Periodontics Roanoke, VA

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.

Periodontal disease is the leading cause of bone loss in the oral cavity, though there are others such as ill-fitting dentures and facial trauma.  The bone grafting procedure is an excellent way to replace lost bone tissue and encourage natural bone growth.  Bone grafting is a versatile and predictable procedure which fulfills a wide variety of functions.

A bone graft may be required to create a stable base for dental implant placement, to halt the progression of gum disease, or to make the smile appear more aesthetically pleasing.

There are several types of dental bone grafts.  The following are the most common:

• Autogenous bone graft – In this type of graft the bone is removed from elsewhere in the body and implanted in the mouth.  Common donor sites for bone grafting include the iliac section of the pelvis, the chin and the posterior third molar areas of the jaw.  If large amounts of bone need to be harvested, the hip or the shin bone (tibia) is generally used.
• Allograft – Synthetic bone (manmade) can be created in the laboratory and used in the bone grafting procedure.  Bone can also be obtained from a bone bank (cadaver bone).
• Xenograft – This is the implantation of bovine (cow) bone. A xenograft is perfectly safe and has been used successfully; ample bone can be obtained, and a secondary donor site is not necessary.

Reasons for bone grafting

There are a wide variety of reasons why bone grafting may be the best option for restoring the jaw bone.

Dental implants – Implants are the preferred replacement method for missing teeth because they restore full functionality to the mouth; however, implants need to be firmly anchored to the jawbone to be effective.  If the jawbone lacks the necessary quality or quantity of bone, bone grafting can strengthen and thicken the implant site.

Sinus lift – A sinus lift entails elevating the sinus membrane and grafting bone onto the sinus floor so that implants can be securely placed.

Ridge augmentation – Ridges in the bone can occur due to trauma, injury, birth defects, or severe periodontal disease.  The bone graft is used to fill in the ridge and make the jawbone a uniform shape.

Nerve repositioning – If the inferior alveolar nerve requires movement to allow for the placement of implants, a bone grafting procedure may be required.  The inferior alveolar nerve allows feeling and sensation in the lower chin and lip.

What does bone grafting treatment involve?

Bone grafting is a fairly simple procedure that can be performed under local anesthetic; however, if large amounts of bone area need to be grafted, general anesthetic may be required.

Initially, the grafting material needs to either be harvested or prepared for insertion.  A small incision is made in the gum tissue and then gently separated from the bone.  The bone grafting material is then placed at the affected site.

The bone regeneration process may be aided by:

• Gum/bone tissue regeneration – A thin barrier (membrane) is placed below the gum line over the grafting material.  This barrier creates enough space for healthy tissue to grow and separates the faster growing gum tissue from the slower growing fibers.  This means that bone cells can migrate to the protected area and grow naturally.
• Tissue stimulating proteins – Enamel matrix proteins occur during natural tooth development.  Emdogain is a matrix protein product which is usually placed on the affected site before the gum is sutured.  It mediates the formation of accellular cementum on the tooth which provides a foundation to allow periodontal attachment to occur.  Tissue stimulating proteins help create lost support in areas affected by periodontal defects.
• Platelet-rich growth factors – A high platelet concentration liquid can be used to create a blood clot at the site of a wound.  It has recently been discovered that PRGF also stimulates bone growth – meaning a denser graft in a shorter time period.

The gum is sutured in place and a follow-up appointment will need to be made within 10 days to assess progress.  Bone grafting is a highly successful treatment and a good base for further periodontal restorations.

If you have any questions about bone grafting, please ask your dentist.

Periodontal disease is an extremely serious progressive condition which can lead to tooth loss if left untreated.  Periodontal disease occurs when a bacterial infection in the gum pockets causes the bone and gum tissue to recede away from the teeth.  The quality and quantity of bone and gum tissue is greatly reduced as the gum pockets continue to deepen.  Fortunately, prompt diagnosis combined with effective regenerative procedures can halt the progression of the disease and save the teeth.

