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).
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.
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:
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 .
- Clenching and grinding teeth
- Poor nutrition
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.
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
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.
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
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.
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.
Gum Grafting Procedures
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.
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.
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
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
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.
Pregnancy and Gingivitis
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
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.
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.
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.
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
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
Major treatments that aren't urgent
can be postponed until after the child is born.
Emergency treatment can safely be done during
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.
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
- A lump or thickening on the skin
lining the inside of the mouth
- Chronic sore throat or hoarseness
- Difficulty in chewing or
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.
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
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
If you have any pain while brushing or have any
questions about how to brush properly, please
be sure to call the office.
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
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
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.
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