Denta Joy Services

Periodontics

 

 

Periodontal Disease

Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. There are numerous disease entities requiring different treatment approaches. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Daily brushing and flossing will prevent most periodontal conditions.

Why is oral hygiene so important? Adults over 35 lose more teeth to gum diseases, (periodontal disease) than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal disease is by good tooth brushing and flossing techniques, performed daily. Periodontal disease and decay are both caused by bacterial plaque. Plaque isa colorless film, which sticks to your teeth at the gumline. Plaque constantly forms on your teeth. By thorough daily brushing and flossing you can remove these germs and help prevent periodontal disease.

Periodontal diseases can be accelerated by a number of different factors. However, it is mainly caused by the bacteria found in dental plaque, a sticky colorless film that constantly forms on your teeth. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar).

Healthy gums
  • Gum are firm,coral pink in color and do not bleed.
  • No gum recession is present.
  • Teeth are held firmly in place with no damage to supporting bone structure
Gingivitis
  • Gums appear red and swollen.
  • Bleeding may occur when gums are touched.
  • Teeth are still firmly in place with no damage to supporting bone structure
Periodontitis
  • Loss of gum/tooth attachment occur.
  • Pockets form between teeth and gums.
  • Tissue that binds teeth to bone is inflamed.
  • Bone loss occurs.
Advanced periodontitis
  • Gums recede dramatically from teeth.
  • Pockets deepen severely and may hold pus.
  • Teeth become extreamely loose and may fall out or need to be extracted.
  • Severe bone loss occurs.

Periodontal Disease

Bacteria found in plaque produces toxins or poisons that irritate the gums, which may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.

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Preventing Gum Disease

The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.

Other important factors affecting the health of your gums include:

  • Smoking
  • Diabetes
  • Stress
  • Clenching and grinding teeth
  • Medication
  • Poor nutrition

Gingivitis is mild gum disease that only affects the gingiva, or gums, the tissue surrounding the teeth. Gum disease that progresses and spreads below the gum line to damage the tooth-supporting tissues and bone is called periodontitis .

  • Gingivitis causes red, swollen gums that bleed easily when brushed. Because gingivitis usually doesn't cause pain, many people don't get the treatment they need.
  • Periodontitis develops if gum disease progresses. The gums pull away from the teeth, leaving deep pockets where bacteria can grow and damage the bone that supports the teeth. Gums can also shrink back, or recede. This can make the teeth look longer. Teeth may become loose, fall out, or have to be removed.

 

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Scaling and Root planing

Many times, the early stages of periodontal disease are best treated with non-surgical periodontal therapy. Even in severe cases of periodontal disease, non-surgical periodontal therapy often precedes surgical therapy. This is done to improve the overall tissue quality prior to surgery and also to help limit the areas requiring surgery.

Treatment methods depend upon the type of disease and how far the condition has progressed. The first step is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits below the gumline.

The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.

Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, your doctor may place an antibiotic in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.

When deep pockets between teeth and gums are present, it is difficult for your doctor to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health. Surgical Services Procedures

Denta-Joy practice provides a variety of surgical services. We pride ourself on the fact that we are very conservative in our treatment recommendations and limits surgery to the areas where it is absolutely necessary. Periodontal procedures are available to regenerate the bone and gum tissue to their original function and cosmetic appearance.When decay occurs below the gumline, it may be necessary to remove a small amount of bone and gum tissue. Our dentist may ask for this procedure before he or she makes a new crown for your tooth.

Reshaping the gum and supporting tissues: This will allow your general dentist adequate room to place a quality final restoration.

Final Restoration: Another indication for crown lengthening is when the front teeth are too short or of uneven length.

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Cosmetic Periodontal Surgery

These procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of periodontal procedures by our periodontist and cosmetic dentistry by our dentist.

Crown Lengthening

When decay occurs below the gumline, it may be necessary to remove a small amount of bone and gum tissue. Your dentist may ask for this procedure before he or she makes a new crown for your tooth.

Reshaping the gum and supporting tissues: This will allow your general dentist adequate room to place a quality final restoration.

Final Restoration: Another indication for crown lengthening is when the front teeth are too short or of uneven length.

Gingivectomy for gum disease

You may need surgery for severe gum disease (periodontitis) if it cannot be cured with antibiotics or root planing and scaling. A gingivectomy removes and reshapes loose, diseased gum tissue to get rid of pockets between the teeth and gums. A gum specialist (periodontist) often will do the procedure.

