periodontics
Non-Surgical Treatment Methods
Osseous Surgery - Pocket Depth Reduction
Periodontal Surgery - Soft Tissue Grafts
Guided Tissue Bone Regeneration
Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Bacteria found in plaque produce toxins or poisons, which irritate the gums. They 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. Plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line. As periodontal disease progresses, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss. Periodontal disease is sometimes hard to recognize because there is often no pain, and may not be any bleeding, redness or swelling. However, this disease damages the teeth, gum and jawbone of more than 80% of population by age 45.
Diagnosis
Sometimes the only way to detect periodontal disease is through a periodontal evaluation. This may be especially important in the following situations:
If you notice any symptoms of periodontal disease, including:
gums that bleed easily, such as during brushing or flossing
red, swollen or tender gums
gums that have pulled away from the teeth
persistent bad breath
pus between the teeth and gums
loose or separating teeth
a change in the way your teeth fit together when you bite
If you have a family member with periodontal disease. Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.
If you have heart disease, diabetes, respiratory disease or osteoporosis. Ongoing research is showing that periodontal disease may be linked to these conditions. The bacteria associated with periodontal disease can travel into the blood stream and pose a threat to other parts of the body. Healthy gums may lead to a healthier body.
If you feel that your teeth are too short or that your smile is too "gummy." Or, if you are missing one or more of your teeth and are interested in a long-lasting replacement option.
If you are not satisfied with your current tooth replacement option, such as a bridge or dentures, and may be interested in dental implants.
If you have a sore or irritation in your mouth that does not get better within two weeks.
Adults over the age of 35 lose more teeth to gum diseases than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal diseases is by daily thorough tooth brushing and flossing techniques and regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once the disease starts, professional intervention is necessary to prevent its progress.
Other important factors affecting the health of your gums include:
Tobacco usage
Diabetes and other health problems
Stress
Clenching and grinding teeth (bruxism)
Medication side effects
Poor nutrition
Periodontal Disease & Tobacco
You are probably familiar with the links between tobacco use and lung disease, cancer and heart disease.
Current studies have now linked periodontal disease with tobacco usage. These cases are often more severe than those of non-users of tobacco. There is a greater incidence of calculus formation on teeth, deeper pockets between gums and teeth as well as greater loss of the bone and fibers that hold teeth in your mouth. In addition, your chance of developing oral cancer increases with the use of tobacco products.
Chemicals in tobacco such as nicotine and tar slow down healing and the predictability of success following periodontal treatment.
Problems caused by tobacco include: Lung disease, heart disease, cancer, mouth sores, gum recession, loss of bone and teeth, bad breath, tooth staining, less success with periodontal treatment, and with dental implants.
Quitting tobacco will reduce the chance of developing the above problems. Quitting tobacco will make the treatment and control of Periodontal Disease more successful.
Diabetes and Oral Health
Individuals suffering from diabetes, especially uncontrolled diabetics, have a higher risk of developing bacterial infections of the mouth. These infections may impair your ability to process insulin, resulting in greater difficulty with controlling your diabetes. Periodontal diseases will be more severe than those of a non-diabetic and treatment more difficult. However, well-controlled diabetics have a lower incidence of problems.
Steps to prevent periodontal disease include daily brushing and flossing to remove plaque from your teeth and gums, regular dental visits for professional cleanings, and regular periodontal evaluation. Your dentist must also be told of your history and the current status of your condition. And finally, you can help resist periodontal infection by maintaining control of your blood sugar levels.
Periodontal Disease and Cardiovascular Disease
Almost half of all adults have some form of periodontal disease. A large majority of these people have the "silent disease" and do not realize they have a problem Periodontal disease can affect people with cardiovascular disease due to the harmful bacteria in sites around the teeth. These harmful bacteria and inflammatory mediators that they cause can contribute to clogging blood vessels that supply the heart and other vital structures. Recent evidence suggests that people with periodontal disease may have twice the risk of having a heart attack then those without periodontal disease.
