The word periodontal means “around the tooth”. Periodontal disease attacks the gums and the bone that support the teeth. Plaque is a sticky film of food debris, bacteria, and saliva. If plaque is not removed (both above and below the gums), it turns into calculus (tartar). When plaque and calculus are not  removed, they begin to destroy the gums and bone. Periodontal disease is characterized by red, swollen, and bleeding gums.

Four out of five people have periodontal disease and don’t know it! Most people are not aware of it because the disease is usually painless in the early stages. Studies have shown that 95% plus of the North American Population do not floss on a regular basis which is a huge cause of Periodontal Disease.

Not only is it the number one reason for tooth loss, research suggests that there may be a link between periodontal disease and other diseases such as, stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy. Researchers are determining if inflammation and bacteria associated with periodontal disease affects these systemic diseases and conditions. Smoking also increases the risk of periodontal disease.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

Signs and Symptoms of Periodontal Disease

• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
• New spacing between teeth – Caused by bone loss.
• Persistent bad breath – Caused by bacteria in the mouth.
• Pus around the teeth and gums – Sign that there is an infection present.
• Receding gums – Loss of gum around a tooth.
• Red and puffy gums – Gums should never be red or swollen.
• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

How To Diagnose Periodontal Disease?

Periodontal disease is diagnosed by our dentists during a periodontal examination. This type of exam should always be part of your regular dental check-up.

A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums / bone. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper.

Our hygienist will record pocket readings of all aspects of your teeth during your initial visit. With this and other diagnostics (ex: x-rays, intraoral pictures, etc…) our dentist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

• Gingivitis : It is a disease of the gums. Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.
• Periodontitis : Plaque hardens into calculus (tartar). As calculus and plaque continue to build up (both above and below the gums), the gums/bone begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria. The gums become very irritated, inflamed, and bleed easily. Slight to moderate bone loss may be present.
• Advanced Periodontitis : The teeth loose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.

How to Treat Periodontal Disease

Periodontal treatment methods depend upon the type and severity of the disease. Together, our dentists and dental hygienists will evaluate for periodontal disease and recommend the appropriate treatment.

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues. When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!

If the disease is caught in the early stages of Gingivitis, and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages of Periodontitis, a special periodontal cleaning called scaling and root planning (deep cleaning) will be recommended. It is usually done two quadrants of the mouth at a time while the area is numb (a lot of patients prefer to have the entire mouth done in one sitting). In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planning). This procedure helps gum tissue to heal and pockets to shrink. An antibiotic solution is used to irrigate and ensure that all the bacteria and toxins have been flushed out and the last of it is cleared from the areas. Additionally LASER THERAPY might be highly recommended for more effective disinfection of your pockets and decreasing the healing time . Medications such as Arestin (antibiotic powder placed in the socket for about 28 days which will ensure that the pocket stays clean and heals) may be placed at follow up visits after the actual scaling and root planning. Special medicated mouth rinses, and an electric tooth brush or other cleaning tools may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planning, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone).

Soft Tissue Management Program

The purpose of our soft tissue management (STM) program is to remove hard and soft deposits from the teeth and gum line and to decrease inflammation. Your gums are not healthy and this is a therapeutic treatment to restore health when combined with proper and effective homecare. After completion of our STM program, periodontal surgery may be recommended after re-evaluation, in order to eliminate periodontal pockets.
The treatment that you may need consists of one or combination of the below listed therapies:

• Full mouth Debridement – Scaling in the presence of gingival inflammation, (full mouth debridement). You have more calculus (tartar) than someone who regularly maintains his/her teeth. Your gums show signs of inflammation that may include bleeding, irregular contour, heat, redness, pain, swelling or loss of function. Topical anesthetic may be need for patient comfort. We will bring you back in 6-8 weeks to reevaluate the gums and determine if you need prophylaxis or Scaling and Root planning.
• Prophylaxis – This is a basic cleaning, a preventative procedure performed in the presence of gum health. At this visit t we remove calculus (tartar and plaque, and polish the teeth to remove any additional plaque and/ or stains, followed by an application of fluoride varnish. Usually no anesthetic is needed for this procedure.
• Scaling and Root Planning – Typically performed in two visits, we numb one side and scale the teeth both above and below the gum, cleaning calculus and plaque to reduce the inflammation and decrease the picket depth. Following the visit we schedule you to treat the other side. You will receive the combination of topical anesthetics and nerve blocks.
• Arestin – A tetracycline antibiotic (minocycline hydrochloride, 1 mg.) that we gently place in the infected pocket around your teeth to treat your periodontal disease and help prom ore healing after scaling and root planning.
• Laser – Soft tissue Dental Laser therapy is usually very comfortable and may not require the use of anesthetic and is used to treat periodontal disease by removing bacteria and infected tissue. Dental lasers also shorten treatment time and healing time and decrease the risk of infection following treatment. In addition, lasers minimize bleeding both during and after treatment, and because they are very precise, we are able to treat the targeted area without affecting nearby healthy tissues.
• Periodontal Maintenance – Approximately 6-9 weeks after scaling and root planning is completed we do a periodontal maintenance, in which we re-evaluate the gums, remove fine calculus and polish the teeth. Most patients need to have their teeth cleaned every three months after scaling and root planning, both to maintain health and reevaluate periodontal pockets.

Maintenance of periodontal health requires daily, thorough debridement of all tooth surfaces. The golden mantra for good care is the rule of 1, 2, and 3.

• Flossing at least once a day, preferably at night before bedtime.
• Brushing for two minutes twice a day and rinsing twice daily, getting your teeth professionally cleaned two times a year.
• Change your toothbrush or tooth brush head at least once every three months.

Periodontal Disease and its Links to other SYSTEMIC CONDITIONS

In July 1998, the American Academy of Periodontology launched an effort to educate the public about new findings which support what dental professionals had long suspected: Infections in the mouth can play havoc elsewhere in the body. For a long time it was thought that bacteria was the factor that linked periodontal disease to other infections in the body, however, new research demonstrates that inflammation may link periodontal disease to other chronic conditions.

Research has shown, and experts agree, that there is an association between periodontal diseases and other chronic inflammatory conditions such as:

• Diabetes
• Cardiovascular Disease (Heart Conditions)
• Osteoporosis
• Respiratory Infections
• Pregnancy

We at RFCD are committed to you and your families periodontal health and make it our top priority to ensure that your entire health, especially the environment in which your teeth sit in are healthy.