|
PERIODONTAL PROCEDURES
What
is Gum Disease?
ADA video
link
Gingivitis
Gum
disease is not just ONE disease. It is the name of many
types of gingival and periodontal diseases. Gingivitis
commonly referred to on the TV can be treated quite
easily in most cases while periodontal disease is
primarily a multifactorial bacterial infection of
various severities and treatment options. Bacteria have
now been proven to travel from the oral cavity through
the blood stream to the heart, lung and to the womb in
pregnant women. Thus periodontal disease has been
implied in cardiovascular disease (ADA video link
Heart Disease and Dental Treatment) diabetes,
(ADA video link
Diabetes) respiratory disease and low
birth weight babies (ADA video link
Pregnancy and oral health),
and stroke. As periodontal disease is
left untreated, the bacteria become more destructive
left unchecked. |
 |
 |
What causes gum disease?
ADA video links
Receding Gums and Treatment Myths
Periodontal disease is a multifactorial infection. It usually starts with
too much of the bad periodontal bacteria in the mouth plus other
factors of immunosensitivity. Oral hygiene plays a huge role and
smoking (ADA video links
Smoking) is a great contributing factor to the progress of
periodontal disease as is uncontrolled diabetes and a family
predisposition (AAP link). Research shows that 30% of the population is likely to
be at risk for periodontal disease and these people are 6 times more
likely to have periodontal disease. Local factors such as deep
fillings or crowns can also aggravate the gums, as will hormonal
imbalances that women face throughout life (ADA video link
Estrogen & Oral Health). Finally stress and
other medical situations such as osteoporosis and multiple
medications can play a role in the progress of periodontal
disease. Clenching and grinding one’s teeth can also aggravate
an existing periodontal situation for which a bruxism guard
might be indicated.
TREATMENTS
Pocket Reduction: Non Surgical - root planning and
curettage
 |
Often
people are referred to the periodontist for “their
pockets”. What this means is that there has been slow
gradual bone loss (WHICH DOES NOT HURT AND YOU DO NOT
FEEL IT HAPPENING) over the years and when their dentist
or hygienist identifies that the gum has “unzipped” to this
lowered bone level then a pocket has occurred.
In order
to mend these pockets, the first step is to start with deep
periodontal cleaning often with local anaesthetic (for
comfort) which is different than your dental cleaning.
This way Dr. Desai can determine if surgery is indeed
indicated or whether it can be avoided. The goal of the
periodontal cleaning is to remove not only the bacteria,
tartar and toxins above the gum line but more
importantly the bacterial toxins below the gum line.
Sometimes Dr. Desai can suggest antibiotics in those
cases which are identified on an individual basis. When
bacterial deposits are left below the gum line –
continual bone loss occurs without any pain and
eventually the tooth’s longevity is in question when it
abscesses and loosens. |
Periodontists in general would agree that the majority of people
do respond favourably to this periodontal hygiene and do not
require any more than ongoing maintenance therapy to sustain
health. Laser therapy has NOT yet been proven to have long
lasting results as an alternative to “dental or periodontal
cleanings”. Dr. Desai will suggest a schedule of maintenance
depending on each individual case: sometimes she would like this
maintenance to be just in her office every 3 months, otherwise
most people can start to return to their general dentist for
alternating appointments with Dr. Desai’s office or even some need
only be seen every 1-2 years. Each case is individual and periodontitis has been deemed to be akin to diabetes –
controllable but not curable. Once you are a periodontal patient
– you will always be one.
Non surgical therapy has its
boundaries of success and if you don’t achieve shallow
maintainable pockets after this then Dr. Desai may suggest
surgical pocket elimination and regeneration.
