The term “periodontics” refers to the dental specialty that pertains to the prevention, diagnosis and treatment of periodontal disease that affects the gums and jawbone. The gum tissues serve to surround and support the teeth and the underlying jawbone anchors teeth firmly in place. Periodontists have completed several years of extra dental training and are concerned with maintaining the function, health and aesthetics of the jawbone and tissues.
According to research conducted by the American Cancer Society, more than 30,000 cases of oral cancer are diagnosed each year. More than 7,000 of these cases result in the death of the patient. The good news is that oral cancer can easily be diagnosed with an annual oral cancer exam, and effectively treated when caught in its earliest stages.
Oral cancer is a pathologic process which begins with an asymptomatic stage during which the usual cancer signs may not be readily noticeable. This makes the oral cancer examinations performed by the dentist critically important. Oral cancers can be of varied histologic types such as teratoma, adenocarcinoma and melanoma. The most common type of oral cancer is the malignant squamous cell carcinoma. This oral cancer type usually originates in lip and mouth tissues.
There are many different places in the oral cavity and maxillofacial region in which oral cancers commonly occur, including:
Oropharyngeal Region (throat)
Reasons for oral cancer examinations
It is important to note that around 75 percent of oral cancers are linked with modifiable behaviors such as smoking, tobacco use and excessive alcohol consumption. Your dentist can provide literature and education on making lifestyle changes and smoking cessation.
When oral cancer is diagnosed in its earliest stages, treatment is generally very effective. Any noticeable abnormalities in the tongue, gums, mouth or surrounding area should be evaluated by a health professional as quickly as possible. During the oral cancer exam, the dentist and dental hygienist will be scrutinizing the maxillofacial and oral regions carefully for signs of pathologic changes.
The following signs will be investigated during a routine oral cancer exam:
Red patches and sores – Red patches on the floor of the mouth, the front and sides of the tongue, white or pink patches which fail to heal and slow healing sores that bleed easily can be indicative of pathologic (cancerous) changes.
Leukoplakia – This is a hardened white or gray, slightly raised lesion that can appear anywhere inside the mouth. Leukoplakia can be cancerous, or may become cancerous if treatment is not sought.
Lumps – Soreness, lumps or the general thickening of tissue anywhere in the throat or mouth can signal pathological problems.
Oral cancer exams, diagnosis and treatment
The oral cancer examination is a completely painless process. During the visual part of the examination, the dentist will look for abnormality and feel the face, glands and neck for unusual bumps. Lasers which can highlight pathologic changes are also a wonderful tool for oral cancer checks. The laser can “look” below the surface for abnormal signs and lesions which would be invisible to the naked eye.
If abnormalities, lesions, leukoplakia or lumps are apparent, the dentist will implement a diagnostic impression and treatment plan. In the event that the initial treatment plan is ineffective, a biopsy of the area will be performed. The biopsy includes a clinical evaluation which will identify the precise stage and grade of the oral lesion.
Oral cancer is deemed to be present when the basement membrane of the epithelium has been broken. Malignant types of cancer can readily spread to other places in the oral and maxillofacial regions, posing additional secondary threats. Treatment methods vary according to the precise diagnosis, but may include excision, radiation therapy and chemotherapy.
During bi-annual check-ups, the dentist and hygienist will thoroughly look for changes and lesions in the mouth, but a dedicated comprehensive oral cancer screening should be performed at least once each year.
If you have any questions or concerns about oral cancer, please contact our practice.
A periodontist is a dentist who specializes in the soft tissues of the mouth and the underlying jawbone which supports the teeth. A dentist must first graduate from an accredited dental school before undertaking an additional three years of study within a periodontology residency training program, in order to qualify as a periodontist.
The primary focus of this residency training is on both surgical and non surgical management of periodontal disease and the placement of dental implants.
Conditions Treated by a Periodontist
The periodontist is mainly concerned with preventing the onset of gum disease (periodontal disease), diagnosing conditions affecting the gums and jawbone, and treating gingivitis, periodontitis and bone loss. Periodontal disease is a progressive condition and the leading cause of tooth loss among adults in the developed world.
The periodontist is able to treat mild, moderate and advanced gum disease by first addressing the bacterial infection at the root of the problem, providing periodontal treatment, then providing information and education on good oral hygiene and the effective cleaning of the teeth.
