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PERIODONTAL DISEASE

Periodontal Disease (Periodontitis) affects the tissues which provide support to the teeth. These tissues are the gingiva (gum), alveolar bone, periodontal ligament (PDL) and cementum. The PDL attaches the cementum covering the tooth root to the bone. When the periodontium is healthy this attachment is secure, the gingivae are light pink and firm, and do not bleed on gentle probing or flossing.

Bacterial plaque forms in our mouths each day. When plaque accumulates around the neck of the tooth and is allowed to age, it produces harmful toxins. The release of these toxins initiate an inflammatory response with the periodontium causing destruction of the tissues supporting the teeth. Eventually the teeth become mobile. Without treatment the teeth are lost.

Gingivitis is the initial stage of the disease. The gingivae and PDL are inflamed. Clinically, the tissues are swollen and bleed easily although there is often no discomfort. At this point the alveolar bone is still intact. Adequate treatment at this stage is reversible; ie: no permanent damage to the periodontium has occurred. If gingivitis is left untreated, however, it can result in periodontitis.

Periodontitis, in addition to inflammation of the gingivae and PDL, involves destruction of the alveolar bone. The cementum covering the tooth root becomes contaminated with calcified accretions of plaque. These accretions are called calculus and will gradually enlarge. A microscopic layer at a time is laid down, much like a coral reef. More toxins are released causing further tissue destruction resulting in loss of support for the teeth.

Periodontitis can be classified as Mild, Moderate or Advanced according to the amount of destruction. In advanced situations periodontal abscesses may form in the pockets surrounding the tooth. Abscesses are a collection of pus. When an abscess is present the tissue is destroyed at a very rapid rate. Abscesses may or may not be symptomatic.

Certain factors can affect the rate of progression of periodontal disease as well as influence individuals which may be at greater risk for the disease. Smoking, hormonal changes, poor dietary habits and certain systemic diseases can largely influence the presence of periodontitis as well as the rate in which the disease progresses. Intraoral factors contributing to periodontal disease are ill-fitting restorations, broken restorations, broken teeth, alignment of teeth including spacing, the presence of excessive gingivae which limits good plaque control, ill-fitting or plaque retentive removable appliances, mouth breathing and an unbalanced bite (occlusion).

 

TREATMENT OF PERIODONTAL DISEASE

The treatment of periodontal disease is aimed at removing the calculus from the roots of the teeth since it is calculus that harbors plaque. This can often be done nonsurgically by a procedure called scaling and root planning. Dr. Turunen numbs the area to be treated with a local anesthetic. She then goes deeply beneath the gum to remove the accessible calculus. Smaller instruments are then utilized to plane the root smooth. This can be a very effective treatment for gingivitis and some cases of mild periodontitis.

When alveolar bone has been lost in a vertical pattern and/or the disease has progressed to the moderate to advanced stage, surgical therapy is often required in order to access the calculus which is now deeper down on the root surface and not accessible to the scaling and root planning procedure. Periodontal flap surgery is similar to scaling and root planning with the exception that the gingivae are flapped away from the teeth and bone. This allows Dr. Turunen full access to the roots. She will remove the calculus, plane the root surfaces and contour the bone if necessary. In some instances bone (osseous) replacement grafts will be placed into vertical defects. This encourages repair of the lost bone.

Dr. Turunen utilizes oral sedation in addition to local anesthetic for both the scaling and root planning and periodontal surgery procedures for enhanced patient comfort. In some instances IV sedation will be utilized.

 

PERIODONTAL MAINTENANCE

Periodontal disease is a chronic disease, very similar to coronary artery disease. Chronic diseases have a likelihood of recurrence. Patients with chronic diseases must take certain measures to reduce the incidence of disease recurrence. For example, it is well known that patients who have been treated for coronary artery disease are advised to see their physician on a regular basis, to consume a low-fat diet, to follow an exercise program, to take any prescribed medications in a compliant manner and to refrain from tobacco use.

Patients with a history of periodontal disease are encouraged to get their teeth professionally cleaned every three months, whereas the standard care in the absence of disease is every six months. This is largely due to the microbiological shift that occurs in dental plaque as it ages. New plaque contains predominately aerobic gram positive bacteria which are relatively harmless regarding the periodontium. Plaque that is 90 days old or more has shifted to predominately anaerobic, gram negative bacteria which are responsible for the initiation of the inflammatory process. A very thorough prophylaxis performed every three months that removes dental plaque before it becomes harmful is the best weapon against the recurrence of periodontitis. Typically, the areas with the most significant bone loss and pockets prior to treatment are the areas where the disease is likely to recur first. These “at risk” areas will be checked very closely during maintenance visits.

Patients who have been treated for periodontal disease are placed on an alternating program for maintenance procedures between Dr. Turunen’s office and that of their general dentist. Most often this recall period is every three months, but there can be exceptions depending on circumstances.

In addition to timely professional recall visits, the recurrence of periodontal disease can be greatly reduced by following meticulous daily plaque control measures, refraining from using tobacco products, eating a balanced diet, getting adequate sleep and keeping stress levels to a minimum.

