1. Why do I need to see a Periodontist?
A periodontist specializes in the surgical and non-surgical management of periodontal diseases, the surgical treatment of correcting gingival abnormalities (gingival recession, gummy smiles, etc), all phases of dental implant treatment planning and surgery, and management of dental implant complications.
2. What is Periodontal (Gum Disease)?
80 percent of American adults currently have some form of gum disease.
A) Gingivitis: Is the inflammation of the gums without the presence of bone loss.
- Bleeding gums (blood on toothbrush even with gentle brushing of the teeth)
- Bright red or red-purple appearance to gums
- Gums that are tender when touched, but otherwise painless
- Swollen gums
- Shiny appearance to gums
B) Periodontitis: inflammation and infection of the tissues that support the teeth including bone
- Gums detach from the teeth and form "pockets" that are infected with bacterial plaque. The body's immune system fights the bacteria as the plaque grows and matures below the gum line. Bacteria release toxins and the body produces enzymes to fight the infection. These enzymes actually start to break down the bone and gum tissue that support your teeth. As this process continues, the bone and gums that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.
3. What causes Periodontal Disease?
Bacteria contained in dental plaque on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form calculus ["tartar"] that brushing doesn't remove. Only a professional cleaning by your dentist or periodontist can remove tartar.
Dental plaque scanning electron micrograph illustrating different microbes
4. Are there any risk factors that contribute to periodontal disease?
Genetic predisposition: Some people are more prone to severe periodontal disease than others.
Smoking: Smoking impairs healing so the body can not resist bacterial damage. Smoking is one of the most significant risk factors associated with the development of periodontitis. Additionally, smokers tend to respond less well to periodontal therapy than non-smokers.
Diabetes: People with diabetes are at higher risk for developing infections, including periodontal disease.
Hormonal changes in girls/women: These changes can make gums more sensitive and make it easier for gingivitis to develop.
Certain medications: Some drugs, such as antidepressants and some heart medicines, can affect oral health because their side effects are dry mouth. (Saliva has a protective effect on teeth and gums.)
5. What is a deep cleaning?
The removal of the plaque and tartar that forms around your teeth above and below the gum line. This therapy is called scaling and root planing and it is usually done under local anesthesia. Sometimes the use of antibiotics in combination with a deep cleaning can be very beneficial and can prevent the need for periodontal surgery. The goal is to bring your gums back to their optimum health by reducing, or eliminating any pockets around the teeth, which harbor infection.
6. What is Periodontal Surgery?
Open Flap Surgery: After scaling and root planing is done, you will undergo a periodontal re-evalution. If you still have periodontal disease after your deep cleaning, surgery might be necessary to gain access to remove tartar deposits in deep pockets. This common surgery involves lifting back the gums and cleaning the infected areas. The gums are then sutured back in place.
Bone and Tissue Grafts. In addition to flap surgery, you may also need a bone graft. Grafting is done to rebuild the bone destroyed by infection. This technique is called guided tissue regeneration, in which a bone graft (taken from cadavers or cows) is placed into the bony defects and then covered with a collagen membrane to keep it in place. The goal of this therapy is to regenerate the lost bone.
Since bone loss varies from case to case, it is impossible to predict with certainty the degree of which grafts will be successful over the long-term. The outcome will be determined by the severity of the disease, your oral hygiene and the risk factors that contribute to periodontal disease.
7. What happens the day of the surgery?
You should eat well before your periodontal procedure. We can provide you with valium or nitrous oxide (laughing gas) to help you relax through the periodontal procedure. We also have headphones that block the noise, so you are welcome to bring your ipod.
Periodontal surgeries usually take 1-2 hours. You must go home and rest the day of your procedure. We will give you post-operative instructions.
8. Why are Periodontal maintenance visits important?
Periodontal supportive therapy after active treatment is necessary for the supervision and maintenance treatment of your gums and teeth.
Periodontal disease is always subject to recurrence. With regular office visits, your diligent attention to prescribed home care, and a good physical health, the tendency for recurrence is minimized. If, however, certain areas show signs of relapsing, they are discovered early. At this stage minimal treatment is usually required.
9. How can periodontal (Gum) treatment be less uncomfortable?
Nitrous Oxide Sedation (laughing gas) is used is to eliminate dental anxiety, making you more comfortable while we are able to more effectively complete the periodontal procedures.
10. What is Gingival (Gum) recession?
Gum recession is the loss of gum tissue causing exposure of the root surface. Recession may cause tooth sensitivity to cold, to sweet foods, or to touch. It may be accompanied by bone loss and may make the teeth more vulnerable to root cavities.
We have two types of gum tissue: One that is thick and attached to the teeth, and one that is unattached and movable that makes up the inside of the lips and cheeks. When recession occurs, sometimes the attached tissue is lost which requires treatment to solve.
11. Why do I have gum recession?
The main cause is an irregular or “abnormal” tooth position that leads to a loss of soft tissue. Recession occurs in response to overaggressive brushing but can also be hereditary. One could simply have thin, delicate or insufficient gum tissue. Most people have some slight recession.
12. What is the treatment for gum recession?
If gum recession progresses without treatment it can lead to bone loss and sensitivity. Treatment involves a grafting procedure, in which soft tissue is removed from the roof of the mouth or from donor tissues and stitched to the area.
13. How can missing teeth be replaced?
Fixed bridges, removable prosthesis or dental implants are all possibilities to replace missing teeth. Rather than resting on the gum line like removable dentures, or using adjacent teeth as anchors like fixed bridges, dental implants are long-term replacements that can be surgically placed in the jawbone.
A dental implant designed to replace a single tooth is composed of three parts: the titanium implant that fuses with the jawbone; the abutment, which fits over the portion of the implant that protrudes from the gum line; and the crown, which is created by your restorative dentist and fitted onto the abutment for a natural appearance.