Periodontal Disease

Do I Have Periodontal Disease?

Periodontal disease is an infection of the teeth, gums, and the bone that surrounds the teeth. Most people who have periodontal disease aren’t even aware of it. It’s rarely painful, especially in the early stages.

The main cause of periodontal disease is the accumulation of plaque. Plaque is the sticky film of food and bacteria that forms constantly on your teeth. It’s hard to see plaque, but look at how it shows up after it’s been stained with red dye.

You must completely remove plaque each day, or it builds up and mineralizes to become tartar, also called calculus. It takes a professional to remove tartar; there’s no way for you to remove it at home. A toothbrush or floss won’t budge it. If tartar isn’t removed, it migrates to the root surfaces.

Tartar shows up on this x-ray as small white lumps on the sides of the teeth. Bacteria that cause periodontal disease thrive here. Bacteria produce toxins, and it’s these toxins, combined with your body’s reaction to them, that destroy bone around your teeth.

Some of the warning signs of periodontal disease are:

  • persistent bad breath
  • bleeding gums when brushing or flossing
  • soft, swollen or tender gums
  • gums pulling away from the teeth
  • loose teeth
  • changes in the spaces between your teeth, which reflect changes in the underlying bone

Keep in mind, however, that you can have periodontal disease and experience none of these symptoms!

The roots of the teeth extend into the bone of the jaw. When everything is healthy, the bone comes up around the necks of the teeth and is even throughout the mouth.

The crevice between the tooth and gums, called the sulcus, is two to three millimeters deep when it’s healthy. When plaque and tartar invade a sulcus and it becomes deeper than three millimeters, it’s called a pocket. Pockets are excellent hiding places for plaque and bacteria, so the problem usually worsens, and bone tissue is lost.

Once bone has been lost, it never grows back. When too much bone is lost, there’s so little support for the teeth that they get loose and have to be removed.

Since you may have periodontal disease, yet have none of the symptoms, your dentist will perform a thorough examination using x-rays and a periodontal probe to measure bone levels around the teeth. When the bone level falls, the gums pull away from the tooth, forming a pocket.

Your dentist measures the depth of this pocket with a periodontal probe. The measurement is from the bottom of the pocket, where the gum is attached to the tooth, to the top of the gums.

These are healthy gums. They’re tight against the teeth and there aren’t any pockets. Below, notice the difference with early periodontal disease. In general, the deeper the pockets, the greater the spread of periodontal disease.

Bleeding is a sign of infection. Healthy gums don’t bleed! Your dentist also examines the color and shape of the gums. Notice the pink color and the lightly stippled appearance of the healthy gums, like the surface of an orange.

Look especially close at the difference of the gums between the teeth. This is where periodontal disease usually starts. X-rays tell us a lot about periodontal disease.

So now you know how your dentist finds periodontal disease:

  • probe readings greater than three millimeters
  • bleeding upon probing of the gums
  • swollen and red gums, especially between the teeth
  •  bone loss or tartar on your x-rays

[ribbon toplink=”true”]Grafting[/ribbon]

When your mouth is healthy, your gums are snug against your teeth and the root doesn’t show.

Unfortunately, in some cases the gums have pulled away from the tooth and some of the root surface is exposed. This apparent lengthening of the teeth can really age a person’s smile. If left uncorrected, the loss of protective gum tissue may also mean even more severe problems down the road.

Fortunately, a procedure called grafting can correct this problem.

The first step in placing a graft is to thoroughly numb the involved areas. Then the graft is taken from the donor site on the palate (the roof of your mouth).

In some cases, the incision heals on its own; it can also be closed with a stitch or two.

At the site of the graft, your dentist gently separates the gums from the tooth. This creates a flap and gives us access to the area. Your dentist then carefully removes any plaque and tartar from the root surfaces.

The graft is strategically placed and carefully stitched in place.

After healing for a few weeks, the grafted tissue blends in beautifully. The results?

The gums have been restored and strengthened, the root surface is covered and protected, and the tooth now has a much more natural and pleasing appearance.

[ribbon toplink=”true”]Root Planing[/ribbon]

The goal of root planing is to eliminate the source of periodontal infection by removing the plaque, tartar and bacterial toxins from surfaces of the roots.

Tartar shows up on an x-ray as small white lumps on the sides of the teeth.

Routine cleanings remove plaque and calculus from above the gum line. Root planing removes plaque and calculus from below the gum line.

To keep you comfortable, the dentist usually numbs you before root planing begins. Then, a dental assistant carefully and meticulously planes the root surfaces with special hand tools.

Once the source of infection is removed, your gums begin to heal. As they heal, your gums will tighten around your teeth.

Homecare is the key to maintaining the healing process. Since brushing and flossing only go about three millimeters below the gum line, something more is needed to clean the deeper pockets that come from periodontal disease.

A dental hygienist or assistant will give you the tools and techniques to use at home as part of your treatment.

