Regular preventative or maintenance care is very, very important. Why? Because the condition of your teeth, gums and the bony structures of your jaw determines the outcome of any restorative or cosmetic work done at any stage of your life. However, as you grow older or consider most treatment options, your overall dental health is a deciding factor in treatment alternatives as well as the cost of these treatments and their durability. In addition, your dental health can have a profound effect on your general health as well. Serious problems such as heart disease, diabetes, strokes and even preterm babies have all been linked to poor dental health.
Prophylaxis: (AKA Teeth cleaning) – Periodic removal of plaque, tartar and stains from the teeth using mild abrasives (mild acids and polishes), scalers and an ultrasound unit.
Perio maintenance: Periodic removal of plaque and calculus under the gumline, with some scaling and root planning followed by polishing the teeth. This prevents subgingival decay, bone and tooth loss.
Periodontal Disease: Treatments and Maintenance
Periodontal disease is a serious problem if left untreated. It starts with gingivitis, which affects only the gums themselves, but without proper attention can turn into a periodontal disease that can lead to irreversible bone loss.
What is it? Gingivitis is simply an inflammation of the gums, caused by bacteria creating a build-up of plaque where the teeth and gums meet. Germs feed off of sugar (and starches) in the diet, whether in foods or drinks. Sugars processed by germs and deposited on tooth surface is called plaque. This plaque will eventually get transformed into calculus (hardened or calcified plaque) which can be seen as discolored build-up on the tooth surface. The gums are often red and swollen, and may bleed easily when you brush or floss your teeth. Persistent bad breath is also a symptom. Periodontitis can be aggravated by a number of factors aside from poor oral hygiene: smoking, some medications, illness, or hormonal changes (for example, during pregnancy). It may not be painful at first, and patients often put off doing anything about it.
Progression to periodontal disease. If gingivitis is left untreated, it eventually becomes periodontal disease, which is a serious condition affecting not only the gums but the teeth and jawbone as well. As periodontitis advances, the plaque and calculus begins to build up below the gum line. The general germ population changes and reorganizes. If the plaque is not removed, the gums can become severely infected. It may even appear as if the gums are pulling away from your teeth as the infected pockets mature. Gum tissue and bone around the teeth are destroyed. Teeth start to get loose. Bone loss is irreversible. As the condition advances, so much bone may disintegrate that the teeth become loose or begin to fall out. Periodontal disease is the primary cause of tooth loss for anyone over 18.
This radiograph shows significant bone loss between the two roots of a tooth. The spongy bone has receded due to infection under tooth, reducing the bony support for the tooth.
Fighting the disease. If Dr. Gotun sees gum disease in an early stage, he will clean away the plaque and calculus. If there is a great deal of calculus build-up so that an accurate diagnosis is difficult, he will need to do a gross scale (initial cleanup above the gums). This first cleanup is very much like a normal cleaning, but often it will generate some bleeding and soreness. If there is established periodontal disease, Dr. Gotun will need to perform a root planning and scaling (deep cleaning). This is usually done on one-half of the mouth (left or right side, both upper and lower “quadrants” or quarters of the mouth) at one appointment, and the other half done at a second appointment. Dr. Gotun will anaesthetize the area to be treated. He will clean under the gums to whatever area is physically reachable. This means that any rough cementum on the tooth will be removed along with infected gum tissue, and the exposed dentin of the tooth will be polished smooth and left clean. A chart will be made of the pocket depths around each tooth so that healing can be monitored accurately. You may also need to take antibiotics to stop the spread of infection in your body.
After a deep cleaning. It is normal for patients to feel sensitivity in both the gums and the surface of the teeth; this will wear off over time, taking from two to twelve weeks, depending on the depth of the necessary cleaning and your own ability to heal. You can use a salt-water gargle to speed recovery (mix ½ tsp. table salt in a cup of warm water and rinse gently) and pain relievers (Ibuprofen, Tylenol, Advil or Aleve). Occasionally, some patients may need a prescription for pain medication. We may also prescribe a chlorhexidine rinse. ( medicated oral rinse). Diligent daily brushing and flossing is a must. Without an improvement in personal hygiene this treatment only produces a short -term effect. The periodontitis will go back to its original level within 3 months if your daily brushing and flossing is not immaculate. In order to succeed in fighting periodontitis you must be commited to making an effort to improve your personal hygiene.
Periodontal (gum disease) maintenance. Once the entire mouth has been completely cleaned, expect regular appointments (every 2-3 months) to keep the periodontal disease under control. As you become healthier, the intervals between periodontal maintenance appointments may become longer, but it is very important to continue this maintenance schedule and regiment. Untreated gum disease usually ends with the need for periodontal surgery and the possibility of removal of multiple teeth. Periodontal surgery is a necessity if a deep cleaning is unable to remove all sub-gingival build up ( build-up under the gums). To access very deep pockets (deeper than 4-5 mm) gums are lifted away from the teeth to create access to the infected areas that are inaccessible otherwise. The healing process after this procedure takes two to three weeks and is tolerated by most people without any major problems. Pain is usually controlled with over the counter pain medication.
More and more research indicates that periodontal disease is strongly linked to significant health problems such as heart disease, strokes, dementia, rheumatoid arthritis, diabetes and can affect healing after any surgery. Oral infections can also be transferred to your family members. In other words, taking care of your teeth and gums means you are also taking care of your overall health and protecting your loved ones!
As always, we want you to understand your dental health and help you make informed decisions about it. We welcome the chance to answer your questions about either treatment or fees at any time!
