Periodontal Treatment

Treatment | Periodontal Surgery

What is periodontal (gum) disease?  

Periodontal disease is a bacterial infection of thegum and bone surrounding the teeth. It is the leading cause of tooth loss in adults. Since periodontal disease is painless, you may not know you have it.  
The primary cause of periodontal (gum) disease is plaque, a sticky, colorless film that constantly forms on the teeth both above and below the gums. This plaque contains bacteria which secrete toxins that can cause inflammation of the gum tissue and loss of the bone which holds your tooth in the jaw.  
Patients may start out with a condition known as gingivitis where they note that their gums are red, sometimes swollen, and may bleed when brushing or flossing. With daily brushing and flossing gingivitis can be eliminated.  
Periodontal disease is different from gingivitis in that the bacteria have invaded far below the gumline and caused destruction to both the gum and bone which support the tooth. Periodontal disease cannot be eliminated by the patient with brushing and flossing alone. A patient with periodontal disease needs to see a specialist (known as a Periodontist) for an evaluation and treatment.  
 

What are symptoms of periodontal (gum) disease?

What does periodontal treatment involve?  
 
First you must see a periodontist for an initial consult where measurements of the space between your teeth and gums are taken with a calibrated probe which acts like a measuring stick. Full mouth xrays are also usually taken at this visit.

In the early stages of periodontal disease, most treatment involves scaling and root planing (also known as "deep cleaning") which removes of plaque and calculus around the teeth both above and below the gumline. This procedure uses local anesthetic “novocaine” to allow the periodontist to clean deeper than a regular cleaning, but the patient will not feel any major pain or discomfort after the novocaine wears off.

The more advanced stages of periodontal disease may require surgical treatment for access to ensure proper removal of the bacteria in the deeper pockets and re-contouring of the damaged bone. Periodontal surgery may also be indicated in other situations such as when there is recession or a decay or a fracture in your tooth may mean that more of the crown needs to be uncovered for the general dentist to use for a crown. 
 

How can I prevent progression of periodontal (gum) disease?

Treatment 

Scaling and Root Planing 

Scaling and Root Planing is also known as a “deep cleaning”. The purpose of scaling and root planing is to clean the teeth and upper root surface to remove plaque and calculus [tartar] from the area between the tooth and gum, also known as a periodontal pocket.

After scaling and root planing, there is a reevaluation visit approximately one month later where patients will have the gums measured with a probe to see if the pockets have decreased in depth now that some of the bacteria has been removed. At this point the periodontist will determine if the patient can be placed on 3-4 month recall visits or if the patient requires surgical therapy. Surgery may be indicated to restore periodontal anatomy damaged by periodontal disease and to facilitate better oral hygiene practices.

Periodontal Surgery  

If you're diagnosed with periodontal disease, surgery may be recommended. Periodontal surgery is necessary when it is determined that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are some of the types of surgical treatments most commonly prescribed:

Osseous Surgery 
 
Osseous Surgery is often recommended following a reevaluation visit when periodontal disease is advanced in nature. If the periodontist determines that there are areas of your mouth which have not been able to be fully accessed by scaling and root planing and there is still disease present, this surgery is used to access the bacteria in the deeper pockets.  

During this procedure, a small incision is made at the area where the gum and tooth meet. The gum tissue is then reflected and the disease-causing bacteria are removed by ultrasonic instruments and hand scalers. 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 gum is sutured (stitched) back together at the level of the bone in an attempt to eliminate the pocket where the bacteria reproduced and caused damage.

Bone Grafting 

Bone Grafting is a surgical procedure in which new bone is grown to replace bone which has been lost. After tooth loss occurs, over time the jawbone around the missing tooth shrinks in height and width. The bone is left in a condition unsuitable for the insertion of dental implants. A bone graft can be placed in a socket at the time of the extraction to prevent this shrinkage in the ridge or if the patient has had a tooth extracted prior and now desires an implant, this procedure is used to add width to the ridge for an implant. This procedure gives the opportunity to use implants of the proper length and width, and to restore esthetics and functionality. It can also be recommended in conjunction with osseous surgery (see above) to add bony support in areas where there may be craters around teeth because the bacteria have eaten away at the bone.

Gum Grafting  

Gum Grafting is designed to enhance the amount of gum supporting a tooth. These procedures are performed when there is inadequate gum remaining to help support a tooth usually due excessive recession which has occurred exposing the root of the tooth.  
Gum grafts are useful in protecting the underlying bone and preventing further recession by the addition of a layer of tougher keratinized gum tissue that has been transplanted from another site (usually the roof of the mouth).

Crown Lengthening 
 
Crown Lengthening is necessary when decay has gone to a level underneath the gum or a tooth has fractured beneath the gumline. This procedure removes a minor amount of gum and bone tissue to expose more of the natural tooth. This then allows the dentist to place a crown fully on natural tooth structure and not on filling material or fractured area.  
A crown lengthening procedure may also be recommended to make a cosmetic dental procedure possible to expose a full broad smile in an esthetic area.