Periodontal diseases in it's most basic sense is an
infection. For an infection to occur, three things are required: an infectious agent
(bacteria), a susceptible host (the patient's mouth) and a method of transmission.
A great deal of time and money have been invested by researchers
trying to understand what causes periodontitis and how we can prevent it. It's an
important puzzle to solve because of the numbers! Periodontal disease is a widespread
public health problem. Studies have shown that about 90 per cent of Americans will at some
point of their lives become afflicted by this disease.
We have been able to isolate many of the bacteria which are
responsible for the majority of the damage. We know how to eradicate them in almost all
cases. We understand how the body's reaction to these bacteria can in fact accelerate the
damage by releasing chemicals (inflammatory mediators) that destroy collagen and increase
loss of bone. We also know how to bolster the body's resistance to this process. The
hardest part is getting our patients to realize that they control the progress of their
disease through their actions. The smoking patient will experience more episodes of
disease recurrence following treatment as will the patient who refuses to floss. There are
only a very few patients that will continue to lose bone and teeth no matter what
treatment is done.
The typical classification of disease is based upon the severity of
The four stages of periodontal disease are:
I. Gingivitis--The gums are inflammed. They may be red, swollen and
bleed with flossing. This is usually reversible with cleaning and thorough home hygiene.
II. Early Periodontitis--The infection is just beginning to destroy
the bone that anchors your teeth. It can be arrested and controlled. Usually a deeper form
of cleaning called root planing with thorough home hygiene is all that is needed
III. Moderate Periodontitis--The infection has caused significant
supporting bone loss which is easily visible on a dental X Ray. It can be arrested and
contained, however at this point, surgical therapy may be required.
IV. Advanced Periodontitis--Severe bone loss is noted. Some teeth
may be loose already. This must be treated aggressively, or tooth loss will soon result.
Your dentist may advise surgery or refer you to a periodontist.
In the pictures below, notice the accumulation of plaque and
calculus around the teeth. As this occurs, the supporting bone for the teeth is damaged.
In cases where significant damage has already occurred, looseness or "mobility"
may be noted. The process must be stopped or tooth loss will occur.
Your examination will consist of a gentle measuring of the tissue
around your teeth. A small rounded instrument with millimeter markings determines if your
tissue may be inflamed from plaque and how far the damage has gone. A current set of
dental X-rays may be obtained. Usually, that is all that is necessary for a complete
diagnosis of the degree of your particular condition.
Treatment for Periodontits:
The type of treatment you will require varies from case to case. It
depends on how far the damage extends into the bone.
The first phase of care is usually a thorough scaling to remove the
calculus, or "tartar" below the gumline. The roots may have to be smoothed by
root planing so that the gums can heal better. Next, you will be educated in how to clean
your teeth at home properly to avoid damage caused by the redepositing of plaque on your
teeth Home care must be performed daily. You will be shown how to do this and some
products may be recommended to help you keep you mouth cleaner.
A remeasuring of your gums will take place after the doctor has
determined that a significant length of time has passed to allow for adequate healing. A
decision will be made as to whether any additional treatment is required. If you are ready
to enter the mainenance phase of your treatment with periodic cleanings, they will be
scheduled at an interval conducive to preventing any recurrence of periodontitis
. Periodontal therapy works! New equipment, techniques and
anesthetics make this care more comfortable than ever. More effective medications are
available to help keep you comfortable and we will tailor them to suit.