What causes periodontal disease?

The main cause of periodontal disease is the accumulation of plaque. Plaque is the sticky film of food and bacteria that forms constantly on your teeth. If all of the plaque isn't removed each day, it builds up and mineralizes to become tartar, also called calculus.

If tartar isn't removed, it begins to accumulate on the root surfaces. Bacteria that cause periodontal disease thrive in tartar. These bacteria produce toxins, and it's these toxins, combined with your body's response to them, that destroy bone around your teeth. Professional help is required to remove tartar, because there's no way to remove it at home. A toothbrush or floss won't even budge it.

What are the warning signs?

While many people with periodontal disease experience no symptoms, others do experience warning signs that include:

• persistent bad breath 
• bleeding of the gums when brushing or flossing 
• soft, swollen, or tender gums 
• gums shrinking away from the teeth 
• loose teeth 
• changes in the spaces between teeth, which may reflect changes in the underlying bone 

How do we diagnose periodontal disease?

Since you may have periodontal disease without experiencing symptoms, we perform a thorough examination using X-rays and a periodontal probe.

The crevice between a tooth and the surrounding gum is called a sulcus. A healthy sulcus is two to three millimeters deep. When plaque and tartar invade a sulcus and it becomes deeper than three millimeters, it is called a pocket. We measure the depth of all pockets using a periodontal probe. The measurement is from the bottom of the pocket, where the gum is attached to the tooth, to the top of the gums. In general, the deeper the pockets, the greater the extent of periodontal disease.

We also examine the color, shape, and overall condition of the gums. Bleeding is a sign of infection; healthy gums don't bleed. Healthy gums are firm and lightly stippled. In moderate cases of periodontal disease, we see swollen gums.
 
X-rays also tell us a lot about periodontal disease, because they allow us to monitor your bone levels. In a healthy mouth, the bone comes up high around the necks of the teeth, and the bone level is even throughout the mouth. With advanced periodontal disease, the bone levels are much lower and are uneven.

In short, we look for the following signs to diagnose periodontal disease:

• probe readings greater than three millimeters, 
• bleeding upon probing, 
• swollen and red gums, especially between the teeth, and bone loss or tartar buildup. 
• Increased efficiency of calculus removal 
• Less need for hand scaling of stubborn deposits 
• More comfortable access to the root surfaces, thanks to the small tip 

Ultrasonic scaling removes calculus and reduces the number of harmful bacteria below the gum line. It is an important tool in the prevention and treatment of periodontal disease.

Scaling & Root Planning

Routine cleanings in our office remove plaque and tartar that exist on your teeth above the gum line, but sometimes, especially if you don't floss regularly, plaque, tartar and bacterial toxins can develop below the gum line. The goal of scaling and root planing is to remove this source of periodontal infection from below the gum line on the surfaces of the roots.

The Procedure 

Normally, we'll spread scaling and root planing over several appointments. This will maximize your comfort and allows us to check on the healing and help you fine-tune your homecare efforts.

To keep you comfortable, we may give you local anesthetic before the procedure begins. Then we'll use either a small scaling instrument or an ultrasonic sealer to carefully and meticulously remove plaque and tartar from the top of your tooth all the way down to the bottom of the pocket.

Then, we'll plane — or smooth — the root surfaces so your gums can heal and reattach to your teeth. If it appears to be necessary, an antibiotic or alternative medication will be placed in the pocket after it's been scaled and planed to control infection and promote healing. Oral antibiotics might also be prescribed to further combat the infection. Once the source of infection has been removed, your gums will begin to heal, and will once again tighten around your teeth.

Maintaining periodontal health

Homecare is the key to continuing the healing process. Since brushing and flossing only removes plaque about three millimeters below the gum line, you'll need special tools to clean the affected areas. As part of your treatment, we'll provide you with the tools and techniques you'll need to thoroughly clean and maintain these areas.

Please call Smile Plus Cosmetic Dentistry to make appointment or if have any questions and needs more details on Periodontal Needs.