Periodontal Dentistry

Periodontal Maintenance is an important consideration for future gum health

Individuals with periodontal (gum) problems, current disease, or a history of previous disease require special attention and care in the form of periodontal maintenance.  Once gum issues have started in an individual, he/she will be prone to relapsing back into a state of active gum disease for the remainder of his/her life.

Patient Annual Comprehensive Periodontal Evaluations are routine at Dr. Butler’s Office, whether you are at a high risk or a low risk for periodontal disease

One out of every two American adults aged 30 and over has periodontal disease, according to recent findings from the Centers for Disease Control and Prevention (CDC).  The recent research has indicated the prevalence of periodontal disease in the US may be significantly higher than originally estimated.  This means that all adults should thoroughly assess the state of their gums to receive accurate information about the health of their mouths.

Periodontal disease is thought to be one of the most prevalent non-communicable chronic diseases in our population. A dental profession should examine each tooth above and below the gum line, and a visual examination alone is not enough. The American Academy of Periodontology recommends that every patient receive a comprehensive periodontal evaluation on an annual basis.

A Comprehensive Periodontal Evaluation is way to assess your periodontal health by examining:

  • Your teeth
  • Your plaque
  • Your gums
  • Your bite
  • Your bone structure
  • Your risk factors

The initial stage of treatment is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line which is known as Scaling & Root Planing. When deep “pockets” between teeth and gums are present, it is almost impossible to thoroughly remove all plaque and tartar. Patients can seldom, if ever, keep these pockets clean.

The tooth roots are planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment. Antibiotics or irrigation with anti-microbials (chemical agents or prescription mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis.

The scaling and root planing treatment is always followed-up with a periodontal reevaluation exam to assess the healing response. Options for treatment are discussed at this time.

Periodontal maintenance follows at an interval appropriate for your condition; this is periodontal “cleaning” to maintain the improved results of our treatment.

After completing periodontal therapy, your condition has been arrested, but not cured. Periodontal diseases are chronic diseases, much like diabetes and cardiovascular disease, which require constant monitoring to ensure that your disease remains inactive.

Most treated periodontal patients require more frequent cleanings, approximately every three months, rather than traditional six month cleanings, since they are more susceptible to periodontal disease.

During your periodontal maintenance visit, your periodontal status is closely monitored for changes. At times, interceptive periodontal procedures are initiated to treat any sites or pockets that demonstrate significant signs of disease activity. In this way, further bone loss can be prevented.

We firmly believe that preventive dentistry is the best dentistry.

Commonly Asked Questions About Periodontal Maintenance

I have heard there is a connection between gum disease and heart disease. Is this true? Where can I find more information?

There is plenty of research that indicates a connection between periodontal disease and heart disease. There are links being studied between gum disease and other diseases such as obesity and stroke. Additionally, women who have gum disease are more susceptible to having a low birth weight baby.

The American Dental Association’s patient website, mouthhealthy.org has some great resources to view. If you prefer to read peer-reviewed scientific research, here’s a good review article in the Journal of the American Dental Association.

Both of my parents have periodontal disease, and I’m worried that it may be genetic. Is there a way to determine my risk for developing gum disease?

There are some genetic links to gum disease in addition to a bacterial link. Some studies indicate that up to 30% of the population has some genetic risk of periodontal disease. In addition to genetic susceptibility, we also get a significant portion of the bacteria in that naturally live in our mouth and digestive tract from our parents. The particular spectrum of bacteria that we get in our mouth can greatly affect our susceptibility to periodontal disease in addition to genetics.

Nothing hurts so do I really have a problem?

Unfortunately, periodontal disease, like many other serious diseases such as diabetes, high blood pressure, and heart disease, has symptoms that often only become apparent after much damage is done. The fact that symptoms are often not obvious is why we take annual measurements of your gum tissue and record bleeding so we can closely monitor changes and treat areas early in the disease process.

What can I do at home to prevent periodontal disease?

There are two big things you can do to best improve periodontal health. The first is what you do at home every day: brushing, flossing and other forms of interproximal (between the teeth) cleaning such as the use of soft picks and proxy brushes. The second most important thing you can do is to have more frequent teeth cleaning intervals. It is critical to remove the bacterial plaque from your teeth every day to prevent the bacteria from organizing and forming colonies that secrete toxins that destroy your gums and the bone supporting your teeth. By coming in for more frequent teeth cleanings we are insuring that the bacterial cycle is interrupted and areas that are not accessible to your typical cleaning aids get flushed out. We are also able to keep close track of any areas that are not responding.

