The periodontium is the attachment apparatus around the tooth. Essentially, it is the hard and soft tissues that connect your tooth root to your jawbone. This attachment apparatus can be lost through periodontitis (bone loss) and also through gingival (gum) recession.
Gingivitis is inflammation of the gingiva. Gingivitis is a type of gum disease that is characterized by red, swollen and tender gums that bleed easily. Increased pocket depths may be found around the teeth as well. It is primarily caused by dental plaque - the soft white/yellow bacterial deposits that form on your teeth, but it can be exacerbated by other factors such as certain medications, diabetes and mouth breathing. Gingivitis is often reversible with proper treatment. Gingivitis may progress to periodontitis. Treatment can help prevent this progression.
Periodontitis is a form of gum disease that involves the loss of the supporting bone around the teeth. The signs of periodontitis may include red, swollen bleeding gums that bleed and are tender to the touch, bone loss and deep pockets. Pain is usually not a symptom of periodontitis but may occur in some circumstances. Periodontitis is usually a slowly progressing disease but can have sudden spikes in activity. It is caused by dental bacteria plaque but can be exacerbated by many factors such as (but not limited to) smoking, diabetes and tooth grinding. When the bone is lost around the teeth, the teeth become loose. You may not be able to notice the looseness yourself but your dentist or periodontist can look for this sign. It is most predictable to treat this disease when it is in the early stages. If left untreated for too long, periodontitis can lead to tooth loss. Periodontitis is an inflammatory disease. Just like other inflammatory diseases (e.g. diabetes, rheumatoid arthritis), periodontitis is not a disease that can be cured (in most cases) but rather it is a disease that needs to be managed over time. Your Periodontist can make recommendations regarding your management.
Gum recession is when the edge of the gum recedes up (or down) the root of the tooth exposing the root of the tooth. When gum recedes up the tooth root, the bone that supports your tooth also recedes up the root of the tooth. Thus, gum recession is a form of attachment loss around the teeth and can lead to tooth loss. Gum recession is caused by a number of factors including (but not limited to) tooth brushing, genetics, tooth position, muscle attachments and orthodontic tooth movement. Gum recession usually is not accompanied by pain and you may notice that you have it. Your Periodontist can measure this for you and determine if treatment is required. It is not unhealthy to have some root exposure. What is important, however, is how much good gum you have left around your tooth. It is best to have recession gum defects treated in the early stages to preserve the attachment around your teeth. Gum recession defects are usually treated with gum grafts.
Visit the American Academy of Periodontology to take the Risk Assessment Test.
Control of Risk Factors - Periodontal disease is caused by bacterial plaque or biofilm that builds up on the teeth and the inflammation associated with it. There are several risk factors for periodontal disease that contribute to the development and advancement of periodontal disease while not necessarily causing periodontal bone loss on their own. In a sense, these risk factors can speed up periodontal bone loss and need to be addressed as part of your periodontal treatment. Some of the following may be suggested as part of your treatment: a biteplane (periodontal appliance), occlusal adjustment, extraction of weakened adjacent teeth, antibiotics, smoking cessation, medical consultation.
Non-Surgical Therapy - Treatment of periodontal disease usually begins with what has become known as a "deep cleaning". This acts to reduce the inflammation in the gums and results in some decrease in your pocket depths. It includes oral hygiene instruction to suit your needs, scaling and root planing (removing tartar and root roughness under the gum line where bacteria can hide) and may also include recommendations to control any risk factors that you may have (see control risk factors). This procedure is done using dental freezing and is usually performed by our experienced dental hygienists. The dental hygienists at Ocean Periodontal are very knowledgeable about the anatomy of the roots of the teeth and have expertise in cleaning the root surfaces. Most of the appointment is spent cleaning below the gum line where it is difficult for you to reach. This procedure is usually completed in 2 to 4 appointments. Some side effects of this procedure include: mild post-operative discomfort that may last for 1-2 days and can be controlled with mild pain medication (usually not required), some mild cold sensitivity (usually short lived) and some contraction of the healing gums (due to decreased swelling in the tissues as they heal and may result in some increase in the spaces between the teeth). The benefits of this treatment far outweigh the side effects as it leads to improved oral and overall health. Without periodontal treatment, periodontal disease will progress and lead to tooth loss.
Periodontal Re-assessment - Approximately 4-6 weeks after initial root planing is completed, a reassessment is completed by the periodontist to evaluate the healing of the tissues and to determine if further treatment is necessary to further improve the health of the periodontal tissues. Additional treatment may include periodontal surgery, additional root planing or maintenance therapy.
Surgical Therapy - Surgical procedures are often necessary to improve the overall health of your periodontium (supporting tissues around your teeth) and provide an environment that is easier for you and your oral health care provider (dental hygienist, dentist or periodontist) to maintain your periodontal tissues in good health, which in turn contributes to better overall health. The goals of periodontal surgery are to remove bacteria and tartar that could not be reached with non-surgical therapy, correction of soft and hard tissue deformities caused by the disease process or correction of defects for esthetic purposes. The side effects of surgical therapy include: gingival recession (and thus longer teeth), increased spaces between the teeth (at gum level), possible esthetic changes and increased cold sensitivity (usually short duration). The benefits of periodontal surgery outweigh the side effects and without periodontal surgery, periodontal disease can progress and lead to tooth loss.
Supportive Periodontal Maintenance - Periodontal disease can return after treatment if your periodontal condition is not maintained. After the active phase of treatment (non-surgical therapy and surgical therapy), your periodontist will recommend a maintenance schedule that is tailored to your needs. During your maintenance visits, you may be provided with scaling the tartar above and below the gum line as well as root planing (deep clean) any sites that are still deep (not all deep pockets can be eliminated), antibacterial dressings below the gum line as indicated by the Periodontist, oral hygiene instruction tailored specifically for your needs, occlusal adjustment and reassessment of your periodontal health. Sometimes additional treatment is required and this is recommended on an as needed basis and is part of the maintenance program.
The Canadian Academy of Periodontology and the American Academy of Periodontology do not recommend or support the use of lasers in treatment of periodontal disease. The few published studies show insufficient evidence at this time to prove that the use of lasers is superior to, or offer additional benefit to traditional modes of periodontal treatment that have repeatedly been researched and shown to be effective in the management of periodontal diseases. Long-term comparative studies are lacking on the efficacy of lasers in the treatment of periodontal disease. Claims of less post-operative pain than traditional periodontal surgery have not been documented with controlled clinical studies and therefore remain unproven. Lasers have the potential to cause permanent thermal damage to bone and tooth root structure if not used properly. For more information on lasers, please visit the website for the American Academy of Periodontology or the website for the Canadian Academy of Periodontology.