PERIODONTAL HEALTH, GINGIVITIS, PERIODONTITIS AND SCALING AND ROOT PLANNING (DEEP CLEANINGS)
An important part of having good oral health is to have healthy gums. In general, patients are most concerned about their teeth and forget that their gums, are just as important as their pearly whites. Healthy gums protect your teeth from bacteria and keep the bone that supports them strong and sturdy. There are millions of bacteria in our mouth and they use the ingredients in our saliva and in our diet to grow and form dental plaque. It is a colorless, soft, sticky film of bacteria and sugars that constantly forms on your teeth, and grow, at and underneath your gum line. If undisturbed it can harden to form tartar (calculus). Dental plaque is the main cause of cavities and gum disease. Everyone develops dental plaque.
Many patients have been told that they suffer from gum disease which is also called periodontal disease. If this has happened to you, you are not alone, more than 75 % of all adults in the United States have some kind of gum disease. Periodontal disease is made of many diseases and the two most common are gingivitis and periodontitis. It is generally accepted that periodontal disease is primarily caused and made worse by the bacteria located in your dental plaque. The disease can range from a localized simple gum inflammation to a more generalized inflammation involving the soft tissues and bone structure of several teeth. Depending on how extensive and how long the inflammation has been ongoing, without treatment, you can lose some or all your teeth.
The most common and well-known form of gum disease is gingivitis. In this stage the bacteria in the plaque builds up, causing the gums to become, red, inflamed and to easily bleed. It is usually painless. Although the gums are affected, the teeth are still firmly held in their bony sockets and no irreversible damage has occurred to the gums or bone. If you do not treat gingivitis it may progress to Periodontitis.
Periodontitis is the second most well-known gum disease. It is also thought of as a painless disease and the patient is usually not aware of its progression until major damage has occurred. In its early stages very few signs and symptoms are experienced. Some of these signs are occasional bleeding during brushing, bleeding during flossing, discoloration of the gingiva, usually in the areas in between the teeth (a darker red) and softening of the gum.
Periodontitis usually begins when the gums become inflamed due to plaque buildup. Once inflamed the gums begin pulling away from the teeth to form pockets which become infected with bacteria from the dental plaque. As the pockets become deeper, there will be a greater concentration of bacteria below the gum line that allows the progression and severity of this disease. It has been repeatedly shown that when the pockets become abnormally deep the patient cannot reach and clean the depth of these “deep pockets” and the body’s immune system will be activated. The reaction between the toxins produced by the bacteria and the body’s immunological defense system will start to break down the bone and tissue that hold the teeth in place. If allowed to advance without treatment, the bones, gums, and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.
Periodontitis is treatable. Although factors such as smoking, heredity, medications and lowered immunity make you more susceptible to gum disease, the most common cause is long term poor oral hygiene and the lack of professional dental care. Over time, poor oral hygiene and the lack of professional dental cleanings, allow periodontal pockets to form around the teeth and become worse. Patients cannot reach the depth of these pockets to clean them and progression of the disease occurs. Daily brushing and flossing and regular professional cleanings can greatly reduce your chances of developing periodontitis and its progression. Unfortunately, if you have periodontal disease you cannot do it all at home. You need professional care to monitor you and to treat you, especially during those times when the disease is more active. Whether your periodontal disease is stopped, slowed, or allowed to get worse depends on how well you care for your teeth and gums every day, and if you seek professional help by a dentist.
In summary, It is important to understand that periodontitis is a silent disease. Those who suffer from it rarely experience pain, and may not even be aware that they have a problem. The early stages of gum disease have very few warning signs. Some of the early warnings to look for are bleeding while brushing, softening of the gums, and discoloration of the gums (darker red/irritated in appearance rather than a light, healthy pink). As the disease gets worse, more noticeable signs may become apparent such as inflamed swollen gums that are red and easily bleed, persistent bad breath that does not go away, gums that are tender to the touch, changes in the position of the teeth and pus between the teeth and/or at the margins of the gingiva. The treatment of periodontal disease is twofold and involves home care and the evaluation and treatment by a dental professional.
SCALING AND ROOT PLANNING
To determine whether you have periodontitis and how severe it is we will review your medical history to evaluate any risk factors such as smoking, medications and systemic diseases. X-rays will be taken to look for the presence of calculus, faulty fillings and bone loss. We will examine your mouth to look for the presence of plaque and calculus buildup, check your gingival health for color, contour, consistency, bleeding on probing, presence of suppuration and the presence of gingival recession. We will also examine your teeth for abnormal mobility. Most importantly, the pocket depth formed between your gums and teeth will be measured by a periodontal probe which is a little ruler that tells us how deep the pockets are around each tooth. There are six sites around each tooth that we routinely measure every year and are recorded; it is a painless procedure and no anesthesia is needed and it is done during your cleaning appointments.
The results of the periodontal probing is very important to us and gives us an accurate picture of the health of your gums. We do not only take into account our immediate probing results but we compare them to past years results to see if the probing depths are better, the same, or worse. It forms a history of your periodontal health and enables us to detect a problem at an early stage when it is treatable with better brushing and flossing and other non-intrusive procedures. By monitoring the recordings against each other, our dentists and hygienists at our dental office are able to make sure no areas become progressively worse, or note improvement where treatment has occurred. In those situations where our periodontal exam discovers that some pocket depths are worsening and home care has not improved them we believe in early treatment and intervention and may recommend scaling and root planning.
Scaling and root planning is one of the most effective way to treat periodontal disease before it becomes severe. This is performed after a thorough examination of the mouth and radiographic confirmation. Ideally, normal healthy pockets will be no more than 3 millimeters. If the pockets depths reach 5 mm or greater and are located in multiple sites we will usually recommend the treatment of scaling and root planning; especially if probing results show a progression of the disease for the worse as compared to previous probings. Occasionally even an isolated 5 mm reading deserves a site-specific scaling. However, treatments are always custom for each patient and their specific clinical situations.
Scaling and root planning is one procedure but is compose of two parts. The scaling part involves removing plaque and tartar from the surface of the teeth above and below the gumline making sure to clean all the way down to the bottom of the pocket. We will do this using either with ultrasonic instruments or manual scaling instruments or a combination of both. The other part of scaling and root planning is the root planning part which involves using scaling instruments to smooth the surface of the root of each of the teeth treated so the gum can reattach properly. We usually perform scaling and root planning in two visits dividing the mouth in two halves but on occasion we will divide the mouth into four quadrants either because of medical needs, patient’s wishes or other circumstances. Often the affected area is localized and treatment is very limited and we will only need to treat a couple of affected teeth. Six weeks after the scaling and root planning, the gums are once again examined to ensure that healing is occurring. Patients that have scaling and root planning’s are usually placed on a 3-4 month recall until long term gingival health has been established but recall are always determined on an individual basis.
We believe in early intervention and prevention. By recording periodontal measurements at regular recall appointments, we can detect small problems before they turn into large ones. We will work together to help you identify where these periodontal pockets are, how you can help and what we can do to help them heal. If you’re looking for a dentist, please feel free to call and schedule an appointment.
Periodically, there are news stories claiming to demonstrate an association between periodontal disease and one or more forms of cardiovascular disease. However, both periodontal disease and cardiovascular disease are complex conditions that share common risk factors and saying that two conditions are associated is not the same as saying that one causes the other. The current position of the American Heart Association and the American Dental Association is that while periodontal disease and heart health have an association, additional research is needed to establish whether one causes the other.