The most common conditions treated by the periodontist are:
Gingivitis – This is the mild inflammation of the gums which may or may not be signified by pain and bleeding.
Mild/moderate periodontitis – When the pockets between the teeth and the soft tissues are measured to be between 4-6mm it is classified as moderate periodontitis (gum disease).
Advanced periodontitis – When the pockets between the teeth and the soft tissues in general exceed 6mm in depth, significant bone loss may occur; causing shifting or loss of teeth.
Missing teeth – When teeth are missing as a result of bone loss, the periodontist can implant prosthetic teeth. These teeth are anchored to the jawbone and restore functionality to the mouth.
Treatments Performed by a Periodontist
The periodontist is able to perform a wide range of treatments to halt the progression of gum disease, replace missing teeth and make the appearance of the smile more aesthetically pleasing.
Here are some of the treatments commonly performed by the periodontist:
Implant placement – When a tooth or several teeth are missing, the periodontist is able to create a natural-looking replacement by anchoring a prosthetic tooth to the jawbone.
Osteoplasty (hard tissue recontouring) – Once periodontitis has been treated, the periodontist can recontour the hard tissue to make the smile both natural-looking and aesthetically pleasing.
Gingivoplasty (soft tissue recontouring) – As gums recede due to periodontitis, the teeth may appear longer; causing a “toothy” smile. The periodontist can remove tissues or straighten the gum line to make the teeth look more even.
Bone grafting – Dental implants can only be positioned if there is sufficient bone to attach the prosthetic tooth to. If bone loss has occurred, bone grafting is an excellent way to add or “grow” bone so that an implant may be properly secured.
Deep pocket cleanings – As gingivitis and periodontitis progress, it becomes more difficult to cleanse the pockets between the soft tissues and the teeth. The periodontist can scale and root plane the teeth (sometimes under local anesthetic) to remove debris and infection-causing bacteria.
Crown lengthening – In order to expose more of the natural tooth, the periodontist can remove some of the surrounding gingival tissue.
The periodontist is a highly skilled dental health professional who is able to diagnose and treat many commonly occurring soft tissue and bone problems in the oral cavity.
Be sure to ask your periodontist if you have any questions or concerns.
A periodontist is a dentist specializing in the prevention, diagnosis and treatment of infections and diseases in the soft tissues surrounding the teeth, and the jawbone to which the teeth are anchored. Periodontists have to train an additional three years beyond the four years of regular dental school, and are familiar with the most advanced techniques necessary to treat periodontal disease and place dental implants. Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.
Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.
Referrals from General Dentists and Self Referral
There are several ways treatment from a periodontist may be sought. In the course of a regular dental check up, if the general dentist or hygienist finds symptoms of gingivitis or rapidly progressing periodontal disease, a consultation with a periodontist may be recommended. However, a referral is not necessary for a periodontal consultation.
If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:
Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.
Bad breath – Continued halitosis (bad breath) which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis or the beginnings of an infection in the gum tissues.
Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease. As this disease progresses and attacks the jawbone, (the anchor holding the teeth in place) the teeth may become loose or be lost alltogher.
Gangrene in the tissues – Gangrene is hard to self diagnose but the general dentist and periodontist will check for its presence in the soft tissues, alveolar bone and periodontal ligament.
Related health conditions – Heart disease, diabetes, osteopenia and osteoporosis are highly correlated with periodontitis and periodontal infections. The bacteria infection can spread through the blood stream and affect other parts of the body.
Diagnosis and Treatment
Before initiating any dental treatment, the periodontist must extensively examine the gums, jawbone and general condition of the teeth. When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth which may be missing.
Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal. Education and advice will be provided on an effective cleaning regime thereafter.
Moderate periodontal disease – If the gum pockets reach 4-6mm in length a more extensive scaling and root planning cleaning might be required. This cleaning is usually performed under local anesthetic.
Advanced periodontal disease – Gum pockets in excess of 6-7mm are usually accompanied by bone loss and gum recession. Scaling and root planning will always be performed as the initial nonsurgical treatment. In addition to tose nonsurgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.
Tooth loss – Where one or several teeth are missing due to periodontal disease, dental implants are an effective option. If the bone is strong enough to provide a suitable anchor for the prosthetic tooth, the implant can be placed. However, if the bone is severely eroded, bone grafts may be performed by the periodontist to provide a suitable anchor for the new tooth/teeth.