There are many regenerative dental procedures available to restore health to the gums, bone and teeth.  The following are the most commonly used regenerative procedures:

Bone Regeneration

Dental implants and other restorative procedures depend on the jawbone being sufficiently strong and thick.  When periodontal disease has taken hold, the jawbone may have become too thin to successfully support an implant.  Natural bone regeneration (or bone grafting) is one of the best ways to promote growth and thicken the jawbone.

Initially, bone grafting material is obtained from elsewhere on the body or from a bone bank.  The gums are gently pulled back, and an opening is made in the jawbone where the grafting material will be packed in tightly.  A membrane is used to maintain the shape of the new bone, and tissue stimulating proteins and a platelet-rich growth factor may be applied to promote faster healing.  The surgical site will be sutured and packed with protective material.  The bone will naturally regenerate and become strong enough to eventually support an implant.

Gum Tissue Regeneration

Gum tissue regeneration is usually performed by way of gum grafting.  When gum tissue has been lost as a result of periodontal disease, the smile may appear discolored, toothy or unpleasant.  A gum graft aims to symmetrically contour the gum line, cover any exposed tooth roots and restore health to the gums.  Initially, a small strip of tissue will be removed from the roof of the mouth and placed in the middle of a split-thickness incision at the recipient site.  The surgical site will be covered with a protective membrane which promotes tissue regeneration, covered in platelet-rich growth factor and tissue stimulating proteins, and then sutured closed.  The soft tissue surrounding the teeth will naturally regenerate, producing a healthy, smile.

Pocket Reduction Surgery

The aim of pocket reduction surgery is to reduce the depth of the gum pockets and make it much harder for bacteria to invade the gum tissue.  Initially, the gum tissue is pulled back from the teeth and the subgingival area is thoroughly cleansed under local anesthesia.  Extensive scraping may be required to fully remove the plaque, debris and tartar from below the gum line.  An antimicrobial agent may then be applied to the affected area to kill any remaining bacteria, and the surgical site will be sutured closed.  Pocket reduction surgery is very effective for halting tissue loss and promoting the natural healing of the gums.

Scaling and Root Planing

The term “scaling” refers to the removal of plaque and calculus (tartar) from the supragingival region (above the gum line).  This treatment is usually conducted in the course of a routine professional cleaning, and performed under local anesthetic.  Root planing usually accompanies scaling and is performed in the subgingival region (below the gum line).  Tartar and toxins are initially removed, and then the tooth root is smoothed down to promote good healing in the gum tissue.  The planing of the tooth root provides a smooth area which prevents bacteria from recolonizing.  If these procedures do not completely eradicate the infection, surgical measures may be required.

If you have any questions about regenerative procedures or periodontal disease, please ask your dentist.

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 a 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.

Please contact our office 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 altogether.
• 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 planing 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 planing 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 that leads to severe inflammation and tooth loss if left untreated.  Antibiotic treatments can be used in combination with scaling and root planing, 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

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 directly delivering antibiotics to the surface of the gums is not affecting the entire body.  Topical gels and direct delivery methods tend to be preferred over their oral counterparts and are extremely effective when used after scaling and root planing procedures. Here are some of the most commonly used direct delivery antibiotics:

• Atridox^® – This doxycycline gel conforms to the contours of gum surfaces and solidifies over them. Over several days, this gel gradually releases the antibiotic medication.
• PerioChip^® – This chip is placed into the actual gum pocket after a root planing procedure.  PerioChip® slowly releases Chlorhexidine, a powerful antibacterial antiseptic. PerioChip® reduces pocket depth in most periodontitis cases.
• Actisite^® – This thin strip is similar to dental floss and contains tetracycline hydrochloride. The thread is temporarily placed between the tooth and gum to kill bacteria and reduce pocket depth.  Several threads are sometimes placed for around 10 days to enhance the antibiotic effect.
• Elyzol^® – This metronidazole antibiotic comes in gel and strip form. It is unique because it is able to destroy parasites as well as oral bacteria.
• Arestin^® – This Minocycline antibiotic comes in mini capsules which are delivered into the gums after scaling and root planing.

Noticeable periodontal improvements are usually seen after systemic or oral antibiotic treatment. We will incorporate antibiotic treatments as necessary for the healing of your periodontal condition.

