PERIODONTAL  DISEASE

Periodontal (gum) disease is a condition in which bacteria attack the tissues that surround and support the teeth. Simply put it is an infection that can result in tooth loss if not treated. Because it is often painless you may not be aware that you have a problem until your gums and bones are seriously affected. The good news is that periodontal diseases often can be treated in the early stages with a treatment called scaling and root planning.

What Causes Periodontal (Gum) Diseases? 

 Plaque is a sticky film of bacteria that clings to the teeth and gums. Even if you brush and clean between your teeth every day, you may not completely remove plaque, especially around the gum line. The bacteria in plaque create toxins that injure the gums and underlying bone. Over time these toxins can destroy gum and bone tissue. Plaque that is not removed completely every 24 to 48 hours hardens into a rough, porous deposit called tartar, or calculus. Once tartar develops the only way to remove it is by having your teeth cleaned at the dental office.

Tartar that builds up below (under) the gum line makes it more difficult to remove the film of plaque. This can lead to chronic inflammation and infection.

If you schedule regular dental checkups , your dentist can detect developing periodontal disease before the gum and the bone supporting your teeth are irreversibly damaged. Periodontal diseases are progressively left untreated, the condition will worsen.

• Gums that bleed easily.
• Red, swollen or tender gum.
• Gums that have pulled away from the teeth.
• Pus between the teeth and gums 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 in the way they bite.
• Any changes in the fit of partial dentures.                                                                        

Diagnosing Periodontal Disease

During a checkup, the dentist examines your gums for periodontal problems. An instrument  called a periodontal probe is used to gently detect "pockets" between your gums and teeth.

Periodontal prove Healthy Gums	Periodontal prove showing pockets

At the very edge of the gum line, gum tissue is not attached to each tooth. Instead there is a very shallow V-Shaped groove called the sulcus between the tooth and the gums. The normal space between teeth and healthy gums should be three millimeters or less. With periodontal diseases , this tiny space develops into a pocket  that collects more plaque bacteria and is more difficult to keep clean.

If gum disease is diagnosed, your dentist may provide treatment, or you may be referred to a periodontist, a dentist who specializes in the diagnosis, prevention and treatment of periodontal diseases. Treating the decease depends on how far the condition has progressed.

                  Healthy gingiva (gum tissue)  and bone anchor teeth firmly in place.                  

Periodontitis is the more advance stage of periodontal disease. At this stage the disease may require more complex treatment to prevent tooth loss. The gums, bone and other structures that support teeth are damaged. Teeth can become loose and fall out or they may have to be removed.

Advanced periodontitis is present when the teeth continue to loose their attachment and the supporting bone is destroyed. Unless treated, the effected teeth frequently become loose and  may fall out or require removal by a dentist.

The first line of defense is prevention. This includes good oral hygiene routine at home and a good diet. Brushing twice or three times a day and cleaning between teeth once a day with floss or an interdental cleaner helps prevent plaque from accumulating. The dental office staff may provide instructions on additional cleaning methods or oral hygiene products to use at home.

Regular dental checkups and cleanings are important in preventing periodontal diseases. If these measures are not taken, the likelihood of disease increases. In some cases even with these measures , a certain percentage of patients experience some form of periodontal disease that must be treated.

When your dentist diagnoses periodontal disease, one of the treatments is scaling and root planning. depending on the extent of the disease, your dentist may recommend that one or more sections (quadrants) of the mouth be treated.  Treatment may require one or more visits.

Scaling is used to remove plaque and tartar beneath the gum line. A local anesthetic may be given to reduce the discomfort. Using a small scaler or ultrasonic cleaner, plaque and tartar are carefully removed down to the bottom of each periodontal pocket. The tooth's root surfaces are then smoothed or planned to allow the gum tissue to heal and reattach to the tooth.

Once the scaling and root planning treatment is complete, another appointment can be made so a dentist can check how your gums have healed and how the periodontal pockets have decreased.  When pockets greater than 3mm after root planning and scaling, additional treatment may be needed.

You'll be given instructions on how to care for your healing teeth and gums. Caring for your teeth and gums after treatment is critical. Practicing good oral hygiene every day will reduce the risk of recurring periodontal disease.

Periodontal disease will not go away by itself. Left untreated, surgery may be needed to save affected teeth. Preventing and treating the disease in the early stages is the best way to keep your smile healthy.

When pockets greater than 3mm after root planning and scaling, additional treatment may be needed:

-Periodontal Surgery: with bone reduction and/or bone grafting for guided tissue regeneration.

-STM: Soft tissue management, including the use of antiseptic and/or antibiotics locally placed inside the pockets.