Ask your periodontist if you have questions about periodontal disease, periodontal treatment or dental implants.
Periodontal disease is a progressive condition which leads to severe inflammation and tooth loss if left untreated. Antibiotic treatments can be used in combination with scaling and root planning, curettage, surgery or as a stand-alone treatment to help reduce bacteria before and/or after many common periodontal procedures.
Antibiotic treatments come in several different types, including oral forms and topical gels which are applied directly into the gum pockets. Research has shown that in the case of acute periodontal infection, refractory periodontal disease, prepubertal periodontal disease and juvenile periodontal disease, antibiotic treatments have been incredibly effective.
Antibiotics can be prescribed at a low dose for longer term use, or as a short term medication to deter bacteria from re-colonizing.
Oral antibiotics tend to affect the whole body and are less commonly prescribed than topical gel. Here are some specific details about several different types of oral antibiotics:
Tetracycline antibiotics – Antibiotics which include tetracycline hydrochloride, doxycycline, and minocycline are the primary drugs used in periodontal treatment. They have antibacterial properties, reduce inflammation and block collagenase (a protein which destroys the connective tissue).
Macrolide antibiotics – This group of antibiotics has proven effective at reducing inflammation, and can also reduce bacterial growth associated with periodontitis.
Metronidazole – This antibiotic is generally used in combination with amoxicillin or tetracycline to combat inflammation and bacterial growth in severe or chronic periodontitis.
Topical Gels and Strips
The biggest advantage of the direct delivery of antibiotics to the surfaces of the gums is that the whole body is not affected. Topical gels and direct delivery methods tend to be preferred over their oral counterparts and are extremely effective when used after scaling and root planning procedures. Here are some of the most commonly used direct delivery antibiotics:
Noticeable periodontal improvements are usually seen after systemic or oral antibiotic treatment. Your Periodontist or dentist will incorporate and recommend the necessary antibiotic treatments as necessary for the healing of your periodontal condition.
If you have any questions about periodontal disease or antibiotic treatments, please ask your dentist.
Bruxism refers to an oral parafunctional activity which occurs in most humans at some point in their lives. The grinding of the teeth and the clenching of the jaw are the two main characteristics of this condition, which can occur either during the day or at night.
Bruxism is one of the most common known sleep disorders and causes most of its damage during sleeping hours. The clenching and grinding which accompanies bruxism is symptomatic of a malfunctioning chewing reflex, which is turned off in non-sufferers when sleeping. For sufferers, deep sleep or even naps, cause the reflex nerve control center in the brain to turn off, and the reflex pathways to become active.
Typically, the incisors and canines (front 6 upper and lower teeth) of opposing arches grind against each other laterally. This side to side action puts undue strain on the medial pterygoid muscles and the temporomandibular joints. Earache, depression, headaches, eating disorders and anxiety are amongst the most common symptoms of bruxism; which often accompanies chronic stress, Alzheimer’s disease and alcohol abuse.
Bruxism is frequently misdiagnosed or not diagnosed at all, because it is only one of several potential causes of tooth wear. Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks and abrasive foods.
Reasons for the treatment of bruxism
Here are some of the main reasons why bruxism should be promptly treated:
Gum recession and tooth loss – Bruxism is one of the leading causes of gum recession and tooth loss; firstly because it damages the soft tissue directly, and secondly because it leads to loose teeth and deep pockets where bacteria can colonize and destroy the supporting bone.
Occlusal trauma – The abnormal wear patterns on the occlusal (chewing) surfaces can lead to fractures in the teeth, which may require restorative treatment.
Arthritis – In severe and chronic cases, bruxing can eventually lead to painful arthritis in the temporomandibular (TMJ) joints (the joints that allow the jaw to open smoothly).
Myofascial pain – The grinding associated with bruxism can eventually shorten and blunt the teeth. This can lead to muscle pain in the myofascial region and debilitating headaches.
Treatment options for bruxism
There is no single cure for bruxism, though a variety of helpful devices and tools are available. Here are some common ways in which bruxism is treated:
Mouthguards – An acrylic mouthguard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep. Mouthguards should be worn on a long-term basis to help prevent tooth damage, damage to the temporomandibular joint and help to stabilize the occlusion.
