Periodontal treatment is necessary when various conditions affect the health of your gums and the regions of your jawbone that hold your teeth in place. Retaining your teeth is directly dependent on proper periodontal care and maintenance. Healthy gums enhance the appearance of your teeth, like a frame around a beautiful painting. When your gums become unhealthy, they can either recede or become swollen and red. In later stages, the supporting bone is destroyed and your teeth will shift, loosen, or fall out. These changes not only affect your ability to chew and speak. They also spoil your smile.

Dental plaque is the primary cause of gum disease in genetically-susceptible individuals. Bacteria found in plaque produce toxins or poisons that 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.

Periodontal diseases are infections of the gums that gradually destroy the support of your natural teeth.

Periodontal Disease

Periodontal (Gum) Disease

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means “around the tooth.” Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself and the tissues and bone that support the teeth are broken down and destroyed.

Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

 

CAUSES OF PERIODONTAL DISEASE

The main cause of periodontal disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. However, factors like the following also affect the health of your gums.

Smoking/Tobacco Use

As you probably already know, tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. What you may not know is that tobacco users also are at increased risk for periodontal disease. In fact, recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Genetics

Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early preventative treatment may help them keep their teeth for a lifetime.

Pregnancy and Puberty

As a woman, you know that your health needs are unique. You know that brushing and flossing daily, a healthy diet, and regular exercise are all important to help you stay in shape. You also know that at specific times in your life, you need to take extra care of yourself. Times when you mature and change, for example, puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy. During these particular times, your body experiences hormonal changes.

These changes can affect many of the tissues in your body, including your gums. Your gums can become sensitive, and at times react strongly to the hormonal fluctuations. This may make you more susceptible to gum disease. Additionally, recent studies suggest that pregnant women with gum disease are seven times more likely to deliver preterm, low birth weight babies.

Stress

As you probably already know, stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. What you may not know is that stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

Medications

Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

Clenching or Grinding Your Teeth

Has anyone ever told you that you grind your teeth at night? Is your jaw sore from clenching your teeth when you’re taking a test or solving a problem at work? Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

Diabetes

Diabetes is a disease that causes altered levels of sugar in the blood. Diabetes develops from either a deficiency in insulin production (a hormone that is the key component in the body’s ability to use blood sugars) or the body’s inability to use insulin correctly. According to the American Diabetes Association, approximately 16 million Americans have diabetes; however, more than half have not been diagnosed with this disease. If you are diabetic, you are at higher risk for developing infections, including periodontal diseases. These infections can impair the ability to process and/or utilize insulin, which may cause your diabetes to be more difficult to control and your infection to be more severe than a non-diabetic.

Poor Nutrition

As you may already know, a diet low in important nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. Because periodontal disease is a serious infection, poor nutrition can worsen the condition of your gums.

Other Systemic Diseases

Diseases that interfere with the body’s immune system may worsen the condition of the gums.

 

Surgical Procedures

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.

Pocket Reduction (Osseous Surgery)

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.

Benefits

Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it’s important for you to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth and decrease the chance of serious health problems associated with periodontal disease.

Soft Tissue Grafts

Periodontal procedures are available to stop further dental problems and gum recession, and/or to improve the esthetics of your gum line.

Exposed tooth roots are the result of gum recession. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or, maybe you’re not bothered by the appearance of these areas, but you cringe because the exposed roots are sensitive to hot or cold foods and liquids.

Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. You may not be in control of what caused the recession, but prior to treatment we can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss. Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession.

Procedure

During this procedure, gum tissue is taken from the palate or another donor source to cover the exposed root.  A recipient site is prepared in the affected areas.  The graft is then gently adapted and sutured into the recipient site to either cover exposed root surfaces and/or to create a wide band of protective gum tissue.  This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

Benefits

A soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve esthetics of your smile.

Crown Lengthening

Crown lengthening (or crown exposure) is required when your tooth needs a new crown or other restoration.  The edge of that restoration is deep below the gum tissue and not accessible.  It is also usually too close to the bone or below the bone.  This procedure creates a new gum-to-tooth relationship.  This allows your dentist to reach the edge of the restoration, ensuring a proper fit of your restoration 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.

Procedure

The procedure involves adjusting the levels of the gum tissue and bone around the tooth in question, to create a new gum-to–tooth relationship. The procedure takes approximately one hour.

When the procedure is completed, sutures and a protective “bandage” may be placed to help secure the new gum-to-tooth relationship.  You will need to be seen in one or two weeks to evaluate your healing.

This periodontal procedure is designed to expose more tooth structure prior to restorative and cosmetic dentistry and/or to improve the esthetics of your gum line. A frequently asked question is whether we can change the esthetics of a gummy smile because the teeth appear somewhat short. Your teeth can actually be of proper length and just covered with excessive gum tissue. In such circumstances, an esthetic crown lengthening procedure will correct this by exposing the shape of your natural teeth.

Esthetic crown lengthening can also be done to single teeth to even your gum line and create a pleasing smile. If your teeth are decayed, fractured at or below the gum line or have insufficient tooth structure for a new crown retention, a crown lengthening procedure may be recommended to enable your dentist to perform a restorative and/or cosmetic dental procedure.

