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Periodontal Disease, Diagnosis and Treatment

The word periodontal means “relating to or affecting the structures surrounding and supporting the teeth.”  Periodontal disease attacks the gums and the bone that support the teeth and is the number one reason for tooth loss. Research suggests that there may be a link between periodontal disease and other diseases such as, stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy.  Smoking also increases the risk of periodontal disease.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

Signs and symptoms of periodontal disease can include:

  • Bleeding gums 
  • Loose teeth 
  • New spacing between teeth 
  • Persistent bad breath 
  • Pus around the teeth and gums 
  • Receding gums 
  • Red and puffy gums 
  • Tenderness or discomfort 

Diagnosis

Periodontal disease is diagnosed by your dentist and dental hygienist during your periodontal assessment, which is an important part of your initial comprehensive examination or periodic recall examination. This type of exam should always be part of your regular dental check-up.

A periodontal probe is gently used to measure the sulcus (pocket or space) between the tooth and the gums.  The depth of a healthy sulcus measures three millimeters or less and does not bleed.  The periodontal probe helps indicate if pockets are deeper than three millimeters.  As periodontal disease progresses, the pockets usually get deeper.

Your dentist and hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, and more important diagnostic information, to make a diagnosis that will fall into a category below:

Gingivitis

Gingivitis is the mildest form of periodontal disease and caused by inadequate oral hygiene.  Plaque and its toxin by-products irritate the gums, making them inflamed, red and cause them to bleed easily. There is often no discomfort during this stage and it is reversible with good home care and professional treatment.

Periodontitis

This is the advanced form of gum disease and consists of a number of different presentations. Unremoved plaque hardens into calculus, commonly called tartar.  As calculus and plaque continue to build up, toxins are produced and stimulate a chronic inflammatory response, resulting in a breakdown of the tissues and bone that support the teeth.  As the disease progresses, deeper pockets form between the gums and teeth and become filled with bacteria.  There are often mild symptoms. In severe and untreated cases, teeth can become loose and may have to be removed. 

Over 40% of adults over the age of 30 have some form of periodontitis and the risk increases with age. Over 60% by age 65 have some form of advanced periodontal disease.

Treatment

Periodontal treatment methods depend upon the type and severity of the disease. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.

If the disease is caught in the early stages of gingivitis, and no damage has been done, regular cleanings will be recommended.  You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (also known as a deep cleaning) will be recommended.  It is usually done one quadrant of the mouth at a time while the area is numb.  In this procedure, calculus, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing.)  This procedure helps gum tissue to heal and encourages deeper pockets to shrink.  Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing. Mostly, after scaling and root planing, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain health.

If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean.  We may also recommend that you see a periodontist (gum specialist). You will receive care instructions for veneers. Our post-operative care instructions are also provided here on our website for easy access. 

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