PERIODONTAL (GUM) DISEASE

What is Periodontics?

Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
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Why You Need A Periodontal Screening

Periodontal disease is a bacterial infection that affects the attachment fibers and supporting bone that hold your teeth in your mouth. A periodontal screening is an easy way for your dental care professional to determine the state of your periodontal health. During this screening, a small measuring probe is gently placed between your tooth and gum to assess your periodontal health. Early detection and treatment of periodontal disease can help you keep your teeth for a lifetime.
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CONTRIBUTING FACTORS TO PERIODONTAL DISEASE

The response of the gums and bone to dental plaque may be modified by one or more of the following factors.
- Poorly fitting dental restorations
- Smoking
- Crowded teeth, improper bite alignment
- Clenching or grinding of teeth
- Hormonal changes, including pregnancy, menstruation and menopause
- Diet
- Systemic diseases, including blood disorders and diabetes
- Medications, including calcium channel blockers and anti-convulsants

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Warning Signs Of Periodontal Disease

- When gums bleed during brushing
- Swollen, red or tender gums
- Longer teeth
- Pus appears when pressing the gums
- Loose teeth
- Change is position of teeth
- Change in the way your teeth fit when you bite
- Bad breath or bad taste
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What Is Periodontal Disease?

Periodontal disease starts by a bacterial infection that destroys the gums, bone and ligaments supporting the teeth. Periodontal disease progresses silently, often without pain or symptoms. It may develop slowly or progress rapidly.Nine out of ten people are afflicted with some form of periodontal disease in their lifetime. Periodontal disease affects more than half the population over 18 years of age. After 35, approximately three out of four adults develop some form of gum disease.
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How Does Periodontal Disease Develop?

Bacteria called plaque forms at the point where the teeth meet the gums, as well as between the teeth. If it is not removed daily, plaque multiplies into colonies. Unremoved plaque hardens into tartar, a tough gritty deposit which, because of its roughness, collects more plaque. Tartar can only be removed by a dentist or dental hygenist. If plaque is allowed to develop, an inflamation of the gums occurs called gingivitis. As gingivitis worsens, gums begin to pull away and recede from the teeth. Pockets of bacteria form and deepen, reaching the bone and destroying the bone that anchors the teeth. The advanced stage of this disease is called periodontitis, which can lead to tooth loss if not treated. Other causes of periodontal disease, aside from plaque (the chief cause), are conditions affecting the immune system such as diabetes, hormone imbalances, thyroid malfunction and pregnancy, and also some medications and hereditary factors.
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Diagnosis Of Periodontal Disease

During checkup, the periodontist uses an instrument called a periodontal probe. This determines if there is any breakdown in the attachment of the gums to the teeth, or early development of pockets between the teeth and gums. The depth of the pockets is measured in millimeters with the periodontal probe. Up to three millimeters is considered normal.. deeper than three millimeters indicates a potential problem. X-rays are taken if there is concern over possible bone destruction.

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TREATMENT OF PERIODONTAL DISEASE

The main goal of periodontal treatment is eradication of the disease process from the gums, ligaments and bones that surround the teeth, and restoration of health that can be predictably maintained in the future.

PHASE I
Initial treatment involves educating patients in the proper methods of effective, daily plaque removal and oral hygiene. This is a critical component of successful therapy.

Scaling and root planing are performed to clean the tooth structure and remove bacterial plaque and calculus deposits (the source of the infection) from the gum pockets. This may be the only treatment necessary in cases of gingivitis and very mild periodontitis

PHASE II
In cases which demonstrate deeper gum pockets and underlying bone loss, it becomes necessary to eliminate the diseased gum pockets and bony destruction with osseous (bone) surgery. The gum is "flapped" and retracted away from the teeth to expose the underlying roots and bone deformities. The bone is contoured to approximate a normal physiologic profile, and the gum is sutured back to place. When the gum heals, normal probing depth is re-established between the gum and tooth (ideally 1-3mm). The attainment of minimal probing depth facilitates easy removal of plaque by patients at home and by hygienists during professional cleaning.

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SEQUENCE OF EVENTS DURING OSSEOUS SURGERY

Additional treatment modalities may be necessary to treat periodontal disease and restore health.
These may include:
- Bone grafts for bone regeneration
- Gum grafts to treat gum recession and pathological root exposure
- Cosmetic plastic surgery of the gums to improve appearance
- Fabrication of night guards for bruxism ( tooth grinding )
- Splinting or bonding teeth together for increased strength and stability
- Orthodontics ( braces ) to straighten and realign teeth
- Removal of diseased roots on some types of molars
- Use of medications such as antibiotics, fluoride and antimicrobial rinses
Laser Dentistry Procedures and Effects:

LASER PERIODONTAL THERAPY

Laser dentistry or laser periodontics allows for the treatment of gum disease at any earlier stage. In addition, it can be useful to pregnant women and people with debilitating medical conditions. While there is no guarantee of total "pain free laser dentistry" discomfort is greatly reduced. By receiving dental laser treatments, patients often have no need for Novocain or other anesthetics! Dental laser treatment, often referred to as laser periodontal treatment, works well for treating canker sores and bacterial infections around teeth and gums.

During a treatment it is also common for the patient to wear protective glasses toprotect his/her eyes from continued exposure to bright light. The laser emits a tiny ticking sound-a far cry from the days of traditional dental drills. However, keep in mind that a laser might not be appropriate for all procedures. Today, many dental services can be performed with either the laser or traditional treatment, and are generally covered by most insurance plans. Dr Phillip F. Ajaje should be able to determine whether or not laser dentistry is right for you.

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LASER PERIODONTAL PROCEDURES

• Full thickness flap

• Partial thickness flap
• Split thickness flap
• Laser soft tissue curettage (The removal of tissue or growths from a body cavity)
• Laser removal of diseased, infected, inflamed and necrosed soft tissue within the periodontal pocket
• Removal of highly inflamed edematous tissue affected by bacteria penetration of the pocket lining and junctional epithelium
• Removal of granulation tissue from bony defects
• Sulcular debridement (removal of diseased or inflamed soft tissue in the periodontal pocket to improve clinical indices including gingival index, gingival bleeding index, probe depth, attachment loss and tooth mobility)
• Osteoplasty and osseous recontouring (removal of bone to correct osseous defects and create physiologic osseous contours)
• Ostectomy (resection of bone to restore bony architecture, resection of bone for grafting, etc.)
• Osseous crown lengthening - refer below
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Osseous Crown Lengthening

When it comes to a procedure like osseous crown lengthening, the OPUS 5 excels. Because it cuts soft tissue, hard tissue and bone, you can use a single instrument to create the biologic width necessary for problem-free aesthetic restorations.Pre-op view, no biologic width for crowns

Trough soft tissue, shaving osseous tissue

Immediately post-op, temporaries in place

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MAINTENANCE AND PREVENTION

Once the active phase of treatment is complete and health has been restored, it is extremely important that patients be seen by a hygienist for routine dental and periodontal cleaning on a regular basis. This regimen, along with diligent home care and oral hygiene, will give the best chance for preventing recurrence of disease and maintaining long term periodontal health.

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