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Treating Gum Disease

What is Periodontal Disease and why do I need to treat it?

Periodontal disease, or gum disease, can present as bleeding of the gums, loosening or drifting teeth, lengthening of the appearance of the teeth due to receding gums and underlying bone loss, pus coming from the gums, foul breathe, and sometimes pain and/or swelling.  The most common form of gum disease involves only bleeding gums and is called gingivitis. Gingivitis is most often caused by poisons produced by plaque that lye along the gumline and cause irritation, but it can also be caused by fillings that are built too deep into the gums (compromised biologic width), reactions to dental filling materials, diseases like leukemia, or even some medications.  Periodontal disease usually occurs after untreated gingivitis and can occur when the patient is genetically predisposed to gum disease and when the right types of bacteria (germs) are present in the mouth.  Healthy patients that have adequate home care can usually fight the occurrence of gum disease because their bodies have adequate immune systems that can fight off infection.  However, when the immune system becomes compromised as occurs in smokers, in aging people, in people with systemic diseases, etc., gum disease can attack.

In periodontitis, which used to be called pyorrhea, the skin because diseased and fails to provide an adequate barrier to the bone.  The bone supporting the teeth then becomes infected.  The body tries to avoid the plaque and tartar that harbors the offending germs by running away.  The bone actually shrinks away in response.  Eventually, the tooth will be lost.  However, along the way, swelling, pus, and pain can occur.  Usually there is also quite a bit of bleeding in the gums during brushing, and the infection causes significant bad breathe.

Once a person is diagnosed with gum disease, they always have gum disease.  Gum disease, at this point in time, cannot be cured.

It can be managed, however, by thorough debridement (different degrees of “cleaning”), which may even require surgery.  Typically, the most conservative treatments are attempted first, reserving surgery for areas that do not respond adequately to non-surgical treatments.  Once the gum disease is initially managed, there are now treatments that may be considered to try to regain some of the bone lost due to gum disease.  Typically, gum disease patients, however, need to be maintained with professional dental maintenance recall visits every 3-4 months for the remainder of the life of their teeth.

The first treatment for gum disease, periodontitis, usually involves non-surgical root planing

This is sometimes called “deep cleaning.” Precision mechanical hand instruments and often ultrasonic instruments are used to remove heavy tartar accretions and to plane the roots smooth to remove diseased build-up on the roots of the teeth. This procedure may require the teeth to be numb for comfort.

Modern therapeutic protocols often also include irrigation with a variety of medications, and sometimes adjunctive antibiotics are prescribed or specifically placed in deep periodontal pockets. Once scaling and root planing has been completed, it is very important that professional recare is provided every 90 days because research has shown that destructive colonies of periodontitis-causing bacteria take 90 days to mature.

If non-surgical therapy fails to achieve its desired result, periodontal surgery may be needed.

This can sometimes be done with a laser, or it may be done by making an incision in the gums to lift them up so that the root surfaces can be seen directly and bone grafting procedures or bone reshaping may be done at this time to improve the ability of the patient to clean the teeth and to promote healing.

Patients who need advanced periodontal therapy may be referred to a gum specialist, called a periodontist, but in the appropriate situations general dentists like Dr. Huff can perform these surgical procedures.

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