If you have any questions about periodontal disease or antibiotic treatments, contact our practice at your convenience.

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/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.  It aggravates the gingival lining of the mouth and causes gum recession when 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, 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 gingival inflammation and clean the teeth.

Once the cause of the gingival recession has been addressed, surgery of a more cosmetic or restorative nature might 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 contact our office.

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:

• Lips
• Mouth
• Tongue
• Salivary Glands
• Oropharyngeal Region (throat)
• Gums
• Face

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.

The objective of scaling and root planing 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 planing 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 planing 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, 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, such as professional dental cleaning or 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 contact our practice.

A dental prophylaxis is a cleaning procedure performed to thoroughly clean the teeth.  Prophylaxis is an important dental treatment for halting the progression of periodontal disease and gingivitis.

Periodontal disease and gingivitis occur when bacteria from plaque colonize on the gingival (gum) tissue – either above or below the gum line. These bacteria colonies cause serious inflammation and irritation which in turn produce a chronic inflammatory response in the body.  As a result, the body begins to systematically destroy gum and bone tissue, making the teeth shift, become unstable, or completely fall out.  The pockets between the gums and teeth become deeper and house more bacteria which may travel via the bloodstream and infect other parts of the body.

Reasons for prophylaxis/teeth cleaning

Prophylaxis is an excellent procedure to help keep the oral cavity in good health and also halt the progression of gum disease.

Here are some of the benefits of prophylaxis:

• Tartar removal – Tartar (calculus) and plaque buildup, both above and below the gum line, can cause serious periodontal problems if left untreated.  Even using the best brushing and flossing homecare techniques, it can be impossible to remove debris, bacteria and deposits from gum pockets.  The experienced eye of a dentist using specialized dental equipment is needed in order to spot and treat problems such as tartar and plaque buildup.
• Aesthetics – It’s hard to feel confident about a smile marred by yellowing, stained teeth.  Prophylaxis can rid the teeth of unsightly stains and return the smile to its former glory.
• Fresher breath – Periodontal disease is often signified by persistent bad breath (halitosis).  Bad breath is generally caused by a combination of rotting food particles below the gum line, possible gangrene stemming from gum infection, and periodontal problems.  The removal of plaque, calculus and bacteria noticeably improves breath and alleviates irritation.
• Identification of health issues – Many health problems first present themselves to the dentist.  Since prophylaxis involves a thorough examination of the entire oral cavity, the dentist is able to screen for oral cancer, evaluate the risk of periodontitis and often spot signs of medical problems like diabetes and kidney problems.  Recommendations can also be provided for altering the home care regimen.

What does prophylaxis treatment involve?

Prophylaxis can either be performed in the course of a regular dental visit or, if necessary, under general anesthetic.  The latter is particularly common where severe periodontal disease is suspected or has been diagnosed by the dentist.  An endotracheal tube is sometimes placed in the throat to protect the lungs from harmful bacteria which will be removed from the mouth.

Prophylaxis is generally performed in several stages:

1. Supragingival cleaning – The dentist will thoroughly clean the area above the gum line with scaling tools to rid them of plaque and calculus.
2. Subgingival cleaning – This is the most important step for patients with periodontal disease because the dentist is able to remove calculus from the gum pockets and beneath the gum line.
3. Root planing – This is the smoothing of the tooth root by the dentist to eliminate any remaining bacteria.  These bacteria are extremely dangerous to periodontitis sufferers, so eliminating them is one of the top priorities of the dentist.
4. Medication – Following scaling and root planing, an antibiotic or antimicrobial cream is often placed in the gum pockets.  These creams promote fast and healthy healing in the pockets and help ease discomfort.
5. X-ray and examination – Routine X-rays can be extremely revealing when it comes to periodontal disease.  X-rays show the extent of bone and gum recession, and also aid the dentist in identifying areas which may need future attention.

Prophylaxis is recommended twice annually as a preventative measure, but should be performed every 3-4 months on periodontitis sufferers.  Though gum disease cannot be completely reversed, prophylaxis is one of the tools the dentist can use to effectively halt its destructive progress.

If you have questions or concerns about prophylaxis or periodontal disease, please contact our practice.