Periodontal Therapy
Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. Adults over 35 lose more teeth to gum diseases than from cavities. Three out of four adults are affected by periodontal disease at some time in their life.
Mechanism of Periodontal Disease
Dental plaque is the primary cause of gum disease. Plaque is a colorless film, which sticks to your teeth, mostly at the gum line. Plaque constantly forms on your teeth. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar).
Bacteria found in plaque and calculus produce toxins or poisons that irritate the gums. These toxins cause the gums to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. As periodontal diseases progress, the supporting gum tissue and eventually the bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.
Preventing Gum Disease
The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleanings. Also taking good care of your overall health such as maintaining a consistently good diet and regular exercise will have a dramatic effect on your oral health. Conversely, poor oral health has been linked to a number of health problems such as heart disease, diabetes and even most recently pancreatic cancer just to name a few.
Periodontal diseases can be accelerated by a number of different factors. These include but are not limited to:
- Smoking
- Diabetes
- Stress
- Clenching and grinding teeth
- Medication
- Poor nutrition
Treating Periodontal Disease
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 or delay its progress. There are numerous and progressive disease entities or types requiring different treatment approaches. The progression of periodontal disease is as follows:
Type I – Gingivitis
Gingivitis is an inflammation of the gum tissues characterized clinically by changes in color, form, position, surface appearance and the presence of bleeding and/or exudates. Probing depths are usually 1-4 mm deep and there is no radiographic evidence of bone loss.
Type II – Early Periodontitis
Early periodontitis is a disease of the gum tissues and supporting bone characterized clinically by all of the above. In addition, the probing depths are in the 3-5mm range and there is slight evidence of radiographic bone loss, either localized or generalized (up to 20%). There also is usually some accompanied recession and start of tooth mobility.
Type III – Moderate Periodontitis
Moderate periodontitis is a more advanced stage of periodontitis characterized by increased destruction of gum tissues and supporting bone with noticeable evidence of bone loss (20-50%) and increased tooth mobility. There usually is bone loss involving the furcation (between roots) of multi-rooted teeth. Probing depths are in the 4-7mm range.
Type IV – Advanced Periodontitis
Advanced periodontitis is a very serious stage of periodontal disease involving probing depths with many values greater than 6-8mm. Severe bone loss is evident and tooth mobility is great in a number of teeth. Bone loss is greater than 50% and tooth loss is a given for many teeth.
As periodontal disease progresses the course of treatment obviously needs to be more aggressive. With gingivitis, treatment consists of removal of the irritants professionally and continued meticulous home care of brushing, flossing and possibly professionally recommended medicaments. This means one, maybe two visits with the hygienist.
With any level of periodontitis the first step is to perform some deep cleanings in the area(s) of the bone loss and deep probings. This is usually done in quadrants (1/4 of the mouth at a time) and the number of quadrants depends on the extent of the periodontitis, from one to four quadrants. We may also recommend utilizing some of the most recent advances available to assist the deep scalings to help you get a better result. These include Periostat, Arestin, and laser therapy. Use the links below to learn more about these and other related topics. With the more advanced periodontitis cases we may then have to refer to a periodontist (gum specialist) to finish treating the periodontal disease.
Maintenance
First and foremost you must brush regularly and clean between your teeth daily. While most people know the importance of brushing, they often don’t understand the importance of cleaning between the teeth. This is where most periodontal problems occur and you must keep these areas clean by flossing and use of interdental cleaners other than floss.
Maintenance appointments need to be more frequent than in the past, usually at a 3 month interval. The combination of daily home care and regular professional cleanings provides the best opportunity to maintain healthy gums.
Learn more about treating periodontal disease:
|