Normally, root planing is spread across several appointments. That way the hygienist can track the healing and help you fine-tune your homecare efforts.

[ribbon toplink=”true”]Gingivectomy (Gum Removal) [/ribbon]

Healthy gums, tight against the necks of the teeth, are an important part of a beautiful smile.

But sometimes, a problem like this can develop. As the gums extend onto the front surface of the teeth, the natural balance between the length of the teeth and the height of the gums was lost.

The first step in a gum-reduction procedure is making sure that all of the involved areas are completely numb. Your dentist then carefully makes a small incision and removes the excess gum tissue.

After a couple of weeks the area will be completely healed. Notice how much more natural this area looks after the procedure.

A gum reduction procedure is a safe and predictable way to remove excess gum tissue and improve the natural appearance of your smile.

[ribbon toplink=”true”]Using a microscope to find infections[/ribbon]

A microscope is a new tool in dentistry that really helps in the treatment of periodontal disease.

The bacteria that cause periodontal disease thrive below the gumline. To look at the bacteria from your mouth, your dentist takes a small plaque sample from a pocket and places it on a slide.

This is a slide from a mouth with active periodontal disease. These are spirochete bacteria and they’re one sign that periodontal disease is present.

You’ll see your own slides when your dentist uses the microscope to help you judge the success of your own periodontal treatment. That way, you may be able to see the return to health in your own mouth after root planing.

[ribbon toplink=”true”]Crown Lengthening[/ribbon]

When a tooth is broken down due to decay or fracture, a crown is an excellent way to cover and protect it. But when damage is severe, there may not be enough remaining tooth structure to support a crown.

Years ago, a tooth like this would have to be extracted. But today, by using a procedure called crown lengthening, your dentist can increase the amount of available tooth structure, and save the tooth.

The first step in the procedure is thoroughly numbing the entire area. Incisions are made, and the gums are gently pulled back.

The area is then reshaped and sculpted to the desired shape.

The gums are replaced and a couple of stitches are placed to speed healing. After a few weeks of healing, a crown is placed to cover and protect the damaged tooth.

Crown lengthening is a minor surgical procedure that is a predictable and effective way to save a tooth that might otherwise be lost.

[ribbon toplink=”true”]Flap Surgery[/ribbon]

Periodontal flap surgery is necessary when pockets and infection still remain after root planing.

After making sure the entire area is completely numb, your dentist gently separates the gums from the tooth.

This creates a flap and gives us access to the infected areas.

Your dentist then removes any plaque and tartar from the root surfaces. The area is reshaped, and the gum line is adjusted to make it easier for you to keep your teeth plaque-free.

Any soreness after surgery can usually be handled with mild pain medication.

Periodontal flap surgery removes the source of infection, reduces the size of the pockets, makes cleaning easier, and raises your overall level of health.

[ribbon toplink=”true”]Alternatives to Gum Disease Treatment[/ribbon]

If you have periodontal (gum) disease, your choices are limited. You may either choose to treat the problem, or to delay treatment.

Treatment involves a combination of root planing, new homecare techniques, more frequent dental cleanings, and in severe cases, surgery.

Delaying treatment will never make periodontal disease go away. Periodontal disease is an ongoing, degenerative condition. Bone lost never grows back. If too much bone is lost, teeth get loose and have to be removed. This means you may end up wearing partial dentures, or even full dentures.

You don’t have to lose your teeth to periodontal disease! Treatment removes the infection and keeps the disease under control.

[ribbon toplink=”true”]Post-Op Instructions: After Gum Surgery[/ribbon]

After your periodontal surgery appointment, your lips, teeth and tongue may be numb for several hours. Avoid any chewing until the numbness has completely worn off. Don’t eat anything for two hours following surgery.

It’s normal to experience some discomfort for several days after surgery. To control discomfort, take pain medication as recommended. Don’t take medication on an empty stomach, or you may feel nauseated.

Apply an ice pack—20 minutes on, 20 minutes off—for 6 hours following surgery to decrease pain and swelling.

After 24 hours, to further reduce pain and swelling, rinse three times a day with warm salt water; put a teaspoon of salt in a cup of warm water, and then gently rinse, swish, and spit. If antibiotics are prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone.

Some slight bleeding is normal for a day or so following the surgery. If bleeding persists, apply firm pressure with a gauze pad or bite on a tea bag for 20 minutes and elevate your head with pillows. Call your dentist if this doesn’t control bleeding, or if bleeding increases.

For the first 48 hours, restrict your diet to soft foods such as yogurt, ice cream, soft soups and cottage cheese.

Relax as much as possible and avoid all strenuous activities for the first 24 hours following surgery. In the other areas of your mouth, continue your normal homecare routine. You may gently rinse around the treated area with warm water or mouthwash, but frequent or vigorous rinsing must be avoided until the area is fully healed.

Call your periodontist or dentist if pain or swelling persists, or if you have any questions or concerns.