Diagnosis, Treatment, Maintenance
Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination. This type of exam should always be part of your regular dental check-up.
A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper.
Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:
Gingivitis | Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.
Periodontitis | Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria and pus. The gums become very irritated, inflamed, and bleed easily. Slight to moderate bone loss may be present.
Advanced Periodontitis | The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.
It is of paramount importance to halt the progression of periodontal disease before it causes further damage to the gum tissues and jawbone. There are many surgical and nonsurgical treatments that a periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone.
When you come to our office, a complete exam of the mouth will be done before any treatment is performed or recommended. Your dentist will initially assess the whole mouth in order to ascertain the progress of the disease. When a diagnosis has been made, your dentist may treat the bacterial infection with antibiotics in conjunction with nonsurgical or surgical treatment or both.
If the disease has progressed to more advanced stages, we will treat the pockets (under the gum line of the teeth) with a special periodontal cleaning called scaling and root planing (deep cleaning) and a laser.
- Scaling and root planing - usually done one quadrant of the mouth at a time while the area is numb. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing). The bacteria and calculus (tartar) which initially caused the infection, must be removed in order to preserve the health of the gum tissue. The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection and promote good healing. A prescription mouthwash may be incorporated into daily cleaning routines and an electric tooth brush may be recommended to help control infection and healing.
- Laser treatment - This can be used to reduce the size of the pockets between the teeth and the gums.
If the periodontitis is too severe and the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths. Your dentist may also recommend that you see a Periodontist (the specialist of the gums and bone support). Severe periodontitis can be treated in several different ways, such as:
Tissue & bone grafting – Where a considerable amount of bone or gum tissue has been destroyed, the dentist may elect to graft new tissue by inserting a membrane to stimulate tissue growth.
- Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures. A membrane may be inserted into the affected areas to assist in the regeneration process.
Pocket elimination surgery – The dentist may choose to perform Pocket elimination surgery (also known as flap surgery) which is a surgical treatment that can be performed to reduce the pocket size between the teeth and gums. Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.
Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone. Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.
It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)! Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.
Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.
In addition to your periodontal cleaning and evaluation, your appointment will usually include:
Examination of diagnostic x-rays (radiographs) | Essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
Examination of existing restorations | Check current fillings, crowns, etc.
Examination of tooth decay | Check all tooth surfaces for decay.
Oral cancer screening | Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
Oral hygiene recommendations | Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
Teeth polishing | Removal of stain and plaque that is not otherwise removed during tooth brushing and scaling.
Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!