The doctor will start by numbing your gums with a local anesthetic. He or she may use a laser to remove loose gum tissue.

After removing the gum tissue, the doctor will put a temporary putty over your gum line. This will protect your gums while they heal. You can eat soft foods and drink cool or slightly warm liquids while the putty is in place and your gums are healing.

What To Expect After Surgery

You can return to your normal activities once the anesthetic wears off. It usually takes a few days or weeks for the gums to heal.

Most gum surgeries are fairly simple and are not too uncomfortable. You can take ASA, ibuprofen (such as Advil or Motrin), or acetaminophen (such as Tylenol) to reduce pain. After a gingivectomy, it will be easier for you to keep your teeth and gums clean.

The contour or shape of your gums may change.

Why It Is Done

A gingivectomy is necessary when the gums have pulled away from the teeth, creating deep pockets. The pockets make it hard to clean away plaque. Gingivectomy is usually done before gum disease has damaged the bone supporting your teeth.

How Well It Works

If you maintain good dental care after surgery, a gingivectomy is likely to help stop gum disease. Your gums should become pink and healthy again.

What To Think About:

  • Gingivectomy may help keep gum disease from further damaging your gum tissue, teeth, and bones by helping you to clean better around and between your teeth. If bones are damaged, it is more likely that you will lose your teeth.
  • Gum disease usually will progress if you do not brush and floss regularly after surgery or if you continue to use tobacco.
  • To promote healing, stop all use of tobacco. It decreases your ability to fight infection of your gums and delays healing. For more information, see the topic Quitting Tobacco Use.
  • Regular follow-up with your dentist is important. If your gum disease gets worse, you may need a different type of surgery.

Risk :

Gum surgery can introduce harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for developing a severe infection, such as:

  • Damaged or artificial heart valves.
  • A congenital heart defect.
  • An impaired immune system.
  • Liver disease (cirrhosis).
  • Artificial joints, such as a hip replacement.
  • A history of bacterial endocarditis.

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Gum Grafting Procedures

(Subepithelial connective tissue grafts)

When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem gum reconstruction using grafting techniques is an option.

When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost.

In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. Also, gum recession, when significant, can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging.

A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth, or gently moved over from adjacent areas, to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root.

The gingival graft procedure is highly predictable and results in a stable healthy band of attached tissue around the tooth.

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Bone Grafting Procedures

Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of Dental Implants. In these situations, most patients are not candidates for placement of Dental Implants.

We now have the ability to grow bone where needed. This gives us the opportunity to place implants of proper length and width, and it also gives us a chance to more effectively restore esthetic appearance and functionality.

Guided Tissue Bone Regeneration

This surgical procedure "regenerates" the previously lost gum and bone tissue. Most techniques utilize membranes, which are inserted over the bone defects. Some of these membranes are bio-absorbable and some require removal. Other regenerative procedures involve the use of bioactive gels.

Ridge Preservation

Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and a better cosmetic outcome of tooth replacement.

Non-surgical services procedures

We can use modern techniques to help rebuild lost bone support. The emphasis in Denta-Joy's practice is conservative periodontal therapy. Many times, the early stages of periodontal disease are best treated with non-surgical periodontal therapy. This usually consists of placing a fine ultrasonic tip in between the tooth and gum tissue to remove any plaque and calculus below the gum line. This procedure is called root planing. Four to six weeks later, periodontal pockets are eliminated due to gum shrinkage. Then the patient can personally maintain these areas with routine brushing and flossing.

Even in most severe cases of periodontal disease, non-surgical periodontal therapy most often precedes surgical therapy. This is done so that the overall tissue quality is improved prior to surgery and also limits the areas of required surgery.

Treatment Methods

Treatment methods depend upon the type of disease and how far the condition has progressed. The first step is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gumline. The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.

Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, our periodontist may place antibiotic fibers in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.

When deep pockets between teeth and gums are present, it is difficult for our periodontist to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodon tal health.

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Pregnancy and Gingivitis

Will pregnancy affect my oral health?

Expectant mothers experience elevated levels of the hormones estrogen and progesterone. This causes the gums to react differently to the bacteria found in plaque, and is many cases can cause a condition known as "pregnancy gingivitis." Symptoms include swollen, red gums and bleeding of the gums when you brush. Remember that it is the bacteria in the plaque and not the hormones that cause gingivitis. Brushing, flossing and any other plaque removal aids that have been recommended will prevent gingivitis during pregnancy.