Women & Periodontal Health
Throughout a woman's life, hormonal changes affect tissue throughout the body. Fluctuations in levels occur during puberty, pregnancy and menopause. At these times, the chance of periodontal disease may increase, requiring special care of your oral health.
Puberty
During puberty, there is increased production of sex hormones. These higher levels increase gum sensitivity and lead to greater irritations from plaque and food particles. The gums can become swollen, turn red and feel tender.
Menstruation
Similar symptoms occasionally appear several days before menstruation. There can be bleeding of the gums, bright red swelling between the teeth and gums, or sores on the inside of the cheek. The symptoms clear up once the period has started. As the amount of sex hormones decrease, so do these problems.
Pregnancy
Your gums and teeth are also affected during pregenancy. Between the second and eighth month, your gums may also swell, bleed and become red or tender. Large lumps may appear as a reaction to local irritants. However, these growths are generally painless and not cancerous. They may require professional removal, but usual disappear after pregnancy.
"Between the second and eighth month, your gums may also swell, bleed and become red or tender."
Periodontal health should be part of your prenatal care. Any infections during pregnancy, including periodontal infections, can place a baby's health at risk.
The best way to prevent periodontic infections is to begin with healthy gums and continue to maintain your oral health with proper home care and careful periodontic monitoring. It is important to continue periodontal therapy during pregnancy to decrease your risk for a periodontal infection.
Oral Contraceptives
Swelling, bleeding and tenderness of the gums may also occur when you are taking oral contraceptives, which as synthetic hormones.
You must mention any prescriptions you are taking, including oral contraceptives, prior to medical or dental treatment. This will help eliminate the risk of drug interactions, such as antibiotics with oral contraceptives- where the effectiveness of the contraceptive can be lessened.
Menopause
Changes in the look and feel of your mouth may occur if you are menopausal or post-menopausal. They include feeling pain and burning in your gum tissue and salty, peppery or sour tastes.
Changes can also occur to your bone health (osteoporosis). It's important to let us know if you have this type of problem and are taking any madications.
Careful oral hygiene at home and professional cleaning may relieve these symptoms. There are also medications to treat the effects of dry or burning mouth concerns.
No matter how successful the periodontal treatment has been, ultimately you are most important in maintaining periodontal health. For maximum results, the patient must accept this role as a "co-therapist". You must take "ownership" in achieving long-term success.
The first responsibility is to eliminate factors that increase susceptibility to periodontal disease. Some of these include smoking, diabetes and excessive use of alcohol.
Secondly, it is important to maintain daily plaque control. This is achieved through brushing and using other homecare aids such as floss, interdental brushes and rubber tips. Most periodontal disease begins between the teeth, therefore, we will recommend hygiene aids for your oral hygiene routine.
Lastly, you are responsible for scheduling regular periodontal maintenance. The frequency of these visits will be determined by your dentist based on the level of your periodontal health. Most patients with moderate to advanced cases or patients who may be susceptible to periodontal disease should have periodontal maintenance appointments every three to four months for their lifetime. Maintaining this schedule is very important to controlling periodontal disease.
To keep your teeth for a lifetime, you must remove the plaque from your teeth and gums every day with proper brushing and flossing. Regular dental visits are also important. Daily cleaning will help keep calculus formation to a minimum, but it won't completely prevent it. A frequent professional cleaning as recommended by your dentist is necessary to remove calculus from places your toothbrush and floss may have missed.
Why Is Oral Hygiene So Important?
Adults over 35 lose more teeth to gum disease (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, daily tooth brushing and flossing techniques.
"Periodontal disease and decay are both caused by bacterial plaque."
Periodontal disease and decay are both caused by bacterial plaque. Plaque is a colorless film that 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.
How To Brush
While brushing the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes. Use light pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort.
When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.
To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don't forget to gently brush the surrounding gum tissue.
Next you will clean the biting surfaces of your teeth by using short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing.
If you have any pain while brushing or have any questions about how to brush properly, please be sure to call the office.
How To Floss
"Flossing is a very effective way to remove plaque from interdental surfaces."
Periodontal disease usually appears between the teeth where your toothbrush cannot reach. Flossing is a very effective way to remove plaque from those surfaces. However, it is important to develop the proper technique. The following instructions will help you, but remember it takes time and practice.
