Periodontal diseases are infections that affect the tissues and bone that support teeth.  The mouth is filled with countless bacteria.   Periodontal disease begins when certain bacteria in plaque (the sticky, colorless film that constantly forms on the teeth and the surfaces lining the mouth) produce toxins and enzymes that irritate the gums and cause inflammation.  The resulting inflammation, which may be painless, can damage the attachment of the gums and bone to the tooth.

Unlike tooth decay, which often causes discomfort, it is possible to have periodontal diseases without noticeable symptoms.   That is why regular dental checkups and periodontal examinations are very important.  Several warning signs can signal a problem.  While periodontal disease may begin slowly for some patients, others may develop a rapidly progressive form of the disease. Some of the signs of periodontal disease are:

1. Gums that bleed easily
2. Red, swollen, or tender gums
3. More than nine out of ten implants last longer than 15 years.
4. Gums that have pulled away from your teeth
5. Persistent bad breath
6. Pus between the teeth and gums
7. Loose or separating teeth

A good oral hygiene routine practiced for a few minutes at least twice a day can help reduce your risk of developing periodontal disease and tooth decay.  Regular checkups and professional cleanings at least twice a year are also very important.

Periodontal treatment methods depend upon the type and severity of the disease.  If the disease is caught very early (gingivitis), and no damage has been done, you may simply be given instructions on better oral hygiene.   The first non-surgical step usually involves scaling and root planing, "deep cleaning," to remove plaque and tartar deposits on the tooth and root surfaces.   We may also recommend medications to help control infection and pain, or to aid healing.  These medications could include a systemic pill, a mouth rinse, or a localized antibiotic "chip."

If the severity of periodontal disease does not heal after scaling and root planing, periodontal surgery may be needed to reduce the pocket depth and make teeth easier to keep clean.  Surgery allows us to access hard-to-reach areas that require the removal fo tartar and plaque.  The gums are sutured back into place or into a new position to make tissue snug around the tooth.

Good oral hygiene at home is essential to help keep periodontal tissue healthy.   It just takes a few minutes 2-3 times a day to care for your teeth and gums!

Healthy gingiva (gum tissue), periodontal ligament and bone anchor teeth firmly in place

Gingivitis develops as toxins, enzymes, and other plaque by products irritate the gums, making them tender, swollen and likely to bleed easily.

Periodontitis occurs when plaque byproducts destroy the tissues that anchor teeth in the bone. As the disease progresses, pockets form, which allow more plaque to collect below the gum line. Tooth roots are exposed and become susceptible to decay and sensitive to cold and touch.

In advanced periodontitis, the teeth lose more support as the disease continues to destroy the periodontal ligament and bone. Unless treated, the affected teeth frequently become loose and may fall out or require removal by a dentist.

Dental Cleanings: Prophylaxis and Periodontal Health
The dental profession refers to the dental cleaning appointment as a dental prophylaxis, or prophy. It's most significant functions are prevention of dental disease and patient education. It is likely the most important and valuable visit a patient may ever make to the dentist. The routine dental cleaning is anything but routine, and should include:

1. Personal oral hygiene evaluation, home care review and recommendations.
2. Toothbrushing and flossing instructions..
3. Supra gingival (above the gum) scaling to remove plaque and tartar from all visible tooth surfaces.
4. Debridement of tartar beneath the gum, as conditions warrant.
5. Topical fluoride treatment to the age of thirteen.
6. Polishing the teeth..
7. Nutrition assessment, if needed
8. Periodontal charting, and scheduling of additional periodontal care as indicated.

The dental prophylaxis is the cornerstone for a lifetime of dental health.

Ultrasonic and Hand Scaling
Plaque is the colonization of natural oral bacteria on food debris that remains on the surface and in the crevices of the teeth and gums. Combining with minerals in the saliva, it ultimately forms a hard, rough sediment known as dental tartar or calculus which attracts further plaque buildup. Calculus must be removed by a dental professional for the prevention of periodontal disease.

Removal of calculus may be performed by a licensed dental hygienist or dentist, either by manual scaling of the teeth, or with an ultrasonic device. The choice of technique is a personal preference by the hygienist or wishes of the patient. Most states permit trained dental hygienists to administer local anesthetic and nitrous oxide (laughing gas), often necessary for deep periodontal scaling and root planing.

Polishing
The dental prophylaxis is refined by a final polishing of the teeth to remove stain and create a sensation of fresh breath and a clean mouth It may be accomplished by spraying high pressured water mixed with baking soda paste onto the surface of the teeth (prophy jet polishing), or a rubber cup and polishing paste. Many states permit a certified dental assistant to polish teeth with a rubber cup and to apply fluoride for children.

Scaling and Root Planing is a common non-surgical treatment for periodontal disease. By using special instruments, we remove bacteria and infection from the unhealthy deep pockets around the teeth below the gum line. This is often referred to as a "deep cleaning".

First the tooth is scaled to remove the plaque and tarter that has accumulated on the tooth..

Then the root is planed or smoothed. This eliminates any rough areas on the root that can easily trap plaque and bacteria.

A smooth clean root provides a healthy environment to allow the gums to heal naturally and reattach to the tooth. This will create a reduced pocket, therefore eliminating areas for bacteria to hide and cause further disease. Scaling and Root Planing combined with a strict home care routine and more frequent periodontal cleanings and exams will increase your chances of keeping your natural smile.

GUM SURGERY

Sometimes, in order to treat advanced gum disease, surgical procedures are necessary, such as:

1. Crown Lengthening
2. Soft Tissue Grafts

We are concerned foremost with your health. However, some of the procedures we perform are intended not only to control disease, but to provide you with a cosmetic benefit. Some patients may look older than their years because their teeth appear to be too long ("long in the tooth"). Soft tissue grafts and other root coverage procedures are designed to cover exposed roots and make the teeth look much better.

When gum tissue recedes due to periodontal disease, it pulls away from the teeth. Periodontal plastic surgery procedures can restore some coverage and dramatically improve a person's smile.

Soft tissue grafts and other root coverage procedures cover exposed roots and restore healthy gum tissue. This will reduce further bone loss and recession, make the tooth less sensitive, protect the root from root cavities, and look more natural when you smile.