What are "pregnancy tumors?"

Pregnancy tumors (pyogenic granuloma) are rare, usually painless lesions that may develop on your gums in response to plaque. Although they are not cancerous, they should be treated.

Could gingivitis affect my baby's health?

New research suggests a link between pre-term, low birth weight babies and gingivitis. Excessive bacteria, which cause gingivitis, can enter the bloodstream through your gums. If this happens, the bacteria can travel to the uterus, triggering the production of chemicals called "prostaglandins, " which are suspected to induce premature labor.

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Can I receive dental treatment while I'm pregnant?

Good oral health is vital during your pregnancy. Continue with your regular dental cleaning and check-ups to avoid oral infections that can affect the fetus, such as gingivitis and periodontal disease.

Major treatments that aren't urgent can be postponed until after the child is born. Emergency treatment can safely be done during pregnancy.

If I do need treatment, what drugs are safe?

One should be cautious of all drugs during pregnancy. Local anesthetics such as novocaine or lidocaine can be taken safely. If antibiotics are needed to treat an infection, many can be safely taken. For pain products containing acetaminophen, such as Tylenol, are approved, but you should be wary of other over-the-counter medications such as aspirin or ibuprofen. Avoid using narcotics for pain until after the child is born.

Oral Pathology

The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathologic process or cancerous growth:

  • Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
  • A sore that fails to heal and bleeds easily
  • A lump or thickening on the skin lining the inside of the mouth
  • Chronic sore throat or hoarseness
  • Difficulty in chewing or swallowing

These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology and, curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer. We would recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body's most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help.

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Oral Hygiene Procedures

While brushing the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes. Use light pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort.

When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.

To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don't forget to gently brush the surrounding gum tissue.

Next you will clean the biting surfaces of your teeth. To do this use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing.

If you have any pain while brushing or have any questions about how to brush properly, please be sure to call the office.

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How to Floss:

Periodontal disease usually appears between the teeth where your toothbrush cannnot reach. Flossing is a very effective way to remove plaque from those surfaces. However, it is important to develop the proper technique. The following instructions will help you, but remember it takes time and practice.

Start with a piece of floss (waxed is easier) about 18" long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand.

To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss tightly between the teeth using a back-and-forth motion. Do not force the floss or try to snap it in to place. Bring the floss to the gumline then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn from one finger to the other to get a fresh section. To clean between the bottom teeth, guide the floss using the forefinger of both hands. Do not forget the back side of the last tooth on both sides, upper and lower.

When you are done, rinse vigorously with water to remove plaque and food particles. Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque your gums will heal and the bleeding should stop.

Caring for Sensitive Teeth

Sometimes after dental treatment, teeth are sensitive to hot and cold. This should not last long, but only if the mouth is kept clean. If the mouth is not kept clean the sensitivity will remain and could become more severe. If your teeth are especially sensitive consult with your doctor. They may recommend a medicated toothpaste or mouth rinse made especially for sensitive teeth.

Choosing Oral Hygiene Products

There are so many products on the market it can become confusing and choosing between all the products can be difficult. Here are some suggestions for choosing dental care products that will work for most patients.

Automatic and "high-tech" electronic toothbrushes are safe and effective for the majority of the patients. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque. You need to brush and floss in conjunction with the irrigator. We see excellent results with electric toothbrushes called Rotadent and Interplak. Some toothbrushes have a rubber tip on the handle, this is used to massage the gums after brushing. There are also tiny brushes (interproximal toothbrushes) that clean between your teeth. If these are used improperly you could injure the gums, so discuss proper use with your doctor.

Fluoride toothpastes and mouth rinses if used in conjunction with brushing and flossing can reduce tooth decay as much as 40%. Remember, these rinses are not recommended for children under six years of age. Tartar control toothpastes will reduce tartar above the gum line, but gum disease starts below the gumline so these products have not been proven to reduce the early stage of gum disease.

Anti-plaque rinses, approved by the American Dental Association, contain agents that may help bring early gum disease under control. Use these in conjunction with brushing and flossing.

Your periodontist is the best person to help you select the right products that are best for you.

Professional Cleaning

Daily brushing and flossing will keep dental calculus to a minimum, but a professional cleaning will remove calculus in places your toothbrush and floss have missed. Visit your periodontist, as he or she is an important part of your program to prevent gum disease. Keep your teeth for your lifetime.

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