Start with a piece of floss (waxed is easier) about 18" long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand.
To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss tightly between the teeth using a back-and-forth motion. Do not force the floss or try to snap it in to place. Bring the floss to the gum line then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn from one finger to the other to get a fresh section.
To clean between the bottom teeth, guide the floss using the forefinger of both hands. Do not forget the backside of the last tooth on both sides, upper and lower.
When you are done, rinse vigorously with water to remove plaque and food particles. Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque, your gums will heal and the bleeding should stop.
Caring For Sensitive Teeth
Sometimes after dental treatment, teeth are sensitive to hot and cold. This should not last long, provided your mouth is kept clean. If your mouth is not kept clean, the sensitivity will remain and could become more severe. If your teeth are especially sensitive, please us. We may recommend a medicated toothpaste or mouth rinse made especially for sensitive teeth.
Choosing Oral Hygiene Products
There are so many products on the market that it may become confusing, and choosing between all the products can be difficult. Here are some suggestions for choosing dental care products that will work for most patients.
"Automatic and high-tech electronic toothbrushes are safe and effective for the majority of patients."
Automatic and high-tech electronic toothbrushes are safe and effective for the majority of patients. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque. You need to brush and floss in conjunction with the irrigator. We see excellent results with electric toothbrushes called Oral B and Braun.
Oral irrigators are effective at rinsing areas around the teeth and into pocket sites. These irrigators are particularly effective for patients with extensive dental restorations. We see excellent results with the Water Pik.
Some toothbrushes have a rubber tip on the handle; this is used to massage the gums after brushing. There are also tiny brushes (interproximal toothbrushes) that clean between your teeth. If these are used improperly you could injure the gums, so be sure discuss proper use of these brushes with your dentist.
If used in conjunction with brushing and flossing, fluoride toothpastes and mouth rinses can reduce tooth decay as much as 40 percent. Remember, these rinses are not recommended for children under six years of age. Tartar control toothpastes will reduce tartar above the gum line, but gum disease starts below the gum line so these products have not been proven to reduce the early stage of gum disease.
Anti-plaque rinses, approved by the American Dental Association, contain agents that may help bring early gum disease under control. Use these in conjunction with brushing and flossing.
There are special considerations in choosing oral hygiene products when you have a dry mouth problem (Xerostomia). Dry mouth can inhibit proper oral hygiene and make you more susceptible to dental problems. If you have dry mouth problems it is best to avoid alcohol based mouth rinses and sugary lozenge candy. There are many over the counter products for dry mouth problems we see excellent results with Biotene products. Your Dentist, Periodontist and Dental Hygienist are the best people to help you select the right products that are appropriate for you.
Professional Cleaning and Periodontal Maintenance
"Daily brushing and flossing will keep dental calculus (tartar) to a minimum"
Daily brushing and flossing will keep dental plaque and tartar to a minimum, but a professional cleaning will remove plaque and tartar in places your toothbrush and floss have missed. Regular professional maintenance care is needed to maintain your dental and periodontal health. Routine cleanings may be adequate for many people, but a person who is susceptible to periodontal disease, a more thorough pocket cleaning is needed on a regular basis. Once your periodontal disease is stabilized an appropriate interval can be selected for you related to routine cleanings and periodontal maintenance in our office. Keep your teeth for your lifetime by staying with the professional maintenance plan.
Non-Surgical Treatment Methods
Periodontal therapy consists of non-surgical and surgical approaches. Both are aimed at arresting the breakdown of the supporting structures of the teeth (including the gums) and creating a stable oral environment. Although there is no "cure" for periodontal disease, there are ways to control the progression and dramatically minimize the risk of tooth loss.
Even if severe cases, non-surgical periodontal therapy often precedes surgical therapy.
Many times, the early stages of periodontal disease are best treated with non-surgical periodontal therapy.
This is done to improve the overall tissue quality prior to surgery and also to help limit the areas requiring surgery. We pride ourselves on the fact that we are very conservative in our treatment. Recommendations are made to limit surgery to the areas where is it absolutely necessary.
