Dentistry focuses on diagnosing, preventing, and treating conditions of the teeth, gums, and oral structures, supporting oral health and overall well-being.
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Periodontal treatment is a journey, not a single event. The goal is to arrest the infection, restore lost form and function, and maintain health for a lifetime. Modern periodontics offers a wide array of non-surgical and surgical therapies, often combining them for optimal results.
The treatment philosophy has shifted from “resective” (cutting away tissue) to “regenerative” (rebuilding tissue). We now have the tools to regrow bone and gum tissue in specific situations. The focus is on saving natural teeth whenever possible and replacing them with implants only when necessary.
Successful treatment relies heavily on the patient’s home care. The periodontist provides the “clean slate,” but the patient must maintain it. This partnership is the key to long term stability.
The first line of defense against periodontitis is non-surgical therapy, commonly known as scaling and root planing. This is a meticulous cleaning of the root surfaces below the gum line to remove plaque, calculus (tartar), and bacterial toxins.
This procedure is typically performed under local anesthesia to ensure comfort. Ultrasonic instruments and hand scalers are used to clean the pockets. By removing the irritants, the inflammation subsides, and the gum tissue can reattach to the clean root surface.
In conjunction with SRP, chemical agents may be used to help control the bacterial infection. This can include localized delivery of antibiotics, such as microspheres placed directly into the gum pockets.
Systemic antibiotics (pills) may be prescribed for aggressive cases or acute infections. Antiseptic mouthrinses, like chlorhexidine, are often used to reduce the overall bacterial load in the mouth during treatment.
Lasers have revolutionized periodontal care. They can be used to treat gum disease with less discomfort and faster healing than traditional surgery. The laser energy selectively targets diseased tissue and bacteria while preserving healthy tissue.
Procedures like LANAP (Laser Assisted New Attachment Procedure) can promote regeneration of the attachment apparatus without scalpel incisions. Lasers also seal blood vessels and nerve endings, reducing post operative bleeding and pain.
If pockets remain deep after non surgical therapy, surgical access may be needed. Flap surgery involves gently lifting the gum tissue to visualize the roots and bone directly.
This allows the periodontist to remove deep tartar that was inaccessible blindly. It also allows for the reshaping of irregular bone defects (osseous surgery) to reduce pockets and create a landscape that the patient can keep clean.
When bone has been destroyed, GTR aims to grow it back. A barrier membrane is placed between the gum and the bone defect. This membrane prevents the fast growing gum tissue from filling the hole, allowing slower growing bone cells to populate the area.
Bone grafts (from the patient, a donor, or synthetic) are often placed into the defect to act as a scaffold. Biological growth factors may also be added to stimulate the body’s natural regenerative processes.
Gum recession exposes tooth roots and can lead to sensitivity and tooth loss. Soft tissue grafting involves taking a small piece of tissue, usually from the roof of the mouth, and stitching it over the exposed root.
This procedure thickens the gum tissue and covers the root. It stops further recession, reduces sensitivity, and improves the aesthetics of the smile. AlloDerm (donor tissue) can also be used to avoid a second surgical site.
Crown lengthening is a procedure used to expose more of the tooth structure. It is often done for restorative reasons, such as when a tooth breaks off at the gum line and needs a crown. It provides the necessary space for the dentist to fix the tooth.
It is also used for cosmetic reasons to treat a “gummy smile.” By removing excess gum and reshaping the bone, the periodontist can make short teeth look longer and more proportional.
When teeth cannot be saved, dental implants are the gold standard for replacement. A titanium post is surgically placed into the jawbone, acting as an artificial root.
Periodontists are experts in implant surgery, ensuring that the implant is placed in the optimal position for function and aesthetics. They also manage the soft tissue around the implant to ensure a natural look.
After active treatment is complete, the patient enters the maintenance phase. This is arguably the most critical part of therapy. Patients with a history of gum disease need more frequent cleanings, typically every 3 to 4 months.
These visits allow the periodontist to disrupt the bacterial biofilm before it becomes destructive again. It also allows for the monitoring of pocket depths so that any recurrence of disease can be caught and treated early.
Just like teeth, implants can get gum disease called peri implantitis. If left untreated, the bone around the implant dissolves, leading to implant loss.
Treatment involves disinfecting the implant surface, often with lasers or specialized brushes, and regenerating the lost bone if possible. Maintenance of implants is critical to preventing this condition.
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Recovery varies by procedure. For simple grafts or laser treatment, you may return to work the next day with mild soreness. For more extensive bone surgery, you may need a few days of rest. Full soft tissue healing takes about 2 weeks, while bone maturation takes months
Most periodontal procedures are performed under local anesthesia (numbing the area), so you feel no pain. For anxious patients or longer procedures, sedation options (oral or IV) are available to help you relax or sleep through the appointment.
Deep cleaning reduces inflammation, causing swollen gums to shrink. This makes the pockets shallower and healthier. While the gums don’t “grow back” up the tooth, the tight reattachment of the healthy gum to the tooth seals out bacteria.
With proper placement and maintenance, dental implants can last a lifetime. The crown on top may need replacement due to wear, but the titanium screw itself is extremely durable. However, peri implant disease can cause failure if hygiene is neglected.
Bacteria causing gum disease repopulate in the pockets about every 90 days. A 6 month schedule allows these bacteria to cause damage for 3 months. The 3 month schedule disrupts the cycle before active destruction can resume, keeping the disease in remission.
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