Periodontal (Gum) Disease

FAQ's
Defining Terms
Stages of Periodontal Disease
X-Rays in Periodontal Diagnosis
Periodontal Therapy 

First a few frank comments about periodontal disease...

HOME CARE, HOME CARE, HOME CARE

One of the biggest misconceptions concerning periodontal disease is that the dentist / hygienist will control the disease. The responsibility of controlling the disease process rests completely with the PATIENT ! This is not to say that professional care (i.e. diagnosis, education, therapy) is not necessary - it 's just that MANY people that have had the best of care, do not perform the diligent home care regimen they should. Once a person has been diagnosed, they forever have periodontal disease. There is NO cure - it can only be maintained, and should be reevaluated at regular intervals so as not progress to the point of tooth loss.

Bacteria is the MAIN culprit. Bacteria exists in everyone's mouth. Some strains of bacteria are much more aggressive than others.

FAQs
What is the cause of most tooth loss in adults?
Periodontal disease - NOT decay

Can I inherit this problem?
Yes, you can. You may inherit the problem of unusually heavy plaque and tartar buildup, or even problems with your immune system which leave you much more susceptible.

Can I tell that I'm having this problem myself?
Not in the earliest stages, it takes a dentist or hygienist using a special instrument to determine early onset.

If my gums bleed when I brush, am I in desperate trouble?
Not necessarily, but the earlier the treatment, the more likely long-term success.

Does everyone diagnosed require surgery?
Not at all. In fact conservative therapy has proven to be successful in the majority of cases diagnosed early.

Is bad breath a sign of periodontal problems?
Possibly, because the very same bacteria can cause both problems.

How long does it take for plaque to reform after a professional cleaning?
1 day

Are there are factors besides bacteria?
Yes, stress, poor nutrition, a poor bite and especially smoking.

Do you know what the difference is between the terms periodontal disease, gum disease and pyorrhea? There is no difference, they are synonymous terms. Periodontal disease is the most common disease in the world, it is estimated that over 70% of the adult population in this country have some periodontal problems..

Periodontal disease is a chronic infection that slowly attacks and destroys the gums and bone that support the teeth. The fact that it is a chronic disease means that a person can not be "cured", rather they must work at controlling the factors which will bring on the full disease process. Other examples of chronic disease are heart disease and diabetes - they can be managed, but NOT cured.

Let's begin by defining terms.

  • “PERIO” means around and “DONTAL” means tooth. By saying “around”, this means that periodontal disease has to do with the gum tissues and bone that support the teeth
  • PLAQUE is a bacteria that is collecting onto teeth and gums. In small numbers, there is no problem, but when it collects in large numbers it causes damage to the teeth (decay) and supporting tissues (period ontal disease)
  • CALCULUS is a hard buildup that occurs around the teeth. This must be removed with a professional cleaning. The combination of calculus and plaque is the primary cause of periodontal disease.
  • TARTAR is the same as calculus.
  • PERIODONTAL POCKETS are areas where the jawbone has been eroded away by the disease process.
  • PERIODONTAL PROBE is a dental instrument used to detect and measure the depth of pockets.
  • GINGIVA is another word for your gums.
  • GINGIVITIS is used to describe the first stage of periodontal disease. The gums are puffy and bleed.

 

When a screening is performed (and it should be performed at each hygiene appointment), a periodontal probe is used. This probe is a depth measurement device - the measurements are taken in millimeters (mm). With very little pressure the probe is slipped down next to the root of the tooth until there is resistance. The mark which is then at the gum line demonstrates the depth of the gum pocket. Healthy gums do have pockets but they don't bleed and are no deeper than 3mm.

THE PRIMARY STAGES OF PERIODONTAL DISEASE


Healthy Tissues
  • No bleeding or puffy gums, pockets all measure to a normal 3mm or less.

Periodontitis I (Gingivitis)
  • Bleeding gums when measured, puffy in appearance and pockets no greater than 3mm. No damage to the supporting bone in this stage.

Periodontitis II
  • Bleeding and puffy gums that measure slightly more than normal at up to 5mm.

Periodontitis III
  • Bleeding and swollen gums with pockets that will measure up to 6mm and more. Recession beginning to appear.


X-Rays in Periodontal Diagnosis

X-rays play a vital part in the overall diagnosis of periodontal disease. They compliment the periodontal pocket charting.
NORMAL X-RAY

In this first film, the bone and supporting tissues are normal. Your gums don't show up on x-rays but the bone does. The red line is drawn across the top of the bone seen on the film.



PERIODONTAL X-RAY

In this film, the PERIO BONE LEVEL refers to the level of bone left supporting the teeth after the destructive process has occurred. HEALTHY BONE LEVEL demonstrates the ideal (See the NORMAL X-RAY above). The BONE LOSS BETWEEN MOLAR ROOTS demonstrates an area where the bone has dropped down below where the roots of the molar divide.




PERIODONTAL THERAPY

Through stages I, II, and III it is usually a more conservative nonsurgical approach that is taken. The usual treatment sequence after proper diagnosis and documentation is performed is -

SCALING and ROOT PLANING

SCALING consists of removing the hard calculus and plaque around the collar of the tooth as well as below the gumline. ROOT PLANING removes the calculus and plaque off the root surface well below the gumline (into the pocket). Depending on the case, these procedures may or may not require numbing. Hand instruments called scalers as well as high-frequency polishers will be used to accomplish a complete and thorough job.

SURGICAL TREATMENT

When the pockets are very deep, procedures must be performed so that all infection, plaque and calculus may be removed. Sometimes the bone around is no longer smooth and it must be corrected. There are times that bone may be actually added to areas where it has eroded away.

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Dr. Maury Hafernik
11645 Angus Road, Suite 10
Austin, Texas 78759
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