To better understand periodontal disease and treatment, you need to understand the anatomy of a tooth’s supporting structures. The word ‘periodontal’ literally means ‘around the tooth’. So, all the structures that are found surrounding our teeth are referred to as the periodontium.
For people entering their 30s and beyond, the threat of gum disease (periodontal disease) is very real and its effects are not limited to the mouth. This illness can be silent in that it causes no pain and often has no symptoms. It does however slowly break down the bone that houses and supports your teeth. As gum disease progresses and the bone loss becomes more severe, teeth become loose and can fall out.
Additionally, as this slowly progressing infection continues within your gums, the bacteria can enter into your bloodstream and have a detrimental impact on other organs such as your heart and liver. In fact, having chronic gum disease has been proven to increase your risk of suffering a heart attack, stroke and diabetes. There is an abundant amount of research that has linked people with chronic gum disease to a higher incidence of these cardiovascular illnesses. It can also cause complications in pregnancy. There is no question that as research continues to emerge, we will continue to learn more of the effects that periodontitis can have on our overall health. Having a healthy mouth is critical to leading a healthy life.
Gum disease can be divided into two broad categories:
Gingivitis is characterized by swelling, inflammation, and bleeding of the gums. It usually arises from inadequate oral hygiene. Gingivitis is reversible with regular professional treatment and proper oral home care.
In the advanced stages of gum disease the bacterial toxins - along with your body’s immune system - can cause bone loss around teeth.
Once bone loss has occurred, it implies the disease has progressed from gingivitis and is now called periodontitis. The latter is harder to treat and has a poorer prognosis. Periodontitis leads to pocket formation (spaces between the teeth and gums where the bone is missing). And as the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process creates very mild symptoms including bleeding gums, bad taste in the mouth, halitosis (bad mouth odor) and, in severe cases, abscesses. Eventually, teeth can become loose and may have to be removed.
The effects of gum disease are best prevented by early detection and proper dental hygiene. Brushing your teeth twice a day helps to remove the biofilm of bacteria that releases dangerous toxins into your mouth. Flossing and other interdental cleaning is also important to keep your mouth free from residual food and bacteria. Using a mouth rinse also helps by reducing the microbial count in your saliva. And lastly, maintaining a balanced diet and scheduling regular dental appointments help stop the advance of gum disease and keep you healthy and smiling bright.
The first step towards gum health is regular professional cleanings and good home care. Early periodontitis can easily be treated by scaling and root planing. Scaling and root planing is a careful and meticulous cleaning of the root surfaces to remove tartar under the gums. We also use a laser in the pockets to disinfect as much bacteria as possible.
Often in mild to moderate cases of periodontitis, many patients do not require any further active treatment. Periodontitis however is something that can return without proper care. Therefore, all patients need to make a commitment to ongoing maintenance therapy (professional cleanings) and vigilant homecare to sustain dental health. Non-surgical therapy does have its limitations and when it does not achieve periodontal health, surgery is recommended.
When gum disease has progressed beyond a point where the patient is able to adequately clean their gums or when scaling and root planing does not help to restore periodontal health, periodontal surgery may be advised. The Most common surgical procedures are:
The goal of pocket reduction surgery is to reduce or completely eliminate the periodontal pockets that have formed due to bone loss. This is achieved by cleaning out the infected pockets and then repositioning the gums to the new bone level. Often, due to the nature of the gum disease, the bone that was damaged by the bacteria needs to be recontoured to allow the gum tissue to sit properly on the bone. It is crucial to understand that while pocket reduction surgery can lead the gums and the body back to health, the potential for gum disease to recur will always remain. As a result, a lifetime of good home care and routine dental cleanings are mandatory. Otherwise there is a significant chance that the periodontal disease will return.
In certain cases, the pattern of bone loss will allow for regeneration to occur. Using grafting materials we're able to actually regrow bone and periodontal ligament. This is a newer procedure than pocket reduction. If possible to perform, it has a more favorable prognosis than pure pocket reduction. And, modern periodontic treatment will generally involve pocket reduction and guided tissue regeneration where possible.
Periodontal maintenance is essential to the ongoing stability and health of your teeth and gums. Optimal periodontal health requires regular follow up care. We will advise the frequency of your follow up care based on the severity of your gum problem. It usually involves visits in 3-4 month intervals.
Gum recession is a multifactorial phenomenon. It is related primarily to genetics and is increased by external factors such as gum disease, acid erosion, teeth grinding and abrasive diet. The result is teeth that look longer and have exposed roots. Patients with root recession often experience sensitivity to cold in the affected area. Recession can also create an esthetic defect if the recession is visible when smiling because the root of the tooth will show.
There are a few reasons that recession should be treated:
In all cases, the treatment modality remains the same. The gum treatment involves using a donor graft and placing it in the site of the lost gum tissue. There are two different sources of gum tissue:
Both materials have their advantages and disadvantages. We would be happy to discuss all your options.
Crown lengthening is done when a tooth needs to be restored, but not enough tooth is present to support a crown or a filling. This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. In order to restore the tooth, gum tissue and bone needs to be removed. This allows more tooth structure to be available above the gum line in order to properly restore the tooth.