Periodontal Disease and Its Treatment
Periodontal disease, also called gum disease, is caused by bacteria that live where gums attach to teeth, and affects 40% of adults.  Here’s the story of how it affects us:  Bacteria secrete a sticky matrix, or biofilm, that attaches to teeth and makes bacteria more difficult to remove.  The bacteria secret toxins that cause an inflammation in the gum tissue next to the tooth and this inflammation, along with the toxins can weaken the fibrous attachment of gum to tooth.  Then the bacteria can travel further under the gum, and begin to cause damage to the bone surrounding the teeth.  Periodontal disease is the primary cause of tooth loss, and can continue and worsen over time with no pain experienced by the patient. 

Other conditions and health issues can make us more susceptible to the disease.  Things that can make periodontal disease progress more rapidly are smoking, dry mouth, stress, hormonal fluctuations, diabetes, immune system disorders, and other disorders.
Additionally, and perhaps most importantly, periodontal disease is now considered to be a risk factor for heart disease, stroke, and diabetes.  

For more information about periodontal disease, we recommend the following webpage:
www.perio.org

We will assess the health of your gums and bone surrounding your teeth at every hygiene and exam visit in our office.  At least once yearly, we will do a thorough charting and documentation of your periodontal status.  This includes measuring the depth of the gums around each tooth as well as any recession or bleeding of your gums.  We will keep a detailed, long-term account of your gums, so that any changes may be detected as soon as they occur.  The key to successful treatment of gum disease is early detection and treatment  The treatments that we recommend are customized to treat the specific type, location, and severity of your disease.  We also will provide you with all the information and recommendations you need for daily home care of your teeth and gums.  Here is a description of the treatments that we may recommend:
Prophylaxis
Also called “teeth cleaning” by many patients, a prophylaxis is meant to help maintain health in an already healthy mouth.  We call it a continuing care cleaning, and if we’ve recommended this to you, congratulations, for you are already very healthy, and this cleaning helps you to maintain your optimal health.  At this appointment, we remove any tartar above the gums, and polish your teeth to remove plaque and stains.  We will keep your visit comfortable with our careful use of ultrasonic cleaning instruments, hand instruments and polishers. 
Gingivitis Therapy
This treatment may also be referred to as “full-mouth debridement” by insurance code systems.  It is meant to treat gingivitis, which is an early and reversible form of periodontal disease, with no bone loss.  Gums that have gingivitis are puffy, red, bleedy,  or swollen from the bacteria in the mouth.  Our therapy is a meticulous cleaning above and below the gums with our ultrasonic cleaning instruments, hand instruments, and polishers.   This is typically a separate appointment from your exam appointment, as it typically requires a full hour to perform this treatment.
Periodontal Therapy
Also called “root planning and scaling,” periodontal therapy is the treatment for gum disease with loss of attachment of gum to tooth, inflammation of the gums, and possible bone loss.  We recommend multiple appointments, as retreating areas of disease is very helpful, and we may spend a full hour of treatment time on just a few teeth, or a section of your mouth.  We keep the appointment very comfortable by numbing the gums with local anesthetic.  The treatment will involve very meticulous cleaning, disinfection, detoxification, and debridement of the areas between teeth and gum.  We will use our ultrasonic cleaning instruments, handscaling instruments, and possible use of antibacterial rinses.  We will give you specific instructions for caring for the treated areas to optimize healing and reattachment of gums to teeth.  Your mouth may be mildly tender for 24 hours after this treatment, but a mild pain reliever such as Tylenol, or ibuprofen should be sufficient to keep you comfortable.

Supporitve Periodontal Maintenence

Periodontal disease can only be controlled, not cured, so maintaining the health that you have achieved through your periodontal therapy requires regular maintenance visits with your hygienist and dentist.  These critical visits are meant to follow periodontal treatments to keep your periodontal disease under control, and are typically scheduled about every two to four months.  This treatment is considered an ongoing therapy for your gums to keep periodontal disease under control and is more complex than a “prophy,” or regular cleaning for a healthy mouth.  Because you have been treated for periodontal disease, you have periodontal pockets, larger spaces between the teeth and gums, possible recession, and/or general health conditions that put you at higher risk for gum disease.  These conditions also require a special skilled maintenance treatment by your hygienist to clean and smooth the teeth where the periodontal disease may be most harmful, and where it is difficult to reach at home with regular brushing and flossing.  The hygienist and/or dentist will reevaluate your progress to help support your optimal health in controlling your periodontal disease, and give you specific tips and pointers about customized home care routines that you can use.  They may also recommend and prescribe medications to help keep your mouth healthy.

Medications for Periodontal Pockets
In some cases of deeper periodontal pockets, we may recommend an antibiotic powder be placed in the pocket to further healing of the gum and keep bacteria from reforming in the gums.  When the antibiotic powder is placed in the gums, you will be instructed not to floss in that area for 5 – 10 days, after which, you will resume flossing daily in that site.