Periodontal Care

Healthy gums support healthy teeth.

What is periodontal care?

middle aged woman with her hand by the side of her faceThe word periodontal comes from two words, “perio” meaning around and “dontal” meaning tooth. Therefore “periodontal” quite literally means “around the tooth”. Periodontal care refers to care of the gums, supporting tissue, and bones that surround the teeth. Just as a house needs a solid foundation, so do your teeth. It does little good to take care for your teeth and ignore caring for their supporting structure. Good periodontal health is a major factor in keeping your teeth for a lifetime. Many people think they visit the dentist to make sure their teeth are free from decay. This is a primary reason to visit your dentist regularly; however, it is not the only reason. Maintaining periodontal health is a significant reason to visit your dentist and dental hygienist regularly.

What are plaque, tartar, and calculus; and how do they affect my periodontal health?

Bacteria live naturally in the mouth. An overgrowth of these bacteria causes a sticky almost invisible substance to develop on teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins that inflame the gums. Most people become familiar with this substance called “plaque” after missing a single appointment with their tooth brush. Plaque is regularly removed by tooth brushing and flossing. Plaque that isn’t removed hardens into rough deposits called tartar or calculus. Bacterial plaque produces acids and toxins which also can result in tooth decay. The calculus buildup creates a barrier between the teeth and gums, causing the gums to recede from the bone.

Even those individuals most fastidious about their dental hygiene are not able to remove all the plaque that accumulates in their mouth (especially under the gums) and so as the plaque hardens calculus continually forms. Calculus forms both above and below the gum line. Once plaque turns into tartar or calculus it is firmly attached to the tooth surface and is so difficult to remove that it requires special instruments in the hands of a trained dental professional. A primary objective at each preventive dental care visit is to have the dental hygienist remove the tartar or calculus that you are unable to remove during your home care regimen. This process of removing plaque and calculus is called a prophylaxis or dental cleaning.

What are dental pockets?

periodontal-disease-progressionAs a turtleneck fits to the shape of your neck, so your bones and gums should fit snugly around your teeth. As calculus forms below the gum line and between the teeth, the gums pull away from the teeth; the bone recedes forming spaces between the teeth and gums called pockets. During your dental examination and cleaning an instrument called a periodontal probe will measure the depth of the pockets surrounding each of your teeth. The probe has millimeter markings on it to identify pocket depth. If the gums are healthy and tight against the teeth the probe will stop below 4 millimeters in depth. Good periodontal health is manifest by maintaining periodontal pockets below 4 millimeters. This ideal is achievable with a good home care regimen and regular dental cleanings and examinations.

At Crabtree Dental, our mission statement speaks to becoming “lifetime partners in the oral healthcare of our patients.” We believe that partnership succeeds in part through regular dental examinations and cleanings. Our dental professionals will focus not only on your teeth but also on your gums and bone. We are regular witnesses to the fact that prevention really drives optimal dental health.

What is gingivitis?

As calculus forms at or near the gum line, the gums become irritated and inflamed. Inflammation causes the gums to swell and even bleed. When gums become inflamed in this way we call the condition “gingivitis”. Gingivitis is a mild form and an early stage of a more serious condition called periodontitis or periodontal disease. Because the bone and fibers holding the teeth into place are unaffected at this stage, damage can almost always be reversed when appropriately treated.

What is periodontal disease (gum disease)?

If gingivitis is left untreated bacterial toxins continue to grow below the gum line. The presence of bacterial infection stimulates an inflammatory response that turns the body against itself. This causes the bone that supports the teeth to break down in turn creating deeper pockets between the teeth and gums. Once bone loss occurs, gingivitis has transformed into periodontal disease. Where gingivitis was reversible, periodontal disease is not. The greater the bone loss and corresponding pocket depths the further along the disease is in its progression. Periodontal disease is nicknamed “gum disease”, probably because it begins with the gums, but untreated gum disease breaks down not only the gums but also the supporting bone. This loss of supporting bone leads to eventual tooth loss. It is possible to never have had a cavity in your life, but still lose all of your teeth to periodontal disease. Just as a house cannot be supported without a solid foundation your teeth cannot be supported without a base of stable, solid bone. Maintaining periodontal health and thereby supporting bone structure is a major factor in maintaining your teeth and therefore your smile throughout your life.

+ What are the signs and symptoms of periodontal disease?