Pocket Reduction: Surgical Pocket Reduction or
Regenerative Pocket Therapy
This procedure is
minor and done with local anaesthetic just like a filling
or a crown and most people return back to work the next day. The
goal of periodontal pocket elimination is the same as
periodontal hygiene – ie to reduce the pockets. Predictably,
only the top 4mm of a pocket can be cleaned with dental hygiene
instruments effectively. Anything deeper then 4mm can only be
predictably cleaned by visualization and access. Thus the gum is
elevated like a “shingle” the root surface is cleaned and
detoxified and the gum is replaced and it reattaches itself. The gum
reattaches itself to a lower level because this is where the gum
wants to live and thus the pocket is eliminated as things are
healthier and detoxified on the root surface.
Sometimes it is possible to regenerate a bony pocket with bone
graft or regenerative material (EMDOGAIN). Through experience, Dr. Desai will assess whether this is a predictable
option in your case.
Maintenance:
This stage of
periodontal treatment is THE most important part of periodontal
therapy. Once stability of the periodontium is achieved either
non surgically or surgically…….. one must MAINTAIN the ground
gained as opposed to losing it all over again. Once you have
periodontal disease, you will ALWAYS have it. It is akin to
diabetes, you can control it but never cure it! The oral cavity
has hundreds of bacteria and in order to keep them in check and
not lose our teeth, Dr Desai will design an individual game plan
for you which may include a 2-3 month periodontal hygiene
schedule and may or may not alternate with your general dentist.
The analogy would be similar to doing a complete automobile
engine rehaul…… if you don’t follow up with oil changes on the
car, all the energy and time spent on the rehaul will be for
naught!
Gum Recession:
ADA video link
Gum Grafting
Gum recession can
occur for a number of reasons and in most cases it is
multifactorial. Often it is due to periodontal disease and in
these cases the tooth cannot be covered with gum as there is no
bone (scaffolding) underneath it to support the gum. Often
aggressive tooth brushing, a ligament or muscle pull and/or
dental decay
can cause recession. All recessions do not need to be treated
but definitely need to be monitored as the recession can change
over time. A gum graft can often be performed to treat the
recession in order to “stop” the recession from worsening as the
bumper around the tooth is gone and the gum is no longer strong
enough to resist regular everyday function such as brushing,
eating etc. Often the tooth can be covered and this can only be
determined after careful examination and Xrays. Donor gum can be
gum from your own mouth or
alloderm (see also
this article) can be used to cover
tooth recession. Usually from your own
mouth is preferred as healing is faster, but in the long run
both produce the same results. Root sensitivity can be one of the
most aggravating parts of tooth recession and this can be
usually solved
with a gum graft.
|
CASE 1
|
 |
|
CASE 2
|
|
CASE 3
|
recession from toothbrush abrasion
after grafting
|
|
CASE 4
|
Laser frenectomy – removal of ligament without local anaesthetic
before
after
|
|
CASE
5
|
When the gingival grafting is not done as soon as the
recession is
evident, it is too late to cover the front teeth! The goal is then to
add a “bumper” of protection to the teeth so the longevity of
teeth are maintained.
|
|
CASE 6
|
The goal NOW is to increase the tooth protection, not
root coverage as there has been bone loss already and
no root coverage is possible.
|
Oral Piercing
ADA
video link
Oral Piercing
Crown
Lengthening
When a tooth crown
or filling breaks and the fracture line ends up below the gum
line, it is very difficult for your dentist to restore this crown with a healthy gum situation. Crown lengthening surgery
is then considered to be a conservative and a recommended
procedure where Dr. Desai will push the gum and bone back
slightly so that your family dentist can provide you with a well
adapted and retentive crown with a healthy amount of room (ie
biological
width).
Aesthetic Crown Lengthening OR “Gummy Smile
Treatment”
ADA Video
link
Esthetic Crown Lengthening
When one has a gummy smile or is undergoing orthodontic
treatment and jaw surgery is recommended then aesthetic crown
lengthening can be used as a potential treatment to create a
more aesthetic result. Excess gum tissue is removed and reshaped
to expose more of your natural tooth surface under the gum to
create a natural broad "hollywood smile".
|
