Periodontal Therapy

What is Gum Disease?

Gum disease is the swelling or soreness of the soft tissue around your teeth.  Generally, it’s caused by the bacteria in plaque, a sticky and colorless film that forms on your teeth.  The plaque bacteria produce toxins that can lead to gingivitis, inflammation of the gums.  That initial stage is reversible.  Over time, if you do not remove the plaque through routine brushing and flossing, it can accumulate and infect your gums, teeth, and bone surrounding the teeth.  This advanced form of gum disease is periodontitis.  If this stage is left untreated, it results to bone and tooth loss.

There are four stages of gum disease:

Stage 1- Gingivitis:  The bacteria from plaque cause gum irritation that leads to inflammation.  The gums appear red, inflamed and swollen.  There is also a chance of some gingival bleeding.

Stage 2- Early Periodontitis: The inflammation progresses into the supporting structures of your teeth.  The minor bone loss can result in a pocket.  Also, your gums continue to bleed.

Stage 3- Moderate Periodontitis:  There is continued inflammation and destruction of the supporting structures of the teeth.  The bone loss now extends between the roots of teeth.  It becomes more noticeable and some tooth movement as well.

Stage 4- Advanced Periodontitis:  This is the most severe form of gum disease.  At this stage bone loss and tooth mobility increases; eventually leading to the loss of one or more teeth.

Diseases like diabetes, blood cell disorders, HIV infections, and AIDS can lower the body’s resistance to bacterial infections within the mouth.  This can place someone at greater risk for more severe forms of periodontal disease.  Smoking is also something that can increase a patients’ risk of developing periodontal disease.

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:

  • Smoking
  • Diabetes
  • Stress
  • Clenching and grinding teeth
  • Medication
  • Poor nutrition

Non-surgical Therapy

Scaling and Root Planing

When deep pockets are present due to periodontitis, a preventive measure needs to be done to prevent further bone loss and better the health of your gums; a scaling and root planing procedure.  This special cleaning involves carefully removing plaque and tartar at the bottom of the periodontal pockets; the deposits underneath the gum line.  The tooth’s root surfaces are then smoothed, in other words planed, to allow the surrounding gum tissue to heal and reattach to the tooth.  The procedure is done with anesthesia to avoid any pain.  Medications might be suggested to ensure that your mouth stays healthy.

After scaling and root planing, the doctor will re-examine your periodontium. Many patients find that this treatment has reduced or eliminated the need for surgery. Almost all periodontal patients need more frequent maintenance cleanings. This is usually done by scheduling visits every three or four months.

Periodontal Maintenance

Once periodontal disease is brought under control with treatment, it is very important to have periodontal maintenance care on a regular basis with our hygienists.  Keeping good oral health at home is a must, but it is not enough to keep periodontal disease in check.  A periodontal maintenance is deeper than a regular cleaning.  This cleaning removes the plaque and tartar that is caused by the accumulation of plaque; the sticky, colorless biofilm that is always forming on your teeth.  The tartar rests on the gumline and it can only be removed through a cleaning.

Patients with a history of periodontal disease need a deeper cleaning because they have deep “pockets”, spaces between the teeth and gums that are prone to trap plaque and tartar.  With routine deep cleanings, the pockets can shrink and the gums can become healthier.  This is a way for patients who have had non-surgical periodontal therapy to ensure their gums stay healthy.

Gum Disease Laser Therapy

The latest conservative gum therapy uses a laser. Using the Biolase Waterlase®, it gently disinfects and evaporates diseased tissues from around the tooth and inside the gum pocket. This treatment interrupts the bacterial destruction of the tissues and bone giving the gum pocket a chance to heal. Systematic repeated visits, generally 2-8, allow the gum pocket to be disease-free and sometimes allow tissues to reattach to the pocket back to a normal or near-normal depth. This new laser therapy is gentle, less painful, has a quick recovery. While surgery may still be indicated for severely advanced periodontal cases, laser therapy is a much more conservative, effective and comfortable option for beginning to moderate periodontal cases.

Medication: Local Delivery of Antibiotics

Systemic antibiotics can reduce the pathogenic bacteria that cause disease in your mouth. Antimicrobials are chemical agents or rinses that you can use at home or that the doctor or hygienist irrigates your pockets with during your office appointment. In some cases, our doctors or hygienists may place slow release antibiotics in the periodontal pockets after scaling and planing.

A medication that is often used is Arestin® (minocycline hydrochloride).  This is an antibiotic that is locally delivered in the gum pockets, underneath the gumline.  Arestin® contains tiny, bead-like particles, called microspheres, which are smaller than grains of sand.  These microspheres slowly release the antibiotic over time, killing bacteria to improve the healing of the gums.  Arestin® is usually placed placed after a scaling and root planning, allowing faster healing, or during a routine periodontal maintenance.

Surgical Therapy

There are a number of benefits to periodontal surgical therapy.  Overall, it is guaranteed to reduce deep periodontal pockets that hold bacteria in the gum tissue.  It also ensure

Osseous Surgery

In the case that the infection within the periodontal pocket, the space between your gums and tooth, has become extensive, surgical periodontal therapy is recommended. It is one of the most effective ways in treating periodontal disease. With osseous surgery, the gum pockets are eliminated.  During the procedure, the infected gum tissue is gently retracted from the tooth and bone, and then it is trimmed.  Uneven bone is recontoured to allow the gum tissue to reattach tightly to the tooth and bone.

Gingival Flap Procedure

When you have advanced periodontitis, it may be necessary to peel back the gums in order to treat underlying infection, referred to as gingival flap surgery.  This includes removing diseased tissue, as well as searching for bone and other malformations that contribute to the gum issues. A gingival flap procedure is normally done after the doctor has tried other periodontal treatments, like a scaling and root planing.  And prior to the procedure you need to maintain good oral hygiene.

Crown Lengthening

If decay or tooth fracture extends below the gum line, there is a chance that the dentist might not be able to properly make a crown or other restoration for the tooth. This is when a crown lengthening is then required.

The procedure involves adjusting the level of the gum tissue and bone around the tooth in question to create a new gum to tooth relationship. This allows the doctor to reach the edge of the restoration, ensuring a proper fit to the tooth. It provides enough tooth structure so the new restoration will not come loose in the future. It also allows you to clean the edge of the restoration when you brush and floss to prevent decay and gum disease.

When the procedure is completed, sutures, and a protective bandage are placed to help secure the new gum-to-tooth relationship. You will need to be seen in 7 days to evaluate your healing.