About
Periodontal Disease

To Our Patients:

During our years of practice experience, we have found it to be in the best interest of our patients if they thoroughly understand their periodontal problems, treatment and the fees involved. Therefore, this letter is to briefly review our discussion at your initial consultation, for we do want you to understand clearly what is involved in the treatment of your problem.

Periodontal disease (pyorrhea) is an infection that begins in the gingival tissue (gums) and then spreads under the gums into the supporting jaw bone surrounding the tooth. In health, the gum is sealed to the tooth in a fashion similar to the seal between your skin and fingernail. This area is infected daily by plaque (a combination of bacteria and saliva that exists in everyone's mouth). If plaque is allowed to remain, then bacteria breaks down the seal. The infected pocket that results is impossible to keep healthy even with scrupulous care.

When the germs remain under the gums, several significant problems occur. There is frequently swelling and bleeding. These bacteria invade the root itself, changing normally glass-like smooth root surfaces to a rough "barnacle-like" one. This infects the gums even further. The plaque itself hardens into a spike-like irritant called calculus or tartar. The most important consequence of this action is further deterioration of the jaw bone around the tooth. Once this bone is lost, it cannot be replaced. Other factors which have a significant effect on the severity of this infection are smoking, diet, stress, grinding and/or clenching of the teeth, general health and resistance, medical problems and hereditary factors.

The goal of periodontal treatment is to reestablish the seal of the gum to tooth, creation of a stable bite, and the establishment and maintenance of a healthy mouth. Treatment is usually in two stages. The objective of the first phase is to promote as much healing as possible by cleaning out the infection from under your gums. Before you get involved in the active treatment, we want to be sure that you can properly care for your mouth. We will, therefore, teach you a technique to remove the plaque daily by proper use of floss, brush and rubber tip. Also, we will take a special set of periodontal x-rays to accurately measure the amount of bone support that has been lost.

The rough root surface must be smoothed to produce a glass-like surface. This is called root planing. Removal of tartar or calculus is called scaling. The inner lining of the pocket is diseased and must be removed to allow the gums to heal properly. This is called curettage. These procedures do not involve surgery and are done in one-quarter to one-half of the mouth at a time. Novocaine is used so that there is very little (if any) discomfort, usually no more than experienced with a routine filling.

When these treatments are completed, the infection should be under control. After this, you can return to your normal activities, including work. We will then carefully reexamine your mouth to evaluate your healing response and determine if any damage to the bone support or gum seals exist. In areas where seals have been reestablished, no further treatment is necessary. Where they have not, they cannot be kept clean and healthy; and we will have to consider the secondary phase of therapy.

The objective of this second phase of treatment is to reestablish healthy seals by minor surgical procedures. The surgery is very delicate and done in small areas at a time, in the office, using "Novocaine." You will not feel any discomfort during the procedure, but may be uncomfortable for a few days after. However, this is usually controlled by some mild pain medication that will be prescribed. The exact amount of discomfort you will experience cannot be predicted because everyone is, of course, different. However, we definitely expect that you should be able to carry out your normal activities the following day.

If we jointly decide not to go ahead with pocket elimination, any seals which are still open will become reinfected, allowing the disease process and bone loss to continue. In these cases, we usually recommend that the patient return every three months, so a specially-trained hygienist can clean out these infected pockets. This is an attempt to maintain the highest level of health for what we call a "holding period" until the secondary treatment can be initiated.

Since essentially we can only repair damage in your mouth and plaque returns daily, our long-term goal is prevention. MAINTENANCE becomes primarily the patient's responsibility and is THE KEY TO LONG-TERM DENTAL HEALTH AND PREVENTION OF DISEASE.

No treatment will be started until you understand the problems that exist, how they should be treated and the cost involved. The fee for the initial treatment can usually be accurately predicted at the first appointment. However, because it is impossible to predict one's healing response, it is impossible to predict exactly how much surgical treatment may be needed and the cost involved. This will be done before any additional treatment is initiated.

Periodontal therapy can achieve a great deal in prolonging and maintaining the health of your teeth and their supporting tissues (our philosophy of treatment is to inform before we perform). Our goals are to establish health and function and help you maintain it. When your treatment is completed, your mouth should be healthy with all damage repaired. We want you to be able to prevent this sort of problem from returning and retain as many teeth a possible for the rest of your life.

GUM SURGERY What is Gum Surgery? The objective of this procedure is to reestablish the seal of the gum to the tooth. When the gum is separated, bacteria and food debris, can build up in this space. This material is impossible to completely remove, even with the most careful brushing and flossing techniques, since it is behind and far under the gum tissue. Therefore, our goal is to create a new seal or attachment of the gum back to the tooth. This will protect the remaining underlying bone, and if kept clean and healthy, will hopefully enable you to preserve your teeth indefinitely. The Procedure The gum is gently lifted away from the teeth. The damage to the underlying from the previous infection is then corrected by smoothing the bone to its original contour. The gum tissue is then placed at the level of the bone to reestablish its seal to the tooth and to provide protection of the bone. Stitches are usually required and a dressing is often placed around the area. You can expect some of your teeth to look and feel slightly longer and the spaces between your teeth to be somewhat larger. You will now be able to clean the entire tooth with your brush daily.

