Periodontal Treatment

What does periodontal treatment involve?

In the early stages of gum disease, the treatment that we will provide involves a special cleaning called scaling and root planing, which removes plaque and tartar around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean. Advanced cases requiring surgery may be referred to a periodontist.

How do you prevent gum disease?

Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. We can design a personalized program of home oral care to meet your needs. The treatment of advanced cases of periodontal disease can involve the use of medications to target certain bacteria or increase your resistance to periodontal bone loss.

What is the role of the periodontist?

A general dentist usually detects gum disease and treats it in the early stages. Dr. Black has acquired additional expertise to treat more advanced conditions of the disease. If we believe that the gum disease requires treatment by a specialist, you will be referred to a periodontist. The periodontist will work together with us to formulate a treatment plan for you.

How can I maintain treatment at home?

Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of periodontal therapy. Patients should visit our office every three to four months (or more, depending on the patient) for spot scaling and root planing and an overall exam. In between visits, you should brush at least twice a day, floss daily and brush your tongue. Manual soft nylon bristle brushes are the most dependable and least expensive. Electric brushes are also a good option, and we have seen improvements in the hygiene of patients who have switched to electric brushes. Proxy brushes (small, narrow brushes) and other interdental cleaners may be the best way to clean between the recesses in your teeth and should be used once a day. Wooden toothpicks and rubber tips should only be used if recommended by your dentist or hygienist. Ongoing medications may also be useful in certain cases.

Periodontal surgery: What can I expect?

We may have examined your periodontal condition and recommended surgery for you. Just as there are many types of periodontal diseases, there are many treatment options. We look upon you as an individual and develop a treatment plan that is tailored to your needs. The goal of periodontal therapy is to reestablish good periodontal health. Following are some of the reasons why surgery may be necessary:

To clean and reduce periodontal pockets:

As you probably have learned by now, the main cause of periodontal diseases is plaque, a sticky, colorless biofilm that constantly forms on your teeth. If the plaque is not removed thoroughly, toxins or poisons produced by bacteria in the biofilm irritate the gums and destroy supporting tissues around the teeth, forming pockets. Eventually the plaque hardens into a rough deposit called calculus or tartar. Over time, as more plaque and calculus build up, the gums continue to pull away from the teeth. Gum and bone attachment is lost and pockets deepen.

You cannot predictably keep deep pockets clean and free of plaque just by brushing and flossing. The pockets may have become too deep even for your dentist or hygienist to clean them adequately. Therefore, we may decide that surgery is necessary to remove plaque and calculus below the gumline. We will reduce the pockets and position the gums to eliminate areas where disease-causing bacteria can hide.

To expose more of the tooth structure to allow us to restore it:

Many times a tooth is decayed or broken below the gumline. In this case periodontal surgery is needed to adjust the gum level and expose more of the tooth so the dentist can repair the damage. This is called “Crown lengthening.” Minor crown lengthening can be done ultrasonically at the time of your crown preparation, or it may require a separate appointment for more conventional surgery.

To improve appearance and prevent recession:

In certain instances, your smile can be improved with periodontal surgery. For example, a “long tooth”, caused by gum recession or shrinkage, often can be corrected by gum grafting techniques. Gum grafting also helps prevent further gum recession. Likewise, teeth can be made to look longer for a patient with a “gummy” smile. When designing your smile in cosmetic dentistry situations, the symmetry of your gumline may need to be improved.

Will it hurt?

You will feel little or no discomfort during the procedure. We will use a local anesthetic (“freezing”) to numb the surgical area, and provide you with a pre-treatment anti-inflammatory to help with the post-operative course. There are many techniques available for relieving anxiety during surgery. You can speak to us about these options.

Following surgery, the affected area will be tender or sore. Swelling of the surgical area may occur. We may prescribe a medication to relieve post-surgical discomfort, but usually any painkiller that you normally take for a bad headache is adequate to relieve discomfort. Antibiotics or antibacterial rinses also may be prescribed. If you take your medications as directed and follow our instructions, you probably will experience only minor discomfort. Most patients resume their normal routines the day after surgery.

Will I be able to speak and eat normally after surgery?

You should be able to speak normally after the anesthetic has worn off. It is important to eat a well-balanced, nutritious diet after surgery. You will want to maintain a soft diet for a few days, or use liquid meal replacements if you are having a difficult time eating.

Following some types of periodontal surgery, the teeth may be more sensitive to hot and cold. This will diminish considerably during the first few weeks after surgery. Please contact us if this problem persists.

When will I need to return to the dental office?

Usually patients return for post-surgical treatment in five to 10 days. At this time, it may be necessary to remove any stitches and cleanse the surgical area. Additional follow-up appointments may be required to evaluate your healing response and review proper oral hygiene procedures.

Will I ever need surgery again?

In most instances, you will not need surgery in the same area again. However, in certain cases, retreatment or additional surgery may be needed. As you have learned, you may be prone to periodontal diseases. Periodontal diseases are chronic diseases that require constant and careful attention. Like other chronic diseases, such as diabetes, hypertension and asthma, there is no cure. Periodontal surgery helps control disease and prevent further destruction to the gums and bone, thereby minimizing tooth loss.

What can I do to help control the disease?

Periodontal diseases can and will recur if you do not follow a strict program of supportive periodontal therapy. You play the major role in preventing further outbreaks of disease. Nothing will help you maintain the results of professional treatment better than daily removal of plaque by proper brushing, flossing and other cleaning methods recommended for you.

There are many benefits to safeguarding your periodontal health. By retaining your natural teeth, you can chew more comfortably and enjoy better digestion. You also keep a healthy smile which is a natural asset to your appearance. For feeling good and looking good, nothing works better than your natural teeth. When your efforts are combined with regular visits to your dentist and hygienist, you have an excellent chance of keeping your teeth for a lifetime.

You will find further information on the Pre-surgical Instructions and Post-Periodontal Surgery Instructions pages of this site.

Adapted from AGD Oral Health Resources

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