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Periodontal Disease Treatment Slows Periodontitis

One of the goals of periodontal disease treatment is to arrest and control the progression of the bacteria that cause gingivitis and periodontal disease. As the bacteria infect the gum tissues, they release toxic substances that trigger the breakdown of gum and bone. The gum then separates from the teeth, forming a gap that is called a periodontal pocket. These spaces are inaccessible to daily oral hygiene techniques. Bacteria settle in these pockets and continue to accumulate and reproduce, creating further gum and bone destruction.

Periodontal disease treatment such as scaling and root planing involve the removal of the irritants and bacterial deposits (plaque and tartar) that have accumulated above and below the gum line in the periodontal pockets. The root surfaces of the teeth are planed (smoothed) to promote healing and to help prevent future bacterial reattachment. At the same time, gingival (gum) curettage can be done to remove the infected soft tissues that line the periodontal pockets.

Most of the time, scaling and root planing is done in two to four visits. For patient comfort, the gums can be numbed by the periodontist using a local anesthetic. One-quarter of the mouth is usually treated at the time and treatment of each quarter can take 45 minutes to an hour (three to four hours for the entire mouth). Most patients report minimal discomfort during these periodontics treatments.

During scaling and root planing appointments, the dental care provider will review oral hygiene techniques that are aimed at improving the person's ability to control plaque and to help avoid bacteria from re-infecting the pockets. Patients also will receive advice on the modification of certain risk factors associated with periodontal disease.

In some circumstances, the dental care provider may recommend the use of adjunctive products for periodontal treatment. To be effective, antimicrobial products such as Chlorhexedine, PerioChip, and Atridox should be used in combination with scaling and root planing. Periostat is also a product that can be used as an adjunct to scaling and root planing in order to impede further tissue breakdown and promote healing.

Several weeks after completion of scaling and root planing, a periodontal re-evaluation should be completed. The purpose of this exam is to assess the response to treatment and determine if there is a need for further treatment.

The best way to stop the progression of periodontal disease is to mechanically remove the bacterial plaque and tartar that have accumulated in the periodontal pocket. Daily oral hygiene and supportive periodontal treatment (see article "Supportive Periodontal Treatment") is key to the success of scaling and root planing. Without treatment, the tartar and plaque buildup underneath the gums will continue to cause periodontal tissue breakdown, progression of periodontal disease, and eventually tooth loss and/or systemic (general) complications.

By Laura Minsk, DMD

Periodontal Disease: Preventing Tooth And Bone Loss

The best way to control periodontal disease and to help prevent tooth loss is with early detection and treatment. Three out of four people are afflicted by periodontal disease at some point in their lives, so everyone should be tested. After reviewing a patient's dental and medical history, the dental care provider or periodontist will conduct a thorough clinical intraoral exam called a periodontal charting.

This consists of taking a series of measurements around each tooth. Unless the gums are very inflamed and sensitive, the periodontal charting causes minimal discomfort.

The space between the gum and the tooth is measured using a periodontal probe. This space is called the probing or pocket depth. In a healthy mouth, this space should be between 0 and 3 millimeters.

The amount of recession or loss of gum around each tooth is measured. In healthy mouths, the gum tissue should be at the junction of where the crown of the tooth meets the root. The two measurements (pocket depth and recession) are then added to calculate the amount of attachment loss around each tooth. The greater the amount of attachment loss, the more advanced the periodontal disease.

While completing the periodontal charting, a dentist will evaluate the conditions of an individual's gums. Healthy gums are pale pink, firm, and immobile. The gums should not bleed during the probing exam. Bleeding gums during this exam are a sign of gum inflammation, gingivitis or periodontitis.

The dentist will also measure tooth mobility. Under normal functional conditions, teeth should not move. Tooth mobility is a sign that there has been bone loss around the teeth or that the biting forces are too strong. If so, the dentist may also assess a patient's occlusion, or bite. If the bite has changed or if the forces on the teeth are too strong, there may be an acceleration of bone loss around the teeth.

A full mouth series of X-rays (approximately 20 films) are also indispensable in a periodontal examination.

In addition to identifying areas with cavities, bone infection, tumors, or developmental abnormalities, X-rays help reveal if bone loss has resulted from periodontal disease. The crest of the teeth's supporting bone is normally 2 mm below where the crown of the tooth meets the root. A greater distance indicates a history of bone loss.

Although bacterial samples are not usually taken for diagnosis of periodontal disease , under certain circumstances, it may be necessary to take a bacterial culture from a plaque sample. This is especially valuable to help detect sites at high risk for disease progression or if conventional treatment is not working.

The culture is analyzed in a laboratory for the presence of certain bacteria that are known to contribute to gum disease. Actually, of the more than 300 different types of bacteria normally found in the mouth, there are only about 13 that are known to be associated with causing periodontal disease. After identifying the specific disease-causing bacteria, the laboratory can test to determine what antibiotics they are susceptible to.

Depending on the risk factors (see article " Risk Factors for Periodontal Disease") involved and a person's specific situation, other tests may also be required. Under certain circumstances, a dentist may require diagnostic casts (molds of one's teeth), medical laboratory tests, medical consultation, or genetic testing.

After completing the periodontal examination, the dentist will be able to discuss with the patient the diagnosis, treatment alternatives, potential complications, and expected results. The key to long-term periodontal health is early diagnosis and treatment. Because everyone is at risk of developing periodontitis, everyone should be routinely tested.

By Laura Minsk, DMD