Periodontal Disease is the term used for a group of diseases ranging from gingivitis to periodontitis. The cause of this disease is the bacteria in dental plaque. If plaque, a colorless sticky film that covers the teeth, is not removed daily with brushing and flossing, the bacteria will cause the gum tissue to become red and swollen. This first stage, gingivitis, can and may be reversed by visiting your dentist and hygienist along with your efforts at brushing and flossing.
If left untreated, however, the bacteria will continue to multiply and change over time. The tissue around the teeth will form pockets of infection and the bacteria will produce toxins. The disease has now progressed from gingivitis to periodontitis, the destructive form of the disease. Like any other infection, your body’s immune system will work to fight off the infection. In an effort to eliminate the infection, the bone and soft tissue that support the teeth will be destroyed. This may result in loss of teeth. Periodontitis is considered a chronic inflammatory infection. Without treatment and continued management of this disease, your body is unable to fight off the infection.
It is important to note that there are several risk factors for periodontitis such as age, stress, family history, smoking and certain systemic diseases, to name a few. Although gums that bleed are a sign of periodontal disease, sometimes there is actually no bleeding at all. Periodontal disease rarely causes pain until the later stages of the disease. For these reasons, it is extremely important to have a complete periodontal examination on a yearly basis by your dentist or periodontist.
Of great concern is the connection between periodontitis and other systemic diseases. It appears the link is chronic inflammation which is also associated with diabetes, cardiovascular disease, respiratory diseases and certain cancers. This is a new area of study called Oral Medicine. Click here to learn more.
Scaling and Root Planning
For some patients, the early stages of periodontal disease may be treated with a procedure called Scaling and Root Planning. The first step of this procedure is accomplished by placing a fine ultrasonic tip between the tooth and tissue, in the periodontal pocket, to remove plaque, calculus and lower the numbers of bacteria. This is followed by the use of specifically shaped instruments designed to clean the root and remove any remaining bacteria. A smooth clean root surface allows the tissue to reattach. In about 4 weeks, periodontal pockets may be reduced or eliminated when the tissue reattaches and the swelling is reduced. With good oral health care techniques and shallow periodontal pockets, patients can, in many cases, maintain these areas.
Scaling and Root Planning procedures are typically done in a series of appointments. Depending on the level of disease, one to four appointments may be necessary, followed by a re-evaluation appointment of the treated areas about 4 weeks later. Local anesthesia may be used during Scaling and Root Planning for your comfort. Post treatment discomfort is minimal, and this procedure, generally, does not interrupt your normal, daily routine.
There are limitations to what Scaling and Root Planning can accomplish. Research has shown that in deeper pockets (6mm or greater) the less effective this procedure will be at removing the plaque and calculus. Also, posterior (back) teeth, due to their location in the mouth and the fact they have more than one root, are more difficult to root plane. In more severe cases, this procedure is recommended prior to surgery to improve overall tissue quality and perhaps limit the areas requiring surgery.
Our practice provides a variety of surgical services. Our periodontists go to great lengths to be gentle in their treatment and limit surgery to only the areas where it is absolutely necessary. Our patients report being comfortable during surgery and most have very little discomfort after surgery, with minimal or no pain medication needed.
Occasionally, periodontal bone and gum destruction has occurred in such a way that regeneration of this lost bone and gum tissue is possible. This treatment helps to reverse the effects of periodontal disease, restoring the tissue closer to how it was originally.
Pocket Reduction Surgery
Pocket reduction surgery is the next step in the continuum of periodontal disease treatment. Although not a necessary step for everyone undergoing periodontal disease treatment, this procedure is needed by most people in order to stabilize their periodontal disease.
There are two main goals for this procedure:
- To gain access to the bacteria and infection located deep below the gums
- To gain access to the underlying bone, smoothing the uneven bone contours which contribute to periodontal disease development and recurrence
This procedure starts with getting the patient comfortable with sedation (oral or intravenous), if desired, followed by administration of a local anesthetic (Novocaine). The gum tissue is gently separated back from the underlying tooth roots and bone. The root surfaces are thoroughly cleansed of the disease-causing bacteria. The attention is then turned to evening out the bone contours around the teeth, limiting the areas where infection causing bacteria can hide. The gum tissue is then secured in place with sutures that dissolve on their own.
The patient is then sent home with thorough instructions on taking care of the surgical areas and medications which help keep them comfortable. Post-operative appointments are typically scheduled 1-2 weeks after the surgery, followed by a second post-operative appointment 2-3 weeks after the first.
At Periodontal Specialists, we strive to make our patients as comfortable as possible during their procedures. In order to accomplish this goal, we offer relaxing medications for use before and during the procedures. These medications are offered in two forms: oral or intravenous (IV). The oral medication is administered in our office, one hour prior to the procedure’s start. This allows the medicine time to take effect prior to beginning the procedure. The IV form of medication is a stronger form of sedation, typically allowing for minimal recollection of the procedure. With either form of sedation, you will be well monitored by the periodontist and staff to assure the highest level of comfort and safety.