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Gum Disease

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Periodontal, or Gum Disease, is a gum infection that can damage tissues and bone around the teeth. If left untreated, it can lead to tooth loss. The main cause of gum disease is a plaque build up. Periodontal disease begins when the bacteria in the plaque produce toxins that irritate the gums, causing infection. These toxins lead to bone and tissue destruction around the teeth. As this happens, the gums separate from the teeth, forming a periodontal pocket. As more tissue and bone are destroyed, the teeth may loosen.

Healthy Gums Healthy gums are firm and pink.
Gingivitis Gingivitis is the earliest stage of gum disease. The gums are red, swollen and bleed easily.
Mild Periodontitis Mild periodontal disease begins when gums begin to separate from the teeth, forming pockets which fill with plaque.
Moderate Periodontitis More advanced periodontal disease progresses as pockets grow deeper and more bone and tissue loss occurs.
Severe Periodontitis Severe Periodontitis has occured when teeth become loose from a large amount of bone and tissue loss.

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The Warning Signs of Periodontal or Gum Disease

Your initial visit to us will involve a medical history, a dental history, and a dental examination. During the dental examination, your gums will be examined and evaluated for bleeding, swelling, firmness and abnormal contours. Your teeth will be checked for movement and sensitivity. Other factors, such as your bite, will also be assessed.
Periodontal Probing During your initial examination, a periodontal probing will also be done to assess the depth of the pockets around each tooth. A probe is like a tiny ruler. The probe is inserted gently in the pocket between the tooth and gums. The deeper the pocket, the more severe the periodontal disease.
After your exam, we will discuss the extent of your gum disease. The various treatment options available to you will be discussed, and a treatment plan will be implemented.

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Periodontal Therapy: Your Options

Non-Surgical Options

If periodontal disease is caught early, a non-surgical option may be the only treatment needed. A dental hygienist often does scaling and root planing, under the periodontist's supervision.

Scaling is a type of cleaning that removes plaque from the teeth at and slightly below the gumline. We may use a local anesthesia as this procedure goes deeper than a regular cleaning Scaling
Root Planing smoothes the root surfaces, so the supportive tissues can better reattach to the tooth surface. We may use a local anesthesia as this procedure goes deeper than a regular cleaning Root Planing

Antibiotics or an antibacterial mouth rinse may be prescribed to control the bacteria that causes periodontal disease.

You may be given a bite guard, a removable device that fits over upper or lower teeth, to protect teeth surfaces and relax jaw muscles.

If teeth are still loose because of bone loss, they may be splinted. This technique wires weak teeth together, combining them into a stronger single unit.

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Surgical Options

Surgical therapies treat the gum infections that are too advanced and pockets that are too deep to reach during a scaling and root planing. The periodontist will open your gums surgically to clean the pockets. He will then reposition your gums for easier cleaning at home and during follow-up appointments. There are various surgical options available.

Flap surgery is performed when the periodontist gently separates the gum from the tooth, creating a "flap" and access to the infected pocket. This allows him to remove deep deposits of plaque. It also reduces the size of the pocket and the areas where bacteria can grow. Little or no gum tissue is removed. This procedure is performed with local anesthesia.

A gingivectomy is performed by removing an overgrowth of gum tissue. By removing this excess gum tissue, the space in which bacteria can grow is elimated. This makes it easier to keep teeth and gums clean.

When periodontal disease is more advanced, more extensive surgery may be needed. If bone loss has become a problem, bone surgery may be necessary. This procedure is used to smooth shallow craters in the bone due to mild or moderate bone loss. After gaining access to the bone with flap surgery, the bone is reshaped around the tooth to decrease the craters, making it harder for bacteria to grow.

Other surgical techiniques include guided tissue regeneration which keeps unwanted gum tissue away from the tooth and bone. This allows ligament fibers to regrow and bone to reform so that the tooth has better support. Bone grafts act as a platform on which new bone can grow to restore stability to the tooth. Tiny fragments of bone are placed into areas of lost bone. Soft tissue grafts can be added to reinforce thin gums or to fill in areas where gums have receded.

The Good News...
The good news is that a combination of your own efforts and those of your periodontist and your general dentist should restore your gums and teeth to good health. Periodontal disease hase been with us for as long as we've had teeth, but we can now provide treatments that control the infection.

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Last Revision Date: March 20, 2000
This page is Copyright 2000 Ivan L. Lapidus, D.D.S., Inc.