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Non Surgical Procedures

Non - surgical periodontal treatments are available for patients with mild to moderately severe forms of periodontal disease.  Most patients in the first two stages and some patients in the third stage can be treated without surgery.

The four stages of periodontal disease are:

I. Gingivitis--The gums are inflamed. 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.

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. Occasionally, an antibiotic and an antimicrobial mouthrinse may be prescribed.  Next, you will be educated in how to clean your teeth at home properly to avoid damage caused by the re-depositing 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.

In the non-surgical phase, the goal is to reduce and control the bacterial colonies that form under the edge of the gum. The second goal is to eliminate any known factors that cause the patient to be more susceptible to breakdown. Primary among these is smoking.

In the early stages of periodontal disease (gingivitis), the gum is infected but the bone has not yet been altered. The pocket depth is generally only slightly deepened, to 4-5 mm. Scaling and root planing ("deep cleanings") are done to remove any calculus that has formed. Removing debris from the crown of the tooth is often referred to as scaling, while root planing (debridment) refers to cleaning the root below the gum. This procedure is sometimes referred to as deep cleaning. To successfully treat periodontal disease it is necessary to adequately debride the periodontal pocket. This is generally accomplished using curettes and/or ultrasonic scalers, although rotary instruments may be useful. Adequately cleaning a periodontal pocket takes time and skill, and many feel it is the most technically demanding procedure performed by dentists. Often a local anesthetic is used to assure patient comfort.

If the pockets are tender, numbing the gums is often necessary so there will be no discomfort during the procedure. There is little or no pain afterward. The patient must keep plaque from reforming by daily brushing and flossing. The healing gum will snug back up around the root, and health will return. Daily plaque removal with regular dental cleanings will prevent a reoccurrence.

Scaling removes plaque & calculus Root planing smoothes the root surface

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 maintenance phase of your treatment with periodic cleanings, they will be scheduled at an interval conducive to preventing any recurrence of periodontitis.

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