For more information on any of the above procedures please click below:

American Academy of Periodontology

 

American Dental Association

 

PERIODONTAL DISEASE

Periodontal Disease (Periodontitis) affects the tissues which provide support to the teeth. These tissues are the gingiva (gum), alveolar bone, periodontal ligament (PDL) and cementum. The PDL attaches the cementum covering the tooth root to the bone. When the periodontium is healthy this attachment is secure, the gingivae are light pink and firm, and do not bleed on gentle probing or flossing.

Bacterial plaque forms in our mouths each day. When plaque accumulates around the neck of the tooth and is allowed to age, it produces harmful toxins. The release of these toxins initiate an inflammatory response with the periodontium causing destruction of the tissues supporting the teeth. Eventually the teeth become mobile. Without treatment the teeth are lost.

Gingivitis is the initial stage of the disease. The gingivae and PDL are inflamed. Clinically, the tissues are swollen and bleed easily although there is often no discomfort. At this point the alveolar bone is still intact. Adequate treatment at this stage is reversible; ie: no permanent damage to the periodontium has occurred. If gingivitis is left untreated, however, it can result in periodontitis.

Periodontitis, in addition to inflammation of the gingivae and PDL, involves destruction of the alveolar bone. The cementum covering the tooth root becomes contaminated with calcified accretions of plaque. These accretions are called calculus and will gradually enlarge. A microscopic layer at a time is laid down, much like a coral reef. More toxins are released causing further tissue destruction resulting in loss of support for the teeth.

Periodontitis can be classified as Mild, Moderate or Advanced according to the amount of destruction. In advanced situations periodontal abscesses may form in the pockets surrounding the tooth. Abscesses are a collection of pus. When an abscess is present the tissue is destroyed at a very rapid rate. Abscesses may or may not be symptomatic.

Certain factors can affect the rate of progression of periodontal disease as well as influence individuals which may be at greater risk for the disease. Smoking, hormonal changes, poor dietary habits and certain systemic diseases can largely influence the presence of periodontitis as well as the rate in which the disease progresses. Intraoral factors contributing to periodontal disease are ill-fitting restorations, broken restorations, broken teeth, alignment of teeth including spacing, the presence of excessive gingivae which limits good plaque control, ill-fitting or plaque retentive removable appliances, mouth breathing and an unbalanced bite (occlusion).

 

TREATMENT OF PERIODONTAL DISEASE

The treatment of periodontal disease is aimed at removing the calculus from the roots of the teeth since it is calculus that harbors plaque. This can often be done nonsurgically by a procedure called scaling and root planning. Dr. Turunen numbs the area to be treated with a local anesthetic. She then goes deeply beneath the gum to remove the accessible calculus. Smaller instruments are then utilized to plane the root smooth. This can be a very effective treatment for gingivitis and some cases of mild periodontitis.

When alveolar bone has been lost in a vertical pattern and/or the disease has progressed to the moderate to advanced stage, surgical therapy is often required in order to access the calculus which is now deeper down on the root surface and not accessible to the scaling and root planning procedure. Periodontal flap surgery is similar to scaling and root planning with the exception that the gingivae are flapped away from the teeth and bone. This allows Dr. Turunen full access to the roots. She will remove the calculus, plane the root surfaces and contour the bone if necessary. In some instances bone (osseous) replacement grafts will be placed into vertical defects. This encourages repair of the lost bone.

Dr. Turunen utilizes oral sedation in addition to local anesthetic for both the scaling and root planning and periodontal surgery procedures for enhanced patient comfort. In some instances IV sedation will be utilized.

 

PERIODONTAL MAINTENANCE

Periodontal disease is a chronic disease, very similar to coronary artery disease. Chronic diseases have a likelihood of recurrence. Patients with chronic diseases must take certain measures to reduce the incidence of disease recurrence. For example, it is well known that patients who have been treated for coronary artery disease are advised to see their physician on a regular basis, to consume a low-fat diet, to follow an exercise program, to take any prescribed medications in a compliant manner and to refrain from tobacco use.

Patients with a history of periodontal disease are encouraged to get their teeth professionally cleaned every three months, whereas the standard care in the absence of disease is every six months. This is largely due to the microbiological shift that occurs in dental plaque as it ages. New plaque contains predominately aerobic gram positive bacteria which are relatively harmless regarding the periodontium. Plaque that is 90 days old or more has shifted to predominately anaerobic, gram negative bacteria which are responsible for the initiation of the inflammatory process. A very thorough prophylaxis performed every three months that removes dental plaque before it becomes harmful is the best weapon against the recurrence of periodontitis. Typically, the areas with the most significant bone loss and pockets prior to treatment are the areas where the disease is likely to recur first. These “at risk” areas will be checked very closely during maintenance visits.

Patients who have been treated for periodontal disease are placed on an alternating program for maintenance procedures between Dr. Turunen’s office and that of their general dentist. Most often this recall period is every three months, but there can be exceptions depending on circumstances.

In addition to timely professional recall visits, the recurrence of periodontal disease can be greatly reduced by following meticulous daily plaque control measures, refraining from using tobacco products, eating a balanced diet, getting adequate sleep and keeping stress levels to a minimum.

For more information on any of the above procedures please click below:

American Academy of Periodontology

 

American Dental Association