TREATMENT OF PERIODONTAL DISEASE
Periodontal Disease Treatment Livingston & Clark NJ
The treatment of periodontal diseases typically involves three phases:
|Phase I:||Control of factors that cause periodontal disease|
|Phase II:||Correction of damage that has resulted from the periodontal disease|
|Phase III:||Preventive care by which the recurrence of the disease is prevented|
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The following is an overview of the components of each treatment step:
This phase is designed to eliminate all of the known causes of periodontal disease. Dental plaque is the primary cause of gum disease. Plaque is a sticky, colorless film of bacteria that is constantly forming on your teeth. If plaque is not removed from the tooth surface, it hardens into a substance known as tartar or calculus. Both the calculus and the plaque must be removed to achieve a successful result. The patient is taught to remove the plaque, while the dental professional must remove the calculus.
The following are factors that may be addressed during Phase I:
- Demonstration of proper oral hygiene procedures to remove surface plaque
- Scaling and root planing to remove calculus and deep plaque
- Smoothing or replacement of fillings that do not fit well and thus retain plaque
- Removal of non-treatable teeth that may jeopardize good teeth and general health
- Bite adjustment (occlusal adjustment) if needed
- Orthodontics to better align teeth if needed
- Occlusal Guard to prevent damage from clenching and grinding
Plaque that collects under the edge of the gum is the cause of periodontal disease. It is vital that the patient remove this plaque daily to prevent recurrence and progression of the disease. Oral hygiene and regular preventive cleaning appointments are the critical steps of long-term success. No matter how successful the initial treatment, without adequate follow-up, the disease will recur. The patient must truly take responsibility for his or her own health.
To brush, angle the bristles of the brush at 45 degrees to the side of the tooth. This allows the bristles to slide under the edge of the gum, reaching the hidden plaque. Think of sliding broom bristles under the edge of a refrigerator to remove dirt. The brush should not be scrubbed back and forth, but rather shimmied or rotated in small circular motions. This allows the bristles to remain under the gum’s edge and also prevents wearing of the gum. Doing this on the inside and outside of all the teeth is important.
When all the teeth have been brushed under the edge of the gum, the top surfaces can be brushed. Brush the cheeks and tongue as well, for plaque forms throughout the mouth.
Brushing removes the bacterial plaque from the sides of the teeth, but no brush is able to go between the teeth AND under the gums. Unfortunately this is where most periodontal disease starts, so it is critical to remove plaque from these areas.
Toothbrush at 45 degree angle to tooth, allowing bristles to slide
between the tooth and gum, to clean plaque below the gum line.
A few brands of power brushes have been shown to be more efficient than manual brushes. For most people, they are easier to use. To be effective requires training, which we will provide, and maintenance which includes changing the bristles on a regular basis. Power toothbrushes do NOT replace the need for floss.
Remember that brushing does not clean between the teeth, and flossing is needed to complete your daily oral hygiene. Flossing is the best way to remove plaque from under the gum and between the teeth. Because most periodontal disease starts between the teeth, flossing is even more important than brushing. Good flossing is a skill that takes practice, but nothing can replace it in preventing periodontal disease. Once learned, it should only take 2-3 minutes a day. When flossing, it is important to slide the floss completely under the gum, wrapping around the tooth as far as possible. When flossing, aim for squeaky clean with five up and down strokes going under the gum on each side of the tooth. It is not important when you floss, only that you do it at least once a day.
Click here for instructions on how to floss.
Oral rinses do not replace brushing and flossing for plaque removal.
The basis of all periodontal therapy is removal of plaque and calculus from the tooth, both above and below the edge of the gum. This is accomplished by scaling and root planing (deep cleaning). Your comfort is always taken into consideration; in some cases, a local anesthetic is used. Based on the extent and type of infection that exist in the gum tissue, antibiotics may be prescribed during this aspect of treatment.
Smoothing or removing defective fillings is needed to remove nooks and crannies where bacteria can hide. Poor restorations can make adequate oral hygiene an impossible task.
Our purpose is to save teeth. However, at times the amount of bone destruction that has occurred makes it impossible to establish periodontal health. If ignored, progressive bone loss can make tooth replacement either complicated or impossible and affect adjacent teeth. Furthermore, continuing infection can jeopardize general health. Teeth also may not be treatable if they are structurally too weak to be restored with a filling or a crown. In these instances, removal is recommended.
When top and bottom teeth do not touch evenly, some may receive forces greater than they can tolerate. This can result in structural damage to the teeth and/or loosening of the teeth within the supporting bone. Polishing of the biting surfaces of the offending teeth will result in a redistribution of forces that will be nondestructive.
Teeth that are misaligned are difficult to keep clean, cannot take their share of the biting load, and may be unsightly. Orthodontic (controlled) tooth movement can correct these problems, create a healthy environment and, in some cases, improve the periodontal health of the teeth being treated.
The habits of clenching and grinding will create excessive forces on teeth and the bone supporting them. This can result in structural damage to the teeth and bone loss. These habits can also stress the TMJ (Temporomandibular Joint) and the muscles that move the jaw. An occlusal guard will protect these structures from the destructive forces of these habits.
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Once the factors responsible for the periodontal disease have been controlled or eliminated, the goal of treatment becomes the correction of residual damage, thereby creating an environment that can more easily be maintained in a state of health. These corrections are accomplished by various surgical techniques.