Scaling and Root Planing
The initial stage of treatment is usually a thorough cleaning that includes scaling to remove plaque and tartar deposits beneath the gum line. The tooth roots may also be planed to smooth the root surface and remove bacterial toxin allowing the gum tissue to heal and reattach to the tooth. These treatments are often completed over a series of visits to maximize the patient's comfort and insure a more thorough and meticulous completion of procedures, and are typically performed under local anesthetic.
Scaling and root planing is the first step to reaching periodontal health and stability.
Antibiotics, irrigation with anti-microbials (chemical agents or mouth rinses), or antibiotic fibers may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, antibiotic fibers may be placed in the periodontal pockets after scaling and root planing to control infection and encourage normal healing. We use antibiotics and antimicrobials these ways:
Prescriptions for acute and chronic infections
Preventive medication for patients at risk due to medical conditions
At the time of treatment as direct application into a site of need
At the time of treatment as a time-released locally applied antibiotic
Antibiotics act as a help in the treatment of periodontal and dental infections. They are not a cure for periodontal disease.
After scaling when deep pockets persist it is difficult to know that we have controlled the periodontal disease. Patients can seldom, if ever, keep these deep pockets clean and free from harmful plaque. It may be necessary to repeat scaling and root planing procedures because of these deep pockets. Surgery may ultimately be needed to restore periodontal health and possibly regenerate bone or gum tissues around the teeth.
Osseous Surgery - Pocket Depth Reduction
The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth. Many factors can cause periodontal disease or influence its progression.
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth.
Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, too much bone is lost, and the teeth need to be extracted.
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Mild Periodontitis | Moderate-Advanced Periodontitis |
A pocket reduction procedure may be recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth - and decreases your chances of serious health problems associated with periodontal disease.
Procedure
During this procedure, we will fold back the gum tissue and remove the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone .
The basic procedure known as open flap curettage involves the following:
The periodontal surgeon lifts, or flaps, the gums away from the tooth and surrounding bone.
The diseased root surfaces are cleaned and curetted (scraped) to remove deposits.
Gum tissue is replaced into position to minimize pocket depth.
The periodontist may also contour the remaining bone (osseous surgery) and attempt to regenerate lost bone and gingival attachment through bone grafts and guided tissue regeneration.
Periodontal Surgery - Soft Tissue Grafts
Periodontal procedures stop further dental problems and gum recession, and can to improve the aesthetics of your gum line.
When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma.
Exposed tooth roots are the result of gum recession. You may wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or the exposed roots may be very sensitive to hot or cold foods and liquids.
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Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. Other factors such as individual tooth misalignment and tooth movement may also play a role in the development and progression of recessions. You may not be in control of what caused the recession, but prior to treatment, we will help you identify the factors contributing to the problem. Once these contributing factors are controlled, a soft tissue graft procedure will help repair the defect and help prevent additional recession and bone loss.
The gingival graft procedure is highly predictable and results in a stable health band of attached tissue around the tooth.
Soft tissue grafts can be used to cover roots or develop gum tissue that is absent due to excessive gingival recession. This procedure can reduce further recession and bone loss, and in some cases it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve the aesthetics of your smile.
Procedure
During this procedure, we take gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity. There are different types of grafts that can be done: connective tissue grafting, gingival grafting and pedicle grafting. Our periodontist can tell you which graft best suits your situation.
Guided Tissue Bone Regeneration
Traditionally, eliminating the gum pockets by trimming away the infected gum tissue and re-contouring the uneven bone tissue treats gum disease. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are used routinely today.
Guided Tissue Bone Regeneration "regenerates" the previously lost gum and bone tissue.
The bone grafting procedure is necessary when the bone supporting your teeth has been destroyed.
Eliminating existing bacteria and regenerating bone and tissue helps to reduce pockets caused by the progression of periodontal disease. In conjunction with daily home care and an individually designed professional maintenance program, you can significantly increase the chances of keeping your own teeth and maintaining a healthy smile.
