Periodontal Disease Treatment
Believe it, or not, your mouth is connected to the rest of your body!
Dentists and periodontists have long known that disease in the mouth can affect the entire body. Periodontal disease, which affects almost 75% of the entire world’s population, is one of the most prevalent diseases that can be prevented in most cases. Only recently, however, has the world of modern medicine begun to recognize that there is a significant correlation among periodontal disease and other systemic diseases, such as: cardiovascular (heart) disease, diabetes, and even some forms of cancer.
Periodontitis is a disease that is classified as an “inflammatory” disease. It creates all kinds of molecules as a response to the hard bacterial deposits on teeth (tartar or calculus) that circulate throughout the body through the bloodstream. Cutting-edge research is currently pointing toward periodontal disease as contributing greatly to other diseases, and that definitive treatment helps decrease your risk and the severity of these diseases.
All in all, inflammation is not good anywhere in the body – whether it be the mouth, the heart or elsewhere. Treatment to reduce that inflammation can result in a healthier mouth, healthier body and healthier you!
How do you treat periodontal disease?
In this patient with mild to moderate periodontitis, changes in tissue contours and color are present. Root surfaces that have been exposed with gingival recession due to destruction of the connective tissue attachment may appear light gray to yellow in color. Spaces between the mandibular teeth are usually a sign of drifting due to loss of supporting bone.
In periapical x-ray , marginal bone levels (line a) are consistent with no history of periodontitis. In periapical x-ray B, periodontitis has caused resorption of approximately 50% to 60% of the bone supporting the mandibular anterior teeth. The approximate level of bone that would be expected in the absence of periodontitis is marked by line a, and the approximate level at the time of the x-ray is marked by line b.
Periodontal disease can be treated in several ways, however, most methods fall into one of two categories – surgical or non-surgical. Truthfully, the road that you need to go down depends upon a lot of factors, including mainly the severity of the disease. Most of the time non-surgical therapy is used as a first-line of treatment in order to reduce the necessity for surgical treatment. There are several methods of non-surgical therapy, however, the primary goal is to remove any bacterial deposits (calculus or tartar) from the roots of the tooth, as they act like a “splinter under your fingernail” and are a constant source of irritation. No matter what course of treatment that is necessary and you choose, removal of these bacterial deposits IS A MUST!
Types of non-surgical therapy:
Scaling and Root Planing (deep cleaning) – This is a necessity no matter what type of therapy (non-surgical or surgical) is right for you – even laser, local antibiotics, etc.) It is absolutely necessary to remove the bacterial deposits (calculus or tartar) so that the irritation to your gums and bone loss do not persist
Laser Therapy – Lasers have been used in medicine and dentistry for over twenty years and have been proven safe and effective in medicine. In dentistry, however, their effectiveness has not yet been proven through research. At this point, even though lasers are being used daily for the treatment of periodontal disease, not a single randomized double-blind controlled clinical trial (the GOLD STANDARD in medicine and dentistry) has been conducted with lasers to treat periodontal disease. Lasers are a tool in the toolbox for dentistry at this point, but, remain unproven.
Local Antibiotics (Arestin, Periochip) – Localized antibiotics, usually in the form of a chip or powder that is inserted into a periodontal pocket are a form of “adjunctive” therapy that is meant to be used after deep cleanings to improve the results obtained or attempt to further treat pockets that did not respond to deep cleaning. These are NOT meant to be used without removing bacterial deposits (calculus or tartar) – in fact, using them by themselves may “trap” the calculus on the root surface and result in an abscess, which is a highly active and painful type of infection that must be treated surgically.
Perioprotect – Perioprotect is a system that was developed in an attempt to treat periodontal disease without the removal of bacterial deposits. It consists of a mouthpiece (similar to a bleaching tray) that contains a medicament (any one that your dentist chooses) to attempt to sterilize the bacterial deposits. This type of therapy does not remove the cause of periodontal disease (calculus or tartar) in most people and may offer some temporary benefit, however, the “splinter under the fingernail” is still there and the active disease will return.
Types of surgical therapy:
Pocket Reduction – This procedure is meant to remove deposits from the roots of the teeth that may be inaccessible via deep cleanings, remove diseased tissue and recontour the bone to mimic “healthy” bone structure.
Guided Tissue Regeneration – This procedure (GTR) replaces bone and the supporting structures for teeth in very specific instances and can be helpful to gain lost support in isolated areas. Bone grafts, and growth factors may be used to enhance success.
Biologic Root Reshaping – Root reshaping accomplishes several goals with one thing in mind – keeping your teeth. This procedure was developed to remove many of the physical causes of periodontitis – the little nooks and crannies in and around the roots of teeth.
Dental implants and periodontal disease. (Periimplantitis)
Dental implants are a fantastic solution to the problem of missing teeth and can be a permanent replacement for lost teeth. In a small segment of the population, however, dental implants are also susceptible to the same bacteria and processes of periodontal disease that can cause implant loss.
Many of the same therapies for periodontal disease in teeth may work for implants with “Periimplantitis”. However, disease around implants can act differently and progress differently, and an examination to determine where you stand is a very important part of the process.
Why should I be treated by a specialist?
Very early forms of periodontal disease are very controllable and can be treated with minimal effort, often in the form of deep cleanings. Once your measurements go beyond 5 millimeters (the numbers the doctor calls out when performing an examination for you), the ability to clean the root surfaces of teeth, especially the back teeth, goes down by 80%! Periodontists and the hygienists that work with them side-by-side treat patients with periodontal disease all day every day. The goal, once again, is to save your teeth and minimize the need for surgical intervention. Your best chance to avoid surgery is to be treated by a team with experience and expertise in your needs.