NTI-tss device – This device is fitted by a health professional and only covers the front teeth. The goal of the NTI-tss is to prevent the grinding of the rear molars by limiting the contraction of the temporalis muscle.
Other methods of treatment include relaxation exercises, stress management education and biofeedback mechanisms. When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts and crown lengthening that can restore a pleasant aesthetic appearance to the smile.
If you have questions or concerns about bruxism, please ask your dentist.
Crown lengthening is generally performed in order to improve the health of the gum tissue, or to prepare the mouth for restorative or cosmetic procedures. In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue. Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue. This treatment can be performed on a single tooth, many teeth or the entire gum line, to expose a pleasant, aesthetically pleasing smile.
Reasons for crown lengthening
Crown lengthening is a versatile and common procedure that has many effective uses and benefits. The vast majority of patients who have undergone this type of surgery are highly delighted with the results.
Here are some of the most common reasons for crown lengthening:
Restoration of damaged teeth – Periodontal disease can cause severe damage to the teeth, as can trauma and decay. Where teeth have been broken beneath the gum line, crown lengthening can be used to prepare the area for a new restoration to correct the damaged teeth.
Cosmetic uses – Extra gum tissue can make teeth look unnaturally short, and also increase susceptibility to periodontal infections. Removing excess gum tissue can restore a balanced, healthy look and thus improve the aesthetic appearance of the smile.
Dental crowns – Crown lengthening serves to provide more space between the supporting jawbone and dental crown. This prevents the new crown from damaging gum tissues and bone once it is in place.
What does crown lengthening involve?
Crown lengthening is normally performed under local anesthetic. The amount of time this procedure takes will largely depend in how many teeth are involved and whether a small amount of bone needs to be removed, in addition to the soft tissue. Any existing dental crowns will be removed prior to the procedure, and replaced immediately afterwards.
The dentist will make a series of small incisions around the soft tissue in order to separate the gums away from the teeth. Even if only one tooth requires the re-contour, neighboring teeth are usually treated to provide a more even reshaping. Separating the gums provides the dentist with access to the roots of the teeth and the underlying bone.
In some cases, the removal of a small amount of tissue will provide enough tooth exposure to place a crown. In other cases, the dentist will also need to remove a small amount of bone from around the teeth. The bone is usually removed using a combination of special hand instruments, and rotary instruments. The rotary instruments roughly resemble the drill that is used in cavity treatment.
When the dentist is satisfied the teeth have sufficient exposure, the wound will be cleaned with sterile water and the gum tissue will be sutured with small stitches. The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.
The dentist will secure the surgical site using an intraoral (periodontal) bandage, which serves to prevent infection. Prescriptions may be provided for pain medication, and a chlorhexidine (antimicrobial) mouth rinse may be given to help reduce any bacteria attempting to re-colonize. The surgical site will be completely healed in approximately two to three months.
If you have any questions about crown lengthening, please ask your dentist.
Gingival recession (receding gums) refers to the progressive loss of gum tissue, which can eventually result in tooth root exposure if left untreated. Gum recession is most common in adults over the age of 40, but the process can begin in the teenage years.
Gum recession can be difficult to self-diagnose in its earlier stages because the changes often occur asymptomatically and gradually. Regular dental check ups will help to prevent gum recession and assess risk factors.
The following symptoms may be indicative of gum recession:
Sensitive teeth – When the gums recede enough to expose the cementum protecting the tooth root, the dentin tubules beneath will become more susceptible to external stimuli.
Visible roots – This is one of the main characteristics of a more severe case of gum recession.
Longer-looking teeth – Individuals experiencing gingival recession often have a “toothy” smile. The length of the teeth is perfectly normal, but the gum tissue has been lost, making the teeth appear longer.
Halitosis, inflammation and bleeding – These symptoms are characteristic of gingivitis or periodontal disease. A bacterial infection causes the gums to recede from the teeth and may cause tooth loss if not treated promptly.
Causes of Gum Recession
Gum recession is an incredibly widespread problem that dentists diagnose and treat on a daily basis. It is important to thoroughly examine the affected areas and make an accurate diagnosis of the actual underlying problem. Once the cause of the gum recession has been determined, surgical and non surgical procedures can be performed to halt the progress of the recession, and prevent it from occurring in the future.