Procedure
Most techniques utilize membranes, which are inserted over the bone defects. Some of these membranes are bio-absorbable and some require removal. The bone grafts consist of small particles of your own bone or synthetic material, that help stimulate bone growth or hold the space for your bone to regenerate into.
Excel Dent dentists have dedicated themselves to this regenerative approach for the treatment of periodontal disease and bone defects associated with implants. We believe that once periodontal infections are stabilized the best approach for the long term involves regeneration of bone and gum tissue. This approach becomes even more important as people live longer for the preservation of their teeth or implants. The ability to eat, chew and smile with confidence is important for the quality of everyone's life.
Ridge deformities of the upper and lower jaw can leave you with inadequate bone and tissue thickness for either an aesthetic and functional bridge or dental implant restoration. The defects may have been caused by trauma, developmental defects, periodontal disease and wearing dentures.
Ridge augmentation procedures have been shown to greatly enhance the cleansability and appearance of your restorations. They increase your chance for long-term successful dental implants, both aesthetically and functionally.
Procedure
1- Soft tissue ridge augmentations are performed to enhance the cleansability and aesthetics of a deficient site prior to its final restoration. During this procedure, an incision is made to expose the bony ridge. A soft tissue graft is then obtained either from a suitable site in your mouth and/or a soft tissue substitute and inserted into the area. The gum tissue is readapted over the soft tissue graft and sutured into place.
2- Hard tissue ridge augmentations are performed to recreate adequate bone dimensions prior to dental implant therapy. The hard tissue augmentation can also be done in combination with a soft tissue augmentation to simultaneously enhance the soft tissue profile of the deficient site. After the incision is made and the gum lifted away, the bony graft or bone substitute is placed in to build up the ridge. A membrane may be adapted over the bone graft based on individual defect morphology. Depending on defect size, an average bony healing and maturation time of 6-12 months is allowed before dental implants can be placed. In some cases, the implant can be placed at the same time as the hard tissue ridge augmentation is performed.
The gum tissue can be very thick and large covering the tooth surface making the teeth look short. This can happen because of medications, bone that extends too close to the surface of the teeth, or inflammation due to gum disease.
Although your teeth appear short, they may actually be the proper length. Sometimes this condition is known as a "gummy smile". The teeth may be covered with too much gum tissue. We can correct this performing the periodontal plastic surgery.
During this procedure, excess gum and bone tissue are reshaped to expose more of the natural tooth. This can be done to more than one tooth, to even your gum line, and to create a beautiful smile.
A gingivectomy is a periodontal procedure that eliminates excess gum tissue. The term "gingivectomy" is derived from Latin and Greek: "gingiva" means gum tissue, "-ectomy" means to remove.
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The following are some reasons a gingivectomy might be needed:
Cosmetics: To make the teeth look normal in size when the gum is covering too much of it, making the teeth look longer and more proportional.
Functional/aesthetics: To remove excess gum tissue (gingival overgrowth) that has formed as a result of certain drugs such as anti-seizure and organ-transplant medications, and certain high blood pressure medications.
Bone and gum health around the teeth: To shrink deep gum pockets. This procedure might require some bone work as well.
Procedure
We first will anesthetize the area(s) to be treated. The excess of gum tissue is removed either with a scalpel blade and sometimes some rotary instruments. In most cases no sutures (stitches) are required. The surgical sites will be sore for 24-48 hours, and medication will be provided to alleviate any discomfort experienced. A week follow-up appointment is usually needed to ensure proper healing.
After completing initial periodontal treatment, your condition has been arrested, but not cured. Periodontal diseases are chronic diseases, much like diabetes and cardiovascular disease, which require constant monitoring to ensure that your disease remains inactive. Most treated periodontal patients require more frequent cleanings, approximately every three months, rather than traditional six month cleanings, since they are more susceptible to periodontal disease.
During your periodontal maintenance visit, your periodontal status is closely monitored for changes. At times, interceptive periodontal procedures are initiated to treat any sites or pockets that demonstrate significant signs of disease activity. In this way, further bone loss can be prevented.
We firmly believe that preventive dentistry is the best dentistry.