Benefits

Whether you have crown lengthening to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health – your keys to smiling, eating and speaking with comfort and confidence.

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.

Regenerative Procedures “regenerates” the previously lost gum and bone tissue.

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 and pockets develop. Eventually, if too much bone is lost, the teeth will need to be extracted.

Regenerative procedures are recommended when the bone supporting your teeth has been destroyed. These procedures can reverse some of the damage by regenerating lost bone and tissue.

Regenerative Procedures

Procedure

During this procedure, we will fold back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts and/or tissue- stimulating proteins can be used to encourage your body’s natural ability to regenerate bone and tissue.

There are many options to enhance support for your teeth and to restore your bone to a healthy level. Dr. Ciniglio will discuss your best options with you.

Benefits

Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you’ll increase the chances of keeping your natural teeth – and decrease the chances of serious health problems associated with periodontal disease.

 

NON SURGICAL PROCEDURES

 

SCALING & ROOT PLANNING

The initial stage of treatment is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line.

The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.

When deep pockets between teeth and gums are present, it is difficult 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.

After scaling and root planning, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

PERIODONTAL MAINTENANCE

After completing periodontal therapy, 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 will communicate with your dentist after each visit to share pertinent information regarding the stability of your periodontal condition. We firmly believe that preventive dentistry is the best dentistry.

 

 General Surgical Instructions

Prescriptions and Medications:

  • Have any prescriptions filled prior to your surgery date.
  • If Motrin (Ibuprofen) and/or an antibiotic are prescribed, begin taking as directed on your prescription.
  • We advise you to take the pain medication before your numbness wears off.
  • Avoid alcohol and aspirin 3 to 5 days prior to surgery, as they are blood thinners and may cause excessive bleeding and delay healing.
  • Please eat a good meal before your appointment, as you will be numb when you leave and may not feel like eating for a while.

Have an Ice Pack at Home:

  • The use of ice will help reduce swelling and pain after surgery.
  • Ice is useful for the first 6-8 hours after surgery. Small bags of frozen peas from the grocery store mold well to the face and work well as ice packs.
  • Moist heat may be applied the day following surgery, for additional comfort.

Diet Suggestions:

  • Have soft foods available: pasta, eggs, yogurt, cottage cheese, tofu and potatoes are good choices.
  • Make certain to eat prior to surgery, you may not feel much like eating after surgery, and it will be helpful when taking your medications.
  • Avoid caffeine before surgery.

Recuperation:

  • Allow 24 to 48 hours of rest after your surgery.
  • Minimize your activity during this time.
  • Avoid activities that will elevate your heart rate and blood pressure.
  • Healing will occur much faster by resting.

 

 

What Is Periodontal Disease?

Periodontal disease mainly starts with the formation of plaque around the teeth. Plaque is the yellow film on your teeth caused by food and bacteria in your mouth. When plaque build-up mixes with the saliva, it hardens over time and turns into tarter. Tarter containing bacteria will irritate the gums around the teeth by attaching to the outer surface of the teeth and roots and releases poisonous toxins. These toxins cause an infection and an inflammation of the gums. Worse, if left untreated they can ultimately cause bone loss and eventually tooth loss. Keep in mind the lost bone will never grow back.

Fortunately, scaling and root planing can help. Scaling and root planing is a procedure that treats the infected area by meticulously cleaning the tarter and bacteria from the teeth and their roots.

Detecting Periodontal Disease

One way to diagnose periodontal disease is by taking dental x-rays. X-ray images assist in making the tarter build up under the gums more visible. X-rays also show the current condition of the bone.

The second method of diagnosis is a clinical examination in which your dentist can visually check the amount of plaque and tarter build up as well as the color and shape of the gums as indicators for gum disease.

The third and last method of diagnosis is by measuring the pockets that form between the gums and teeth. Destructive bacteria contained in plaque and tarter cause the formation of these pockets. Any pocket that measures greater than 3mm is probably an indication of periodontal disease. 

Scaling And Root Planing Treatment

Deep cleaning, or scaling and root planing is normally performed by your dentist or dental hygienist in a couple of visits. The exact number of visits however depends on your dentist and the amount of tarter build up. Often your dentist will choose to administer local anesthetic to make the procedure virtually painless. The goal of the procedure is to eliminate the infection by removing the bacteria containing plaque and tarter that has attached to your teeth and their roots under the gum.

The deep cleaning is either done manually or with an ultra-sonic instrument called a cavitron, or sometimes a combination of the two. Both techniques loosen and remove plaque and tarter build up.

In addition, antibacterial irrigants or local antibiotics such as Arestin may be used in conjunction with the cleaning procedure to further reduce the number of bacteria around the gums.

Can You Get A Regular Cleaning Instead?

The answer is NO.
As the name deep cleaning implies, the main difference is that scaling and root planning goes below the gum to remove plaque or tarter build up from the tooth’s root where the bone is affected by the infection, whereas, regular cleaning only removes the plaque or tarter above the gum.

Periodontal Follow-up Care

Periodontal disease cannot currently be cured; it can only be controlled, so it is important to follow your dentist’s recommendations for follow-up maintenance and treatment. In addition to routine check ups, performing proper dental hygenie at home is of course also important to help prevent the reoccurence of this distructive disease.