The most common causes of gingival recession are:
Overaggressive brushing – Over brushing can almost be as dangerous to the gums as too little. Brushing too hard or brushing with a hard-bristled toothbrush can erode the tooth enamel at the gum line, and irritate or inflame gum tissue.
Poor oral hygiene – When brushing and flossing are performed improperly or not at all, a plaque build up can begin to affect the teeth. The plaque contains various bacterial toxins which can promote infection and erode the underlying jawbone.
Chewing tobacco – Any kind of tobacco use has devastating effects on the entire oral cavity. Chewing tobacco in particular, aggravates the gingival lining of the mouth and causes gum recession if used continuously.
Periodontal disease – Periodontal disease can be a result of improper oral hygiene or caused by systemic diseases such as diabetes. The excess sugars in the mouth and narrowed blood vessels experienced by diabetics create a perfect environment for oral bacteria. The bacterium causes an infection which progresses deeper and deeper into the gum and bone tissue, eventually resulting in tooth loss.
Treatment of Gum Recession
Every case of gum recession is slightly different, and therefore many treatments are available. The nature of the problem which caused the recession to begin with needs to be addressed first.
If overly aggressive brushing techniques are eroding the gums, a softer toothbrush and a gentler brushing technique should be used. If poor oral hygiene is a problem, prophylaxis (professional dental cleaning) may be recommended to rid the gum pockets of debris and bacteria. In the case of a severe calculus (tartar) build up, scaling and root planing will be performed to heal the gingival inflammation and clean the teeth.
Once the cause of the gingival recession has been addressed, surgery of a more cosmetic or restorative nature may be recommended. Gum tissue regeneration and gum grafting are two excellent ways to restore natural symmetry to the gums and make the smile look more aesthetically pleasing.
If you have any questions or concerns about periodontal disease, periodontal treatments, or gum recession, please ask your dentist.
The objective of scaling & root planning is to remove etiologic agents which cause inflammation to the gingival (gum) tissue and surrounding bone. Common etiologic agents removed by this conventional periodontal therapy include dental plaque and tartar (calculus).
These non-surgical procedures which completely cleanse the periodontium, work very effectively for individuals suffering from gingivitis (mild gum inflammation) and moderate/severe periodontal disease.
Reasons for scaling and root planing
Scaling and root planning can be used both as a preventative measure and as a stand-alone treatment. These procedures are performed as a preventative measure for a periodontitis sufferer.
Here are some reasons why these dental procedures may be necessary:
Disease prevention – The oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body. Research has shown that lung infections and heart disease have been linked to periodontal bacteria. Scaling and root planing remove bacteria and halts periodontal disease from progressing, thus preventing the bacteria from traveling to other parts of the body.
Tooth protection – When gum pockets exceed 3mm in depth, there is a greater risk of periodontal disease. As pockets deepen, they tend to house more colonies of dangerous bacteria. Eventually, a chronic inflammatory response by the body begins to destroy gingival and bone tissue which may lead to tooth loss. Periodontal disease is the number one cause of tooth loss in the developed world.
Aesthetic effects – Scaling and root planing help remove tartar and plaque from the teeth and below the gumline. As an added bonus, if superficial stains are present on the teeth, they will be removed in the process of the scaling and root planning procedure.
Better breath – One of the most common signs of periodontal disease is halitosis (bad breath). Food particles and bacteria can cause a persistent bad odor in the oral cavity which is alleviated with cleaning procedures such as scaling and root planing.
What do scaling and root planing treatments involve?
Scaling and root planing treatments are only performed after a thorough examination of the mouth. The dentist will take X-rays, conduct visual examinations and make a diagnosis before recommending or beginning these procedures.
Depending on the current condition of the gums, the amount of calculus (tartar) present, the depth of the pockets and the progression of the periodontitis, local anesthetic may be used.
Scaling – This procedure is usually performed with special dental instruments and may include an ultrasonic scaling tool. The scaling tool removes calculus and plaque from the surface of the crown and root surfaces. In many cases, the scaling tool includes an irrigation process that can also be used to deliver an antimicrobial agent below the gums that can help reduce oral bacteria.
Root Planing – This procedure is a specific treatment which serves to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed in order to promote good healing. Having clean, smooth root surfaces helps bacteria from easily colonizing in future.
