the roots have been thoroughly cleaned through scaling, a drill and hand tools will be used to reshape the bone around the teeth. Bone is removed in some areas to restore the normal rise and fall of the bone, but at a lower level. Bone grafting may also be necessary to fill in large defects.
Next, the gums will be placed back over the remaining bone and suture them in place. The site will also be covered with a bandage (periodontal pack) or dressing. Pain medicine and mouth rinses containing chlorhexidine are generally prescribed following the surgery.
Do not be alarmed if bleeding and swelling occur after the surgery. This can be controlled easily by placing an ice pack on the outside of the affected area. In cases where the bleeding and swelling is in excess, it is advised that you call to notify our office. Several follow up visits may be necessary and you must fulfill a meticulous maintenance program especially during the initial phases of healing to avoid post-operative infection.
When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem, gum reconstruction using grafting techniques is an option.
When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost.
In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance of the gum and tooth. When significant, gum recession can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging.
A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth or gently moved over from adjacent areas to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root.
The gingival graft procedure is highly predictable and results in a stable, healthy band of attached tissue around the tooth.
A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower). It connects the inner aspect of the lip with the gum. A lack of attached gingiva, in conjunction with a high (closer to the biting surface) frenum attachment, which exaggerates the pull on the gum margin, can result in recession. Additionally, an excessively large frenum can prevent the teeth from coming together resulting in a gap between the front teeth. If pulling is seen or the frenum is too large to allow the teeth to come together, the frenum is surgically released from the gum with a frenectomy. A frenectomy is simply the surgical removal of a frenum.
When Orthodontic treatment is planned or initiated, the removal of an abnormal frenum, with or without a gingival graft, can increase stability and improve success of the final orthodontic result.
Crown lengthening is usually performed to improve the health of the gum tissue, prepare the mouth for a procedure, or correct a “gummy smile”. A “gummy smile” is used to describe an instance where teeth are covered with excess gum tissue resulting in a less esthetically-pleasing smile. The procedure involves reshaping or recontouring the gum tissue and bone around the tooth in question to create a new gum-to–tooth relationship. Crown lengthening can be performed on a single tooth, many teeth or the entire gum line.
Crown lengthening is often required when your tooth needs a new crown or other restoration. The edge of that restoration is deep below the gum tissue and not immediately accessible. It is also usually too close to the bone or below the bone.
Crown lengthening allows us to reach the edge of the restoration, ensuring a proper fit to the tooth. It should also provide enough tooth structure so the new restoration will not come loose in the future. This allows you to clean the edge of the restoration when you brush and floss to prevent decay and gum disease.
Crown lengthening takes approximately one hour but will largely depend on the amount of teeth involved and if any amount of bone will need to be removed. The procedure is usually performed under local anesthetic and involves a series of small incisions around the tissue to separate the gums from the teeth. Even if only one tooth requires the procedure, it will probably be necessary to adjust the surrounding teeth to enable a more even reshaping. In some cases, extraction of a small amount of bone will be necessary as well.
When the periodontist or general dentist is satisfied that the teeth have sufficient exposure and the procedure is completed, the incisions will be cleaned with sterile water. Sutures and a protective bandage are then placed to help secure the new gum-to-tooth relationship. Your teeth will look noticeably longer immediately after surgery because the gums have now been repositioned. You will need to be seen in one or two weeks to remove the sutures and evaluate your healing. The surgical site should be completely healed in approximately two to three months following the procedure.
Over a period of time, the jawbone associated with missing teeth atrophies, or is reabsorbed. Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implant of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
What is Bone Grafting?
Over a period of time, the jawbone associated with missing teeth atrophies is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
With bone grafting, we now have the opportunity to not only replace bone where it is missing, but also the ability to promote new bone growth in that location! This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. There are numerous disease entities requiring different treatment approaches. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Daily brushing and flossing will prevent most periodontal conditions.
Why is oral hygiene so important?
Adults over 35 lose more teeth to gum diseases, (periodontal disease) than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal disease is by good tooth brushing and flossing techniques, performed daily.
Periodontal disease and decay are both caused by bacterial plaque. Plaque is a colorless film, which sticks to your teeth at the gum line. Plaque constantly forms on your teeth. By thorough daily brushing and flossing you can remove these germs and help prevent periodontal disease.
Periodontal diseases can be accelerated by a number of different factors. However, it is mainly caused by the bacteria found in dental plaque, a sticky colorless film that constantly forms on your teeth. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar).
Bacteria found in plaque produces toxins or poisons that irritate the gums, which 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. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.
Preventing Gum Disease
The best way to prevent gum disease is effective daily brushing and flossing as well as 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: