What is Periodontal Disease?
Simply put, periodontal disease is the loss of bone around the teeth. The root cause of bone loss is specific types of bacteria in the mouth and their by-products. Some people have these bacteria, some do not. Outside factors, e.g. smoking, can affect the prevalence of the disease. Periodontal means “around the tooth”.  It is a disease that attacks the gums and the bone that support the teeth. 

Many patients have periodontal disease and do not know it!  Most people are not aware of it because the disease is usually painless in the early stages. In fact, more people lose teeth from periodontal disease than from cavities. Research has found links between periodontal disease and many other systemic diseases such as stroke, diabetes, cardiovascular disease, and increased risk during pregnancy.  Smoking also increases the risk of periodontal disease. Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

How do you know if you have periodontal disease? There are many signs and symptoms that may indicate that you have periodontal issues: loose teeth, spaces opening between teeth that were not present before, bleeding gums to brushing and/or flossing, receding gums, red or swollen gum tissues, and pus around the gum tissues.

Diagnosis
A periodontal exam is part of the regular exam conducted once every six months. At this exam a periodontal probe is gently used to measure the bone levels around your teeth. There is a gap between the tooth and gums called a sulcus or pocket. Normal measurements of the depth of the sulcus are 2-3 millimeters with no bleeding. The periodontal probe helps indicate if pockets are deeper than three millimeters.  As periodontal disease progresses, the pockets usually get deeper. Deeper pockets are more difficult to keep clean and are areas where the periodontal disease-causing bacteria cause damage.

Periodontal disease begins as gingivitis, which is inflammation of the gum tissues. This is indicated when the gum tissues bleed when brushing or flossing. Plaque on the teeth cause the inflammation. Left untreated, gingivitis may progress to the loss of bone around the teeth. This is periodontitis. As bone is lost around the teeth, deeper pockets form between the gums and teeth and may become filled with bacteria and pus.  If not treated, severe bone loss will occur. The teeth will lose their support from the surrounding tissues and become loose and may need to be extracted.

Treatment
Once periodontal disease is present, it is difficult, if not impossible, to be fully treated by improved homecare. Your dental team is needed to stop the progression of the disease. Once bone loss has occurred, it is difficult to replace the bone. In most cases, the hope of periodontal treatment is to stop any further bone loss and to improve the health of the tissues around the teeth. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.

For cases of gingivitis (no bone loss), typically a thorough dental cleaning and improved homecare will improve the situation. However, for patients who have bone loss, more aggressive treatment may be necessary. Typically a deep cleaning (scaling and root planning) is indicated. This is different from a normal cleaning because the dental hygienist will be cleaning the teeth surface below the gumline. It is typically done as a quadrant or half of the mouth per visit. For the patient’s comfort, the area is numb during the procedure. The goal of scaling and root planning is to help the gum tissues to heal and for the periodontal pockets to shrink. This is achieved by removing or destroying the bad bacteria around the teeth. Other treatments may be recommended, such as Arrestin placement in the periodontal pockets, special mouthrinses, or medications to help control infection and healing.

In severe cases that do not respond to scaling and root planning, a consultation with a specialist called a periodontist may be recommended.

Once periodontal treatment is completed and the disease is under control, your dentist and hygienist will usually recommend that you have periodontal maintenance visits every 3 months. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy.  If satisfactory results are not achieved, more aggressive treatment or more frequent dental visits may be necessary.

Scaling & Root Planing (Deep Cleaning)
One of the principal causes of gum inflammation and bleeding is the inability for some people to floss below the gum line to remove the bacteria and plaque out of the gum crevice. This can cause periodontitis, which is the initial phase of periodontal disease. For those people, our hygienists perform root planning, a process in which the hardened plaque, food debris and pus is removed from beneath the gums and on the root surfaces of the teeth. Special instruments are used to clean the pockets of debris and to smooth the root surfaces. Once the causes of the infection are removed, the gum tissues are allowed to heal and become healthy. On- going maintenance, local antimicrobial medication and good home care are usually very effective in the treatment of periodontal disease.

Arrestin
Arestin fights periodontal infection where it starts: in the pockets around the teeth. ARESTIN® (minocycline hydrochloride) Microspheres, 1 mg, is an effective antibiotic treatment that comes in powder form. This powder is placed inside infected periodontal pockets just after the dental professional finishes the scaling and root planing (SRP) procedure. The bacteria that cause periodontal disease are destroyed, allowing the gum tissues to heal properly and healthy bacteria to occupy the periodontal tissues.

Periodontal maintenance
For patients who experience repeated infection to the gums due to enlarged pockets or other periodontal problems, periodontal maintenance may be required to maintain optimum dental health. Typically, patients are scheduled for cleanings every three to four months until the periodontal disease is controlled. As active periodontal infection progresses, it causes exponentially more damage: the majority of damage can be avoided simply by increasing the frequency of appointments.

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