Local Dental Care - Gum Disease

Dental Procedure, Pocket Depth Reduction

As the bacteria that cause periodontal disease release toxic substances, they trigger the breakdown of gum and bone. The gum then separates from the teeth, forming gaps that are called periodontal pockets. Bacteria settle in these pockets and because they cannot be removed by the patient's daily oral hygiene, they continue to accumulate and reproduce. Without proper treatment, the bacteria will continue to populate these pockets, creating further gum and bone destruction.

The first step in the treatment of periodontal disease involves the removal of the bacteria that inhabit the periodontal pockets in the form of plaque and tartar. The removal of the pocket irritants, scaling and root planing is combined with oral hygiene instructions that are aimed at improving the patient's ability to control plaque and avoid bacteria from re-infecting the periodontal pockets. Several weeks after completion of scaling and root planing, a periodontal re-evaluation should be completed to assess the healing response. If the periodontal pockets do not reduce to below 4 mm and the gums are still unhealthy, surgical treatment may be indicated.

Pocket depth reduction is a term used for a series of different surgical procedures (gingivectomy, flap surgery, osseous surgery). The purpose of these procedures is to gain access to the root surface to effectively remove calculus and to reduce the size of the pockets to help prevent bacteria from settling in.

What to Expect

Pocket depth reduction is done in the dentist's office with local anesthesia (lidocaine). After lifting the gum back, the bacterial plaque and tartar are removed from the root surfaces. It also may be necessary to remove the infected gum tissue and to smooth the bone surface. Stitches (sutures) are placed to aid in healing. The stitches are usually removed five to ten days after the surgery. Follow-up appointments are scheduled as necessary to evaluate healing and plaque control.

Post-surgical discomfort may last a few days and is usually minimal. It can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after surgery. A dentist will provide special instructions related to diet, exercise, and medications.

After pocket depth reduction, patients may experience heightened tooth sensitivity. This is temporary and usually resolves within a few weeks. There are chemical aids available that help reduce sensitivity.

Some people also may experience looser teeth after periodontal surgery. This also is a transient finding that occurs as part of the normal healing process. With proper plaque control and bite adjustment, the teeth usually tighten up in a few weeks.

Another concern after pocket depth reduction is that the teeth may appear longer and that there are spaces in between the teeth. Actually, longer teeth are the result of periodontal disease, not of periodontal surgery. As periodontal disease infects and destroys the bone that encases the roots, the root surfaces become exposed. They do not appear exposed because they are covered by the inflamed, swollen gums that form the periodontal pocket. Without proper treatment, the periodontal pockets continue to deepen, giving way to more infection, bone loss, and eventually tooth loss and systemic complications.

There are treatments that can help improve esthetics after periodontal treatment. In addition to periodontal plastic surgery procedures, orthodontic tooth movement (braces) or restorative treatment (crown and bridges) can help create a more pleasing smile line.

Benefits

If periodontal pockets do not resolve after scaling and root planing, a dentist may recommend pocket depth reduction. Whether a dentist performs a gingivectomy, periodontal flap surgery, or osseous surgery, the patient will benefit from the reduction in pocket depth and the reattachment of the gums to the root surface. Pocket depth reduction, when followed by supportive periodontal treatment, is a predictable procedure that can help keep teeth healthy and reduce the risk of serious health problems related to periodontal disease. If a general dentist does not frequently do surgeries, he or she may refer the individual to a periodontist that specializes in this technique.

By Laura Minsk, DMD

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Gum Disease and Diabetes

Periodontitis and diabetes are both chronic diseases that modulate each other. That is, they can exacerbate each other, each making the other more severe. Diabetes can have a negative effect on periodontal health and periodontal disease can increase the need for insulin in diabetics.

Periodontal Disease Has a Negative Effect on Diabetic Control

Periodontal disease is an infection that, like any infection, can make it hard to keep blood sugar under control. Increased blood sugar levels can result in an increased risk for diabetic complications such as harm to the eyes, nerves, kidneys, and other important organs. But studies have shown that treatment of periodontal disease can reduce the need for insulin in diabetics. So, by treating and controlling the periodontal infection, a person also is controlling insulin need and diabetes.

Poor Diabetic Control Has a Negative Effect on Periodontal Health

Compared to non-diabetics, people with poorly-controlled diabetes (those with blood glucose levels above normal) are more likely to develop periodontal abscesses and other oral infections. The longer someone has diabetes, the more likely they are to have periodontal disease. And if the person smokes and has poorly-controlled diabetes, the risk of developing periodontal disease is even greater.

Poor diabetic control can affect the gum tissue in two ways. One is the result of the thickening of the blood vessels that occurs with diabetes. This results in a reduction of oxygen and nutrient delivery to the tissues and a diminished ability of the immune system to fight infection, including periodontal disease. The second is because many of the bacteria that cause oral infection thrive on the sugar linked to diabetes (glucose). Poor diabetic control can actually feed the bacteria that cause periodontal disease.

Oral symptoms associated with poor diabetic control include:

• Increased tooth mobility
• Dry mouth that can increase the risk for ulcers, root cavities, and infections
• Infections that take longer to heal and are more severe

These symptoms can all be managed with control of blood glucose and improved periodontal health. If the diabetes is well controlled and blood sugar level is within the normal range, the risk of developing periodontal disease is not greater than in people who don't have diabetes. On the flip side, treating periodontal disease reduces the need for insulin on people that have diabetes.

To prevent complications from periodontal disease and diabetes, it is important to maintain normal blood sugar levels and periodontal health. Follow the diet and medication guidelines supplied by your physician and see your dental care provider routinely for periodontal screenings and professional cleanings. Meticulous plaque control is critical. If you have diabetes, your dentist needs to know what your blood glucose level is before starting any dental surgical procedures, and although abscesses and acute dental infections should be treated as soon as possible, non-emergency dental treatment should be postponed until the blood glucose is well controlled.

By Laura Minsk, DMD