Periodontal Therapy Follow-up

Six weeks after Active Periodontal Therapy (APT), we have our patients back for re-evaluation. We reprobe every tooth in the mouth, evaluate the tissue tone and texture and take intra-oral photos to show you the results. This is our report card. How well did we do with our clinical treatment, with our homecare instructions to you, and with our emotional appeal and motivation to you to save your teeth? (For more information go to www.lajolladental.com)
We may have been totally successful, or only partially successful. If we are totally successful and all the pockets have shrunk to 3mm or less, the tissue tone pink and firm, and you are religiously cleaning your mouth, then we celebrate! If we were only partially successful, we need to identify what is going on – or in some cases, what is not happening (i.e. daily) through homecare. We may be able to make some corrections and reconvene in another 6 weeks for re-evaluation, or we may need a referral to a gum specialist for evaluation of one or more sites. Often, the treatment of gum disease is not all or nothing. We may be successful in 60, 70, 80 or even 90% of the areas, and unsuccessful in just a few spots. Those few spots may need treatment by a gum specialist, and often involve surgery.
http://www.nidcr.nih.gov/oralhealth/topics/gumdiseases/periodontalgumdisease.htm

Periodontal Disease is a Silent Disease

Knowing all that we know about Periodontal Disease (PD), how is it that 75-80% of us are affected by it?
Periodontal Disease is a silent disease in that it does not hurt (until advanced stages) and can go undetected in its earliest stage. Too often, people don’t go to the dentist regularly and start to build up plaque between their teeth. If the person is not a flosser, the plaque starts to accumulate more and more between their teeth. The once healthy gums, pink and firm around each tooth, now start to become inflamed between the back teeth where the plaque is building up. With gingivitis now established, the bacteria residing in the plaque produce toxins that start to break down the attachment of the gums to the teeth. The body’s inflammatory response is to bring increased amounts of blood to those areas to fight off the toxins. The gums become puffy, tender and swollen, and can bleed easily with brushing and flossing (not likely any flossing is occurring in this person).
A cleaning at the dental office at this point could start to turn things around. Flossing and brushing would go a long way toward health. Of course, this person doesn’t have any pain, and is unaware of this situation.
Periodontitis sets in as the plaque by-products, the toxins, destroy the tissues that hold the teeth in the bone. The attachment of the gum to the root surfaces start to be destroyed and pockets develop between the gum and the teeth. The gums pull away from the teeth and recede. More plaque is now accumulating below the gum line in these pockets. Some of the plaque on the root surfaces is hardening into tartar. Like the barnacles forming on the piers at the ocean, the tartar is rough and more plaque sticks to the rough surfaces and become hardened. As the disease progresses, bone under the gums that anchors the teeth begins to dissolve away. The person may notice an unpleasant odor coming from their mouth – bad breath. The gums may bleed when brushing. At this point, with less bone anchoring the teeth and less gum tissue covering the roots, the teeth appear longer and are sensitive to cold and are more susceptible to decay.
In advanced periodontitis, the toxins deep in the pockets continue to destroy the periodontal ligaments and bone, causing the teeth to lose more support. Unless treated, the affected teeth become more mobile and may fall out.
The key, is to not let this all get started. Should you find yourself progressing down the path described above, work hard on brushing and flossing and get into the dental office for evaluation and necessary treatment. You do not have to lose teeth to periodontal disease!

For more information, visit my website.

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.

For more information, visit my website