Often gum disease is silent and many of the symptoms do not appear until later stages of the disease. Here are some warning signs of gum disease.

  • Bleeding while brushing and flossing
  • Sensitive and/or loose teeth
  • Tartar buildup that can be seen and felt
  • Red, swollen, tender or bleeding gums
  • Receding gums (gums that are shrinking away from the teeth)
  • Persistent bad breath or taste that won’t leave
  • A change in your bite
  • A change in the fit of partial dentures

The likelihood of developing periodontitis increases as we age. Some estimates reveal that 30% of people under 50 years old have periodontitis and 50% of people over 50 have the condition. Many people are neither aware of nor are receiving treatment for their condition. Research from the Centers for Disease Control and Prevention suggests that 64 million people in this country have some form of periodontitis. Because it is a silent disease, many people do not know they have it until it is already in its advanced stages. The American Academy of Periodontology has a Gum Disease Risk Assessment Test to see if you are at risk for this disease.

+ How is periodontal disease diagnosed?

oral-hygiene-instructionYour periodontal health is evaluated at each dental examination even if you do not have periodontal disease. Every tooth is evaluated to assess whether gum disease is present and localized to a specific area or generalized throughout your mouth. The gums are evaluated for swelling, redness, and recession. The teeth are examined for looseness and mobility. Gum disease does not have to be present throughout every tooth to be identified as such. The amounts of plaque and tartar buildup along with other risks are factored in to making the appropriate diagnosis. Once the gum and supporting structures are thoroughly evaluated, a diagnosis is made and treatment is prescribed. A treatment regimen will be localized or generalized depending on the presence of periodontal disease in your mouth. The dentist and hygienist will measure your pocket depths and evaluate your x-rays for bone loss. These measurements are used to identify the stage and progress of the disease.

+ How is periodontal disease treated?

Treatment depends on the stage of periodontal disease, but the most common treatment for the early-to-moderate stages of the disease is called scaling and root planing. This non-surgical procedure is performed under local anesthesia during which the tooth and its root surfaces are cleaned of plaque and calculus inside the periodontal pockets. This is intended to remove the bacterial toxins and corresponding infection. Though bone once lost will never be restored, if the pockets are kept clean they can shrink allowing the gum to reattach to the tooth. Healthy pockets will keep the inflammatory process from further affecting the bone.

More advanced stages of the disease are manifest by the presence of even deeper pocket depths and greater loss of bone. The deeper the pocket, the more difficult it will be for you to clean them out each day. Pockets can be so deep that hand instrumentation by a dental professional will not permit access to the deepest portion of the pocket. In such cases scaling and root planing serves as a preliminary therapy, but the deeper pockets will necessitate surgical intervention. During surgery, the gum is folded back while the bacteria are removed following which the tissue is secured back into place. If you are a candidate for periodontal pocket reduction surgery we will refer you to a periodontal specialist for this service. Your periodontal health will be coordinated and managed between our dentists and the specialist.

The purpose of these treatments, whether surgical or non-surgical, is to prevent the damage caused by further progression of the disease so that you can maintain a healthier smile. Removal of the bacteria-laden calculus and plaque is not enough to halt the disease in its progress. The deep pockets caused by periodontal disease must be kept clean. A patient with periodontal disease must be even more vigilant in caring for their oral hygiene during their lifetime. Patients with periodontal disease will need more frequent dental cleanings (usually every three months) throughout their life to maintain their periodontal health. At Crabtree Dental we partner with you to provide the ongoing maintenance therapy needed to maintain your oral health and increase the chances of keeping your natural teeth for your lifetime. The idea of a “partnership” is very important in maintaining your periodontal and dental health as it cannot be achieved through home oral hygiene care alone. Only a dental professional can remove the bacterial toxins below the gum line and in difficult-to-reach places and monitor the changes in your periodontal health. It is important that patients with periodontal disease recognize this and commit to an ongoing and more frequent relationship with their dental professional.

+ Is gum disease a risk factor for other conditions?

Research shows that periodontal disease is associated with other conditions. It was once thought that bacteria was the link associating gum disease with other health concerns, but recent studies have identified inflammation as the linking association. Therefore, treating inflammation caused by gum disease can help with the treatment of other chronic inflammatory conditions such as respiratory disease, cardiovascular disease, and diabetes.

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