Regular hygiene appointments are highly recommended to help maintain good dental health and avoid conditions like gingivitis and periodontal diseases.
Periodontal diseases are infections of the gums and bone that surrounds the teeth.The primary cause of these infections is the sticky accumulation of bacteria called plaque. Millions of people have some type of periodontal disease and are unaware that they have a problem. These diseases are almost always painless, and may go completely unnoticed in their early stages. There are two stages of periodontal disease. Gingivitis is a superficial infection of the gum. Periodontitis is a more-advanced infection which involves the surrounding bone.
Plaque forms continuously, so it must be removed daily with regular brushing and flossing. If plaque is allowed to build up, tartar (calculus) forms, which cannot be removed by brushing or flossing. The bacteria that cause periodontal disease thrive in these calculus deposits. The bacteria’s toxic waste products, and the body’s own immune response to them, will begin to destroy the bone surrounding the teeth. Gingivitis can sometimes be recognized by a redness and puffiness of the gums, bleeding of the gums when brushed, and sometimes a bad mouth odor, or halitosis. However, you may not be able to diagnose the disease – so it is essential that you receive regular dental examinations.
When the infection moves from the gum to the underlying bone, the problem is now periodontitis. In this stage the bone that supports the teeth is lost. And once this bone is lost it will not grow back. Periodontitis can be characterized by a receding of the gums, spaces opening between teeth, discomfort in the gums, and loosening of the teeth. Gum recession is never normal, and can expose the root, making it more vulnerable to decay. Tooth loosening is almost always a sign of severe bone loss. Spaces occur when the gums and underlying bone have receded, and is typically a sign of an advanced problem.
Periodontal Examination – In addition to a visual examination, we will use x-rays and a periodontal probe to determine if you have any disease present, and if so, to what extent. We first look at the gums. Depending on skin tone, they should be light pink in color, have a stippled appearance, and be tight against the teeth. Note the difference between normal gums and those affected by early periodontal disease. X-rays will reveal the extent of any bone loss that may have occurred, and will also expose any decay that the visual exam may not have discovered.
The periodontal probe is particularly valuable because it can reveal disease long before it’s apparent on x-rays. In a healthy jaw, the bone and gum extend to the base of the enamelled portion of the teeth. The periodontal probe measures the depth of the sulcus, the separation that exists between the gum and the tooth.
A normal sulcus is 2 to 3 millimeters deep. Anything more than that indicates that a pocket has developed – the result of calculus buildup or bone loss due to periodontal disease. The deeper the sulcus, the more advanced the disease.As periodontal disease progresses, more bone is lost. If too much bone is lost, there will be insufficient support for the teeth, and they will have to be extracted.
Treatment
Root Planing – Normal tooth cleanings remove plaque and calculus deposits from above the gumline. When these deposits extend below the gumline, root planing is necessary. Root planing is performed with the same tools as normal cleanings, but the procedure is more aggressive. Often it is necessary to numb the affected area before the procedure. Once the accumulated plaque and calculus have been removed, the gums will heal, tightening around the teeth. Depending upon the extent of disease found in the examination, root planing may be done over several office visits. In this way, we can assess the progress of treatment, and alter tactics if necessary.
Once the basic treatment has been completed, we may suggest a series of periodontal cleanings. These cleanings differ from regular tooth cleanings as the roots are examined and cleaned each time. Done at two to three month intervals, these cleanings increase the long-term success of periodontal treatment, reducing the risk of relapse and or periodontal surgery.
Periodontal Surgery – Surgery is required if pockets still exist and the gums are still infected after root planing. The gums are retracted to expose the jaw and the roots. Any remaining plaque and calculus are removed. The remaining bone is cleaned and re-contoured. The gums are then repositioned. Periodontal surgery is often surprisingly quick and pain-free. More importantly, it eliminates the infection and improves overall health.