  • thoroughly brush your teeth twice a day
  • clean between your teeth with floss or another interdental cleaner once every day
  • visit your dentist for a checkup
  • If you smoke or chew tobacco, stop. Tobacco use greatly increases the risk of developing periodontal disease.
  • eat a healthy balanced diet
Why do I need a periodontal maintenance cleaning?

Your toothbrush can only reach 2-3 millimeters below the gum tissue to effectively clean it out. Virtually all patients on periodontal maintenance have pockets over 3 millimeters. A pocket over 3 millimeters needs the help of our instruments to remove bacteria. This process requires specific skills and extra time beyond what a normal teeth cleaning requires.

What will happen if I don’t have more frequent teeth cleaning appointments?

If the bacterial plaque is not controlled and is allowed to colonize and multiply, there will be an increase in gum irritation and the potential for hard deposits (calculus/tarter) to form. Once the plaque forms a sticky biofilm or hardens into calculus it is difficult to have effective homecare, which leads to increased bleeding and pocket depths, which leads to poor oral hygiene, which leads to more plaque, and so on — a vicious cycle begins.

In addition, extra time is spent on education and proper home oral hygiene technique. With good oral hygiene at home and a 3-4 month periodontal maintenance schedule, the bacteria can be controlled and the cycle can be broken.

Can children be at risk for developing periodontal disease?

Children can get generalized gum disease. Gingivitis, the beginning stages of gum disease, is very common in kids and can be characterized by red, puffy gums. The best way to prevent gingivitis in kids is to be sure they are doing a good job brushing twice a day and flossing once a day. There are also specific forms of juvenile periodontal disease that children and teens are susceptible to. Kids with underlying medical issues, such as diabetes or Down syndrome, can be more prone to periodontal disease.

What is the difference between plaque and calculus?

Plaque is a sticky film that is always forming on the teeth. There are bacteria in plaque that secrete toxins that can irritate the gums. Plaque can be cleaned off with a toothbrush but hardens into a rough substance called calculus (tartar) if not cared for. Because it is harder than plaque, tartar can only be cleaned off with special instruments or sonic cleaners at the dental office.

Is a topical antibiotic treatment necessary in conjunction to scaling and root planing?

Scaling and root planning is the deep cleaning that is used to treat gum disease. This is how we remove the calculus and bacteria that cause gum disease. Because bacteria are involved in periodontal disease, antibiotic treatment can sometimes assist in treatment. Your dentist or periodontist will let you know if you would benefit from the use of antibiotics for your condition.

Is periodontal disease treatable?

Periodontal disease is treatable, but the condition can do lasting damage to the gums and bone in the mouth which can sometimes result in tooth loss despite treatment. It is always best to catch periodontal disease or any changes in gum health early.

What products or procedures will help my periodontal condition?
  1. Toothbrush — we recommend an electric toothbrush if at all possible. The brand we carry is Oral B, but there are other acceptable options available. The brush should ideally have a two-minute timer and we recommend a minimum of two minutes of twice daily brushing.
  2. Flossing — see-saw the floss to get it between the teeth; try not to snap the floss through the contact point. Wrap the floss around the tooth (like you are hugging the tooth) and then take the floss up and down. You need to go down until you feel the resistance of the gums. We recommend a waxed flossor dental tape . The “glide” type of floss (very thin floss) does not have enough surface area and is too slippery to clean effectively. Flossing should ideally be done once daily. Flossing is a difficult habit for most people to establish. Try committing to at least 2-3 times per week and work form there. We recommend finding a specific time to work the flossing into your routine — if you like to watch the news at night in your favorite chair, put the floss on your table next to the remote. Some people find that putting the floss in the shower works well into their routine. Find something that you can be consistent with.
  3. Other interproximal tools — we highly encourage the use of soft picks or a proxy-brush to aid in cleaning between the teeth. We find that our patients who do a combination of flossing and soft picks/proxy-brush have a greater level of oral hygiene than flossing alone.
  4. Water picks — we consider water picks an additional adjunct that can be beneficial, but they should never be considered a substitute for flossing and other interproximal cleaning tools. The water pick is like trying to wash your car with just a stream of water: the water is sprayed on the surface but there is still a film of dirt on the car. Plaque/bacteria is like the film on the car because the sticky biofilm needs to be physically rubbed off the surface of the tooth.
Will my insurance cover my periodontal treatment?

Everyone’s insurance plan is different in what it does and does not cover. It is best to consult your particular insurance plan’s explanation of benefits or contact your insurance carrier about your particular coverage.

Will I need surgery?

Conservative treatment options will always be considered first, but sometimes gum surgery is necessary, especially in more advanced stages of the disease. This is why it is best to prevent and treat the disease in earlier stages to avoid reaching the point of surgical treatment.

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