BONE GRAFTS What is a Bone Graft? The goal of periodontal therapy is to restore diseased tissue to a healthy state. For more advanced types of periodontal disease, a special type of gum surgery may be required in order to attempt to rebuild tissue that has been previously destroyed. This procedure is called periodontal regeneration. Normally, during periodontal surgery, the gum tissue is opened to expose the damaged underlying bone support. If the damage is minor, the bone can be smoothed over much like a scratch in a piece of furniture can be sanded down. In that way, we create a smooth floor of bone to support the carpet of gum tissue and its seal of gum to tooth. Unfortunately, in more advanced stages, the damage to the bone is so sever that smoothing it out becomes impossible. In these cases, we try to fill in the areas of bone destruction with new bone material. This material, made up of freeze-dried demineralized bone, provides a framework for your body to regenerate its lost bone support. Studies have shown that this material is highly effective in accomplishing this task. In addition, the grafted material completely vanishes in less than a year and is replaced by your body's own bone structure. The material that is used for the bone graft has an extraordinary safety record. This bone material has been used in modern periodontics for over 30 years, in millions of cases, with not one case where any infection has been transmitted. Our bone material is obtained from the American Red Cross Tissue Bank. This freeze-dried demineralized allogenic bone material is obtained under sterile conditions from carefully-screened donors. Studies have shown that this material, in its freeze-dried form, has less than a one in eight million chance of transmitting any living particles (such as the hepatitis or AIDS viruses). In addition, the material is then pulverized and kept in alcohol for 30 minutes (it has been proven that the AIDS virus is killed in 10 minutes with the use of this technique). The material is then demineralized by immersion in a concentrated solution of hydochloric acid for three to eight hours (studies have shown that such a solution kills all viruses and microorganisms on contact!).

GUM GRAFT What is Soft Tissue Augmentation? The zone of gum tissue is the defense mechanism of your mouth. It is this tissue that maintains the seal of the gum to the tooth, preventing plaque from getting under the gum and destroying the underlying bone support. When this tissue is thin or completely absent, this defense mechanism is no longer effective. Studies have shown that inadequate zones of gum tissue to not break down in a regular pattern. Usually, it stays stable for a non-specified period of time. Then, once it has been irritated by some factor, it breaks down and recedes significantly down the root. The irritant that causes this recession may be a toothbrush, hard food, a filling, braces, a crown, gum infection, or other factors. Once this tissue has receded (and the tooth looks longer), it is very difficult to place new gum tissue back to the original height. A gum graft is performed in order to correct this problem, protect the underlying bone, and prevent the gum tissue from receding even further. The goal is to create a new zone of defense (gum tissue). The longer tooth, caused by recession, is extremely difficult to cover up again once it is exposed. There are, however, special circumstances and procedures where exposed roots can be covered. The Procedure: Once the areas are numb, a small piece of gum tissue is gently taken from around the necks of the teeth on the palate. This area heals "like a scraped elbow" and grows back, leaving sufficient gum tissue there. The piece of gum tissue taken from the palate is used to replace the weakened tissue of the tooth being grafted. The gum graft is placed over the root, at the level of the old receded gum tissue and held on by either resorbable stitches or a special biological glue. This area will heal with a thicker, more dense gum tissue which will protect the underlying jaw bone. A dressing is placed on the palate and the grafted area and will remain for a period of one to two weeks.

CROWN LENGTHENING   What is Tooth Exposure? Many times a tooth is decayed or broken below the gum line. On other occasions, the gum has never receded back properly to the correct position. This results in a tooth that is "too short" for a crown to be retained. Periodontal surgery is needed to adjust the gum level and expose more tooth so that your dentist can construct a cap or bridge that will fit properly. The Procedure: The gum is gently lifted away from the teeth. The underlying bone is recontoured to expose adequate tooth structure. The gum tissue is then placed at the level of the bone to reestablish its seal or attachment to the teeth. Stitches are usually required and a dressing is often placed around the area.

GUIDED TISSUE REGENERATION What is Guided Tissue Regeneration? The goal of periodontal therapy is to restore diseased tissue to a healthy state. In more advanced cases of periodontal disease, a special type of gum surgery may be required to rebuild tissue that has been destroyed. This procedure is called Guided Tissue Regeneration. The Procedure: The biologic principle is to keep unwanted tissues away from the tooth and allow only desirable tissues to grow in their place. This allows regeneration of lost attachment fibers to occur. A special piece of material is used in this procedure as a barrier. The gums are then put back into place so that they cover the material. At this point the gums are sutured back into position. The healing process is similar to conventional periodontal surgery. Some types of barrier material resorb over time, other types may need to be removed later.

FREQUENTLY ASKED QUESTIONS ABOUT PERIODONTAL PROCEDURES Will it Hurt? You will feel no discomfort during the procedure. We will use a local anesthetic to numb the area. If you are concerned or anxious about the procedure, you should know that there are many techniques available for relieving anxiety during surgery. Just ask us and we will be happy to discuss these options with you. Following surgery, the affected area may be tender or sore. Minor swelling may occur. We generally prescribe a non-narcotic pain medication which does not interfere with your ability to drive yourself home. We generally have you take this medication while you are in the office so that by the time the novocaine wears off, the medication has already started working. Antibiotics are antibacterial rinses may also be prescribed. If you take your medications as directed and follow post-operative instructions, you will probably only experience minor discomfort. Most patients resume their normal routines the day after treatment. Will I Be Able to Speak and Eat Normally? You should be able to speak normally after the local anesthetic wears off. It is important to eat a well-balanced, nutritious diet after treatment. Do not chew on the side where surgery is done for at least two weeks. You should also try to avoid smoking and minimize drinking alcoholic beverages during this time. Following some types of periodontal treatment, the teeth may be more sensitive to hot and cold. This will diminish considerably during the first few weeks. When Will I Need to Return? Usually patients return for a check-up in 7 to 14 days. At this time, it may be necessary to remove the dressing (the stitches usually dissolve themselves) and cleanse the area. Additional follow-up appointments may be required to evaluate your healing response and review proper oral hygiene procedures. Any Other Questions? If there is anything we can do to make you more comfortable before, during or after the procedure, please do not hesitate to ask the doctor or any of our staff.

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