Following these deep cleaning procedures, the gum pockets may be treated with antibiotics. This will soothe irritation and help the gum tissues to heal quickly.
During the next appointment, the dentist or hygienist will thoroughly examine the gums again to see how well the pockets have healed. If the gum pockets still measure more than 3mm in depth, additional and more intensive treatments may be recommended.
If you have any concerns or questions about scaling and root planing, or periodontal disease, please ask your dentist.
Periodontal disease is a progressive condition which leads to gum inflammation, the recession of bone and gum tissue, and tooth loss if left untreated. There are a variety of effective treatments and procedures available, including pocket irrigation, which can assist in treating the progression of the disease.
Pocket irrigation aims to cleanse plaque from the interdental (between teeth) and subgingival (under the gumline) regions of the mouth in order to prevent the colonization of harmful oral bacteria. This procedure is also used to deliver antibacterials to the subgingival areas.
Reasons for pocket irrigation
Pocket irrigation, which is also known as oral irrigation, is a versatile dental treatment used for several different preventative purposes. Pocket irrigation may be performed as part of a professional dental cleaning, or at home with a specially modified oral irrigator.
Here are the main ways in which pocket irrigation can be beneficial:
Interdental cleaning – Pocket irrigators blast plaque, food particles and other debris from between the teeth. The removal of harmful materials and bacteria keep the gum pockets cleaner and shallower; thus helping the gum tissue remain healthy.
Halitosis prevention – Halitosis (or bad breath) is generally a result of old food particles between the teeth, and tooth decay. A toothbrush or dental scraper alone may not be able to reach into the depths of the gum pockets, but water jets can flush out food particles and help clean above and below the gumline.
Subgingival cleaning – Pocket irrigators have a rounded tip which eliminates the risk of tissue damage while cleaning under the gumline. The side port opening facilitates extensive cleansing by flushing out bacteria, particles and toxins from below the gumline.
Antimicrobial application – Antimicrobial substances have proven effective for eliminating and preventing some strains of harmful oral bacteria. Antimicrobial substances can be combined with water, or used as a stand-alone treatment for successful pocket irrigation.
What does pocket irrigation treatment involve?
Pocket irrigation is generally performed in combination with other dental treatments; for example, as part of a professional dental cleaning or in combination with pocket reduction surgery.
In the case of a pocket reduction surgery, the tartar and subgingival plaque will be removed with special scaling and root planing instruments. When the pockets are free of debris, an antimicrobial agent may be applied using an oral irrigator. This will help reduce harmful oral bacteria which still remain in the pockets.
During a deep cleaning procedure, a pocket irrigator may be used after scaling and root planing to cleanse the pockets. Again, an antimicrobial agent may be applied to help reduce subgingival oral bacteria.
Pocket irrigation can be performed at home as part of the daily oral routine using a water jet or water pick. Flushing the interdental area with water is less harmful to soft tissue than dental floss, but should not be used as a substitute for professional dental cleaning.
If you have any questions about pocket irrigation, cleaning your teeth, periodontal disease and treatment, please ask your dentist.
Pocket reduction surgery (also known as gingivectomy, osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus).
The human mouth contains dozens of different bacteria at any given time. The bacteria found in plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface, and ultimately contribute to periodontal disease.
Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.
Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets can eventually lead to teeth falling out. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of the bacteria-harboring pockets.
Reasons for the pocket reduction surgery
Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:
Reducing bacterial spread – Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
Halting bone loss – The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
Facilitate home care – As the gum pockets become progressively deeper, they become incredibly difficult to clean by the patient. The toothbrush and dental floss cannot reach to the bottom of the pockets, increasing the risk of further periodontal infections.
Enhancing the smile – An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by brown gums, rotting teeth and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.
What does pocket reduction surgery involve?
Before recommending treatment or performing any procedure, the dentist will perform thorough visual and x-ray examinations in order to assess the condition of the teeth, gums and underlying bone. Pocket reduction surgery may be performed under local or general anesthetic depending on the preferences of the patient.
The gums will be gently pulled back from the teeth and bacteria and calculus (tartar) will be eliminated. Scaling and root planing will generally be required to fully remove the ossification (tartar) from the surface of the tooth root. If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.
The final part of the surgery is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that are left in place for 5-10 days.
Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.
If you have any questions about pocket reduction surgery or treatment for periodontal disease, please ask your dentist.