Active Periodontal Therapy

Active Periodontal Therapy (Treatment for Periodontal Disease)

How do we treat gum disease (periodontal disease)? See my website at http://www.lajolladental.com/Procedures_Treatment_42712.aspx It depends where you are at with the progression of the disease. A major component of dental health is what we do for ourselves everyday – homecare. Brushing three times a day (after breakfast, midday, and after dinner) and flossing after dinner are the minimum you should be doing to get back to dental health. The other major component is regular dental visits. Cleaning and check-up at least every six months. With early gum disease (gingivitis) this may be enough. Let the dental team clean your mouth up twice a year and you maintain it daily.
Once we slip to a more advanced stage of gum disease, periodontitis, we have receding gums and/or bone loss. Here, the dental team will need to be more aggressive in their treatment of you. They will take a complete medical-dental history to identify any underlying or predisposing conditions, and do a complete clinical exam. The dental team will take X-rays, a full set is usually indicated. They will also evaluate the depth of the pockets around each tooth using a calibrated probe.
Most patients at this point will require Active Periodontal Therapy and/or a referral to a gum specialist. We treat most patients here and refer out only the surgical needs. the Active Periodontal Therapy consists of scaling and root planing, debridement, irrigation of the pockets with a medicated rinse, and perhaps placement of antibiotics in specific isolated pockets.

Active Periodontal Therapy is similar to the scaling normally done during a routine oral hygiene visit, however, it differs in several significant ways. Infection and the resulting deep pockets exist around your teeth requiring deeper than normal scaling. Since vision is blocked into the tooth structure, small scaling devices (either manual or ultrasonic) will be placed carefully into the pockets and a systematic smoothing of the tooth root surfaces will be performed. Debris that has collected on the tooth surfaces will be removed along with the diseased soft tissue. This procedure (called curettage) requires significant time and expertise. Usually, only one area of your mouth will be done per appointment. The number of the one-hour appointments needed will depend on the severity of your infection. You will be anesthetized for your comfort during these procedures.

Your gum tissue may shrink somewhat as it heals. This is desirable because it reduces the depth of the pockets allowing you to better remove bacteria and debris during your home care. Active Periodontal Therapy is the most conservative way to treat gum disease.

Risk Factors for Periodontal Disease

The risk factors that increase the chance of developing Periodontal Disease (PD) are many. Some of the major ones are:

**Genetics – Some people have a greater genetic predisposition to developing a more aggressive, severe type of Periodontal Disease. People with a family history of tooth loss and dentures should be diligent in their efforts to control PD.

**Tobacco – People that chew or smoke tobacco have a greater chance to develop PD, and the effects are usually greater – deeper gum pockets due to increased amounts of plaque and tartar; more loss of bone and soft tissue that support the teeth.

**Medical Conditions – Systemic (the whole body) diseases such as diabetes, cancer, HIV, blood cell disorders, and AIDS, and the treatment for some of these, can lower one’s resistance to infections, making PD more severe.

**Stress – Stress reduces the body’s natural defenses, including the ability to fight off infection. Thus, when under stress, you have an increased chance of developing PD.

**Medications – An increasing number of drugs (antidepressants, steroids, blood pressure drugs, cancer therapy drugs, some heart medications, some anti-epilepsy drugs) can decrease the saliva flow creating a drier mouth than normal. Saliva has a cleansing and protective effect on the gums and teeth. A lack of saliva allows plaque to accumulate on the teeth and gums and cause inflammation and decay.

**Hormonal Changes in Females – Puberty, pregnancy and oral contraceptives change the body’s hormone levels. These changes cause the gums to become hypersensitive to the slightest levels of plaque and tartar.

**Ill-fitting Dentistry – Old fillings, crowns, and bridges may harbor more plaque and increase the liklihood of developing periodontal disease.

**Crowded Teeth – The tongue rubbing on the back side of the teeth, and the cheeks and lips rubbing on the front side of the teeth, have a self-cleansing effect on the teeth. When the teeth are crowded and overlapped, this self-cleansing doesn’t happen very well, and there is an increased chance of decay and gum problems due to plaque retention.

**Insurance Dependency – People that count on their insurance for all the answers are often the patients with the most problems – gum problems, decay problems, and missing teeth problems. The insurance companies write the rule on whether they will have to pay out some of your premium dollars to help get you healthier. If you need to have your teeth cleaned 4 times a year and your insurance only pays for 2 times a year, it does NOT mean you can only get your teeth cleaned twice a year. DON’T be insurance dependent. In today’s market you want to maximize your insurance. But, insurance allowance is a help in covering some of the cost of treatment, not a pay-all.

Gingivitis

Gingivitis is inflammation of the gums caused by the prolonged presence of plaque and tartar on the teeth. The gums become red, puffy and swollen. Gingivitis is a mild form of gum disease that can be reversed with professional dental cleanings by our hygienist and daily brushing and flossing. The gums may bleed during the cleaning and initially when flossing. Gingivitis can be reversed (the inflammation eliminated) because it does not involve bone loss or gum recession.
When the gums are not treated (the person may be brushing but not flossing) the inflammation increases to a point in becomes periodontitis. Here, the plaque builds up below the gums forming pockets. The body’s natural immune system creates enzymes that fight the bacterial toxins within the pockets, but mechanical removal of the plaque and tartar are essential. Left untreated, with time the pockets become deeper, bone loss around the teeth occurs, and the gums recede. Sooner or later the teeth become loose.

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Periodontal Disease and Alzheimer’s Disease

Periodontal Disease (gum inflammation, infection, bone and attachment loss) and Alzheimer’s Disease (AD)-
Is there a link? The exact mechanisms responsible for the cause and development of AD have yet to be identified, but inflammation within the brain is believed to play a key role. As reported in Alzheimer’s Dement, July 2008, peripheral infection/inflammation may affect the inflammatory state of the central nervous system. Chronic Periodontal Disease is a prevalent peripheral infection that has been associated recently with several systematic diseases (see previous blogs) including AD. These studies suggest that chronic periodontal disease may potentially contribute to the clinical onset and progression of Alheimer’s Disease. As chronic periodontal disease is a treatable and controllable infection (not curable), it may well be a readily modifiable risk factor for Alzheimer’s Disease. Establishing and maintaining healthy gums now, could lessen your risk of developing this awful disease.

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