- Pocket Reduction Surgery: To correct damage from gum disease
- Crown Lengthening: To enable a dentist to effectively restore a tooth
- Gum Grafting: To correct recession defects and lack of gum tissue
- Cosmetic Corrections: To correct the appearance of short or long teeth
Flap and Osseous Surgery
Gum opened and bacteria cleaned out
Gum sutured close to bone
to reduce pocket depth
Traditionally, gum disease is treated by recreating the adherence of the gum to the tooth. This can be accomplished by a variety of techniques, depending on the type of gum tissue present as well as the amount and pattern of bone loss that has occurred. The area is made numb with local anesthesia (novocaine). The gum is separated from the teeth, thereby enabling the removal of bacteria and diseased tissue and providing access to treat the bone. Depending on the pattern of the bone destruction that has occurred, regeneration of new bone could be accomplished by using a variety of bone grafting or regenerative techniques and materials. Subsequently, the gum is sutured around the teeth to develop an adherence upon healing.
Regenerative Surgical Procedures
The ideal outcome in the treatment of periodontal disease is to return the tissues to their original state, as they were before the disease started. In some cases, depending on the type of gum disease and the pattern of bone destruction that has occurred, it is possible to recreate the previously lost tissues. This is accomplished by a variety of regenerative surgical procedures, Bone Grafting, Guided Tissue Regeneration, and Cell Stimulation that use a number of bio-compatible materials, alone or in combination, to aid the body in producing new bone.
Decay under gum
Gum reflected to access decay
Bone removed to provide access
for dentist to treat decay.
Gum replaced with decay visible for
dentist to restore with a filling or crown.
Crown lengthening (tooth exposure surgery) is indicated when more tooth structure needs to be exposed for either restorative or cosmetic purposes.
The area is made numb with local anesthesia (novocaine). The gum is separated from the tooth, thereby providing access to the damaged tooth structure. The gum and bone tissue are reshaped so that the restorative dentist will have adequate access to repair the tooth or to make a crown. The gum is then sutured into place.
This same procedure can be performed for cosmetic reasons to correct situations such as short teeth, a gummy smile, or an uneven appearance of the teeth and gums. This small procedure can make a dramatic change in your appearance.
In periodontal health, there are two types of gum tissues that surround the tooth. The part that is around the neck of the tooth and is firmly attached to the tooth and underlying bone is called attached gingiva. The attached gingiva is immovable and tough and deflects food as it passes over the gum. Below the attached gingiva is looser gum, called alveolar mucosa. This tissue contains muscle and is flexible to allow movement of the cheeks and lips. The muscles in the alveolar mucosa are constantly contracting which pulls on the bottom edge of the attached gingiva. However, normally the attached gingiva is wide and strong enough to act as a barrier, which prevents the gum from being pulled down, resulting in recession.
Some people are born without sufficient quantities of attached gingiva to prevent the muscle in the alveolar mucosa from pulling the gum down. In these cases the gum slowly continues to recede over time, even though the patient may be very conscientious with their oral hygiene. Recession of this type is not a result of an infection, as is seen with periodontal disease, but rather an anatomic condition. Unfortunately, bone recession is occurring at the same time the gum is receding. This is because the bone, which is just under the gum, will not allow itself to become exposed to the oral cavity and recedes with the gum.
Gum recession can be treated with grafting techniques. The area is made numb using local anesthesia (novocaine) and a thin piece of tissue is taken from another part of the mouth or gently moved over from an adjacent area. This provides a stable band of attached tissue around the tooth. The gum graft may be placed in such a way as to cover the exposed portion of the root.
Another approach Dr. Eskow uses to treat gum recession is the Pinhole Surgical Technique.™ After the gum is numbed, a small hole (pinhole) is made in the gum, providing access to move the gum to cover the exposed root surface. Collagen is placed under the gum to stabilize it in its new position. This technique does not require incisions or sutures.
|Pre-treatment: right tooth has exposed root||Post-treatment: gum moved down to cover exposed
root, creating same gum level on both teeth
|Pre-treatment: extreme recession revealing
too much tooth
|Post-treatment: gum graft creates proper tooth
size enhancing attractive smile
|Pre-treatment: 3 teeth with gum recession
and exposed roots
|Post-treatment: correction of recession
and coverage of roots following gum grafting
|Pre-treatment: exposed root||Post-treatment: root coverage following
Frenectomy is a procedure to remove a limited area of alveolar mucosa (loose gum) that is connected to the gum edge of a tooth or concentrated between two teeth. At times, the frenectomy is combined with gum grafting to increase the quantity of attached gingiva (immovable gum) or improve the esthetics of the gum tissue.
|Pre-treatment: excessive alveolar mucosa
(loose gum) between front teeth
|Post-treatment: tissue corrected by frenectomy|
The smile can reveal too little tooth, too much gum, or too much tooth. These situations are correctable by periodontal surgical procedures. The exposure of additional tooth or the reduction of excessive gum tissue is accomplished by crown lengthening procedures. In instances when the root surface is exposed, resulting in too much tooth being visible, a gum grafting procedure can be performed.
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Preventive care is the most important phase of treatment designed to inhibit the recurrence or progression of gum disease. This consists of effective daily oral hygiene (brushing and flossing) and preventive periodontal cleanings performed at the appropriate interval. The frequency of these cleanings is patient specific, depending on the level of oral hygiene performance and one’s susceptibility to gum disease. This phase of treatment is initiated at the completion of Phase I therapy continues through the corrective phase (Phase II) and for the rest of the patient’s life.
This type of care is appropriate for anyone, even those without a history of periodontal disease, who wishes to have optimal oral health.