Friday, October 18, 2013

Periodontal Disease

Also referred to as gum disease (pyorrhea), it is an infection that invades and destroys the tissues that support and surround the teeth. An estimated 67 million people (nearly one in three adults) in the U.S. suffer from some degree of periodontitis. It is the leading cause of tooth loss in adults; it insidious onset and slow progression (usually); along with the fact that it is nearly always painless make it a challenge to mange and treat. Even the most successful treatment outcome allows for an "arrest" of the disease; not a cure. The common cold is the only disease known to mankind that is more prevalent than periodontitis.

Stages of Periodontal Disease

Periodontal disease most always begins as gingivitis, inflammation of the gum tissue (gingival) that has not yet advanced to the bone. Its silent progression starts with a growing colony of toxin producing bacteria called plaque. In time this plaque gets mineralized from bathing in saliva and becomes calculus (tartar). the calculus that exists underneath the gumline (subgingival) is the most destructive element of periodontal disease. Lack of proper oral hygiene and a variety of other risk factors result in an accumulation of plaque and calculus that inflames and infects the gingival and bone. A periodontal pocket forms (crevice/space between the gum and bone) forms along with swelling, bleeding and tenderness of the gum tissue; and eventually permanent gum and bone damage; and ultimately tooth loss.

Scientific research has uncovered a relationship between periodontitis and other serious health conditions such as heart disease, stroke, diabetes, respiratory disease, pregnancy; and pre-term, low birth weight babies. Genetic makeup, smoking, stress, hormonal changes and various medications are also risk factors.

Periodontal Treatments and Procedures

Early detection and appropriate treatment is the key to halting disease progression. During and after treatment; a serious long term commitment is necessary for a patient to arrest the disease process.

Treatment is basically divided into 2 types: Surgical and non-surgical. Surgical treatment is usually carried out by a periodontist; although some general dentists have been known dabble. The extent and success of Non-surgical treatment vary from dentist to dentist. I have recently organized and implemented a proactive, comprehensive Soft Tissue Management (STM) program which utilizes various modalities to offer my patients the best chance of treating their conditions without surgery.

1. Scaling: this should not be confused with a dental prophylaxis/teeth cleaning that is performed only in a healthy mouth for primarily preventive purposes.

A. Gross Scaling: carried out with an ultrasonic device, it removes the gross or large particles of calculus that can be very tenaciously adhered to the tooth/root surface.
B. Fine scaling: uses hand instruments called scalers or curettes which are intimately adapted to the root surface to remove the finer particles of plaque and calculus above and (mostly) below the gumline.

2. Root Planing: a meticulous and technique sensitive procedure to remove bacterial plaque, biofilm calculus and diseased root surface to allow for healthy reattachment of the gums. This usually requires local anesthetic.
3. Irrigation: although there are different ways to accomplish this; we use a specialized blunt tip needle (with 4 ports)  attached to a "piezo electric device which pulsates medicaments into a periodontal pocket. This device allows the solution to be warmed. The most common medicament is Chlorhexidine. It is an FDA approved antibacterial mouthrinse that is available only by prescription. The goal is obviously to minimize the amount of bacteria in the pocket. This procedure is usually carried out along with Scaling and root planing.

4. Antibiotic therapy. Although there are a few different topically applied antibiotics; we prefer "Arestin" a crystal/powder form of minocycline (cousin to tetracycline) that is manually placed ina pocket (indicated in pockets over 4 mm that do not respond to scaling/root planing alone). Arestin dissolves in the pocket over a 21 day span.

5. Personal Oral hygiene. Besides the conventional brushing and flossing, there are specialized toothbrushes (Rotadent: recommended and sold only by participating dentists) and other periodontal aids that assist in the daily removal of plaque at home. A good dental hygienist/dentist should suggest an individual program for each patient undergoing our STM program. This is essential for successful treatment.

6. Recall/Supportive periodontal therapy. There is some evidence and immense clinical observation to support the facet that 90 days is the time necessary for bacteria to re-establish to the point they can cause more damage to periodontal tissues. This time interval is often the benchmark for successful follow up aftercare from STM and conventional Scaling, Root planing. 4 months is permissible in some patients.

The goals of non-surgical periodontal therapy are as follows:
A. Gingival tissues that are not red, puffy, swollen and DO NOT BLEED.
B. Fresher tasting/better smelling mouth.
C. Continuous personalized home care/oral hygiene.
D. Healthy periodontal pocket depths.
E. Avoidance of surgical periodontal treatment.

Creating Confident Smiles
416 N. Bedford drive, suite 409
Beverly Hills, CA  90210

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