What is Periodontal Disease?

Periodontal (gum) diseases are chronic infections of the tissues which surround and support the teeth. Not only can these diseases lead to tooth loss, but there is increasing evidence that they can also affect your overall health.

Periodontal disease begins with an accumulation of dental plaque, which is a collection of bacteria that constantly form around your teeth. Plaque is a soft, sticky film which can be easily removed with a toothbrush and dental floss (remember that a toothbrush doesn’t reach in between the teeth). If plaque is left on the teeth, it mineralizes to form a hard deposit (tartar).

The early form of the disease is called gingivitis and the signs of this disease can be quite subtle. They include swelling, redness and bleeding of the gums. The treatment for gingivitis is usually a thorough cleaning of the teeth at the dentist’s office. If left untreated, gingivitis can often progress to periodontitis. This is a more severe form of the disease in which bacteria and the body’s own immune system attack the ligaments and bone that hold teeth in place. If periodontitis is not treated, it will lead to bone loss and loss of teeth.

There are many factors which an affect a person’s susceptibility to periodontal disease, including genetics, smoking, diabetes and hormonal changes associated with puberty or pregnancy. Certain medications can also affect your gum tissues.

Treatment of Periodontal Disease

Non-Surgical Treatments

Non-surgical periodontal treatment involves scaling and root planing (“deep cleaning”). This is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smoothen the tooth root to remove bacterial toxins, followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis.

Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Antimicrobial Therapy

Anti-microbial therapy is the use of antibiotics or antiseptics in localized or generalized oral bacterial infections.

In the treatment of periodontal disease, anti-microbial therapy is used in the special situation of the periodontal abscesses and in the more general condition of severe periodontitis which is resistant to mechanical procedures such as dental scaling and root planning.

Re-Evaluation

Between 4-6 weeks after the initial therapy is completed, Dr. Jang will re-examine your periodontal health in order to evaluate the healing that has occurred, determine if additional treatment is recommended and plan the latter. Treatment may consist of periodontal surgery, non-surgical treatment and preventive maintenance visits. This important phase confirms the short term improvement in your periodontal condition and determines the long term potential that can be obtained with further treatment.

Maintenance / Prevention

Maintenance therapy is an ongoing program designed to prevent disease in the gum tissues and bone supporting your teeth. The building blocks of this program are simple: conscientious care of your mouth at home and regular maintenance visits with your dentist and periodontist. The main cause of gum disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. Toxins (or poisons) produced by the bacteria in plaque constantly attack your gums and teeth. If the plaque is not removed, it hardens into a rough porous deposit called calculus, or tartar. Daily oral hygiene including brushing and flossing will keep the formation of calculus to a minimum, but it won’t completely prevent it. No matter how careful you are in cleaning your teeth and gums, bacterial plaque can cause a recurrence of gum disease from two to four months after your last professional cleaning. To keep your teeth and gums healthy, a dental professional must check for potential hidden problems and remove the hardened plaque at a time interval appropriate for you.

Surgical Treatments

If you are diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the two types of surgical treatments most commonly prescribed:

Different types of periodontal conditions may require different types of surgical treatment. Surgery is completed in our office using local anesthesia (“freezing”). General sedation is available off-site for extremely apprehensive patients.

Pocket Reduction Surgery

Pocket Reduction Surgery is performed to decrease or reduce the depths of the pockets around your teeth. The gum is lifted and rolled back creating a “gum flap.”  This provides direct access to the roots for a careful inspection and smoothing/debridement (removal of any debris attached to the root surfaces of the tooth) and removal of any diseased gum tissue.    Irregular surfaces of bone that have been damaged by gum disease are gently reshaped to allow a better “fit” of the gum tissue to the bone around the roots.

Regenerative Surgery

Similar to Pocket Reduction Surgery, the gum is lifted and rolled back creating a “gum flap,” providing direct access to the roots for a careful inspection and smoothing/debridement (removal of any debris attached to the root surfaces of the tooth) and removal of any diseased gum tissue. At that time, Dr. Jang will carefully evaluate the pattern of bone loss around the roots to determine if regeneration materials (bone graft and/or membrane) may be placed to help your body replace lost bone. This is not always an option. Dr. Jang will advise you if this procedure may help contribute to a favourable outcome.