Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. Dental plaque is common in all people and the daily removal of it is important to avoid periodontal disease. Plaque is a biofilm comprised of oraganic materials and bacteria. Inadequate removal of plaque leads to periodontal disease and tooth attachment loss. Some periodontal disease is more aggressive than others and classification of the particular disease is important for treatment protocols. Individuals may have varying responses to periodontal disease which may also affect and be effected by systemic diseases such as:
- Diabetes (controlled and uncontrolled)
- Cardiovascular disease
- Total Joint replacements (more often recently replaced joints)
- Autoimmune diseases
Why is oral hygiene so important?
Adults over 35 lose more teeth to gum diseases, (periodontal disease) than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal disease is by good tooth brushing and flossing techniques, performed daily.
Periodontal disease and decay are both caused by bacterial plaque. Plaque is a soft sticky film, which adheres to your teeth at the gum line and between them. Plaque is constantly forming on your teeth and is affected by dietary issues and salivary flow. By thorough daily brushing and flossing you can remove these germs and help prevent periodontal disease.
Periodontal diseases can be accelerated by a number of different factors such as diabetes, and xerostomia (dry mouth). However, it is mainly caused by the bacteria found in dental plaque, a sticky colorless film that constantly forms on your teeth. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus
Bacteria found in plaque produces toxins or poisons that irritate the gums, which may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.
Preventing Gum Disease
The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.
Scaling & Root Planning
When the deposits on the roots and teeth have hardened, it is not possible to remove them with a toothbrush, floss, or a rubber cup. The tartar will have to be removed with specialized hygiene instruments or ultrasonic scaling or a combination of both. Generally the area is anesthetized and the hygienist cleans the area(s). By having the area numb, they can get to the bottom of the pocket (sulcus) and removed the bacteria comfortably. Each quadrant of the mouth is generally cleaned on separate appointments depending upon the patient’s clinical needs. All four quadrants of the mouth should ideally be root planed within 30 days of each other. Occasionally we can root plane an entire side of the mouth in one appointment if the periodontal disease is mild.
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After root planing, there is generally mild to moderate discomfort for two to three days that should respond well to Advil or Tylenol. You may notice that the gums become less swollen and you have more gaps between the teeth. This is a good thing and normal. The bacteria have been removed and now the gums can heal back to the tooth in a better position.
A diagnosis of periodontal disease indicates that there has been attachment loss of the teeth into the jaw bone. This attachment loss is a result of the bacteria that live under the gum line around the teeth. The bacteria that reside in the deeper pockets (> 4 mm) are usually more harmful to the attachment. When the pocket is cleaned through periodontal therapy the bacteria is disrupted and are pulled to the surface where they cannot survive.
Periodontal therapy will ideally kill 80-85% of the bacteria. Within 90-120 days, the bacteria recolonize the pocket and the cycle begins again. Therefore it is very important to maintain regular three to four month (90-120 day) visits and do the very best job of home care. Fortunately the pockets will heal to some extent and we often see deeper pockets (6-7 mm) shrink to 4-5mm in certain individuals. Some pockets greater than 7 mm will need to have periodontal surgery to artificially reduce the pockets by removing some of the gum tissue. Keep in mind that a tooth brush can penetrate a maximum of 4 mm into the pocket with ideal technique.