What Is Gum Disease?
Gum (or periodontal) disease is a chronic infection that begins in the space between your tooth and gum. It is usually not painful. Over time, the infection causes the destruction of the bone that holds the teeth in place and causes tooth loss. Gum disease that has progressed beyond the early stage is best managed by a Periodontist. When it comes to gum treatment, there is no substitute for the advanced training of a Periodontist.
For most patients, there are 3 basic steps involved in the treatment of their gum disease.
- Scaling & root planing to reduce the infection – often done with the comfort of I.V. sedation. Scaling & root planing is commonly called Deep Cleaning. Approximately 3 months after the initial Deep Cleaning we reevaluate the condition of the gum tissues.
- Corrective gum surgery – if needed depending upon the condition of the gums when reevaluated. There are different types of gum surgery that are utilized depending upon the conditions of the gums. Some of these are discussed below.
- Periodontal Maintenance – Once the gums are healthy, we maintain them in a healthy state by seeing patients every three months for monitoring and dental cleaning.
Who Has Gum Disease?
According to the American Dental Association, 75% of the adult population has some form of gum disease. It affects normal healthy people and can begin as early as age 9. Over 40% of persons over age 65 have lost ALL of their teeth. Most because of gum disease.
Certain medical conditions and other risk factors place a person at a high risk for the development of gum disease. These include:
- Persons with autoimmune diseases (arthritis, lupus)
- Women experiencing hormonal fluctuations (during pregnancy, menstruation, menopause and oral contraceptives)
- Persons with a depressed immune system; (Lyme Disease, HIV+ persons and excessive stress)
- During and after cancer treatment
- Certain medications such as cyclosporin, dilantin, nifedipine and other calcium channel blockers
- Living with a person with gum disease (gum disease can be passed among individuals in close contact, such as family members, spouse-to-spouse and parent-to-child).
How Do I Know if I Have Gum Disease?
A person probably has gum disease if they have ever had ANY of the following:
- Bleeding gums when brushing or flossing
- Stain, plaque or tartar deposits on the teeth
- Bad breath
- Tooth loss
- Shifting of teeth
- Gum recession (exposed tooth roots)
- Gaps or spaces that develop between teeth
- Swollen or red gums
- Soreness in the gums or teeth
- Ever been told that you have gum disease
- Ever had scaling/root planing (deep cleaning)
- On a 3- or 4-month recall schedule with a dentist
A Periodontist can quickly and easily detect gum disease with a periodontal evaluation. During this evaluation, a periodontal probe (measuring instrument shown in picture) is placed gently between your tooth and gum and the depth of the pocket is measured in millimeters. Any probing depth over 4 millimeters indicates that a patient has gum disease and should be evaluated and treated by a Periodontist. Gum disease can progress rapidly in some cases that is why it’s best to have it treated as early as possible. According to the American Academy of Periodontology, very adult should have an annual periodontal exam.
Gum Disease Laser Treatment
Laser surgery has been used in our office since 1998 for reducing periodontal pockets and controlling periodontal disease. Laser pocket reduction is less invasive than traditional corrective surgery and is an option when periodontal pockets range from 5 to 6 millimeters deep. Laser surgery is not appropriate in situations that require bone regeneration. With the laser, there is virtually no bleeding and the procedure is can be completed in a short period of time.
The laser is also very useful for reshaping the gum tissues, frenectomy, and removal of small growths on the oral tissues and lips.
Periodontal (Gum) Corrective Surgery
Gum disease causes bone loss and periodontal pocketing. Corrective gum surgery is often necessary to correct the periodontal pocketing and bone loss that accompanies moderate to advanced gum disease. Periodontal regeneration is a process to re-grow bone that has been lost due to progressive gum disease. We use growth factors derived from platelets to enhance bone regeneration and accelerate healing following surgery. (Please see Platelet Rich Plasma below).
Non-Surgical Treatment of Gum Disease
Although corrective surgery is often the best way to correct the damage caused by gum disease, corrective surgery is not the only option. We discuss ALL treatment options giving the risks and benefits associated with each. Ultimately each patient decides what is best for them and how their treatment will proceed. There are several non-surgical options that can be used in combination to control gum disease. One such product, Arrestin, is an antibiotic that is specifically formulated to work inside the infected gum pocket and kill bacteria for over three weeks.
Gum Disease Medication (PerioStat)
There is only one FDA approved medication called Periostat that helps improve the health of gum tissues. By taking this medication on a regular basis, a person can better rebuild lost gum tissue and slow future breakdown. We are happy to prescribe this safe medication knowing that we are doing everything possible to keep our patient’s gums healthy.
Established standard of care for patients with a history of gum problems is to have their teeth cleaned every 3 months in order to control gum their gum disease long term. Our Team includes two highly trained and experienced Dental Hygienists that excel in the maintenance of healthy gums and teeth. With good home care and cleanings on a 3-month interval, most patients can greatly extend the longevity of their teeth.
Platelet Rich Plasma (PRP)
PRP is used in conjunction with some gum surgeries. It is most commonly used when maximum regeneration of the bone is desired. In our office we us a state-of-the-art cell separator that isolates and concentrates your platelets from a small quantity of your blood (55cc). The concentrated platelets are called Platelet Rich Plasma or PRP. PRP is a rich source of at least three key growth factors that accelerate soft tissue healing and bone regeneration.
PRP has long been used in hospital settings for tissue regeneration and accelerated wound healing. The cell separators used in hospitals are large machines that require large quantities of patient blood. The technology used in our office allows us to achieve the same high quality PRP as hospitals, but with much less patient blood and at a fraction of the cost. Optimum healing is more predictable with the use of PRP.
Correcting a Gummy Smile
There are surgical and non-surgical alternatives that can help reduce a gummy smile, depending upon severity and individual anatomy of the patient. One type of gum surgery called crown lengthening is used to correct a gummy smile in some instances. With this procedure the soft tissue is reshaped as well as the underlying bone (if needed). The procedure allows an uneven smile line (gum line) to be evened out. Short teeth can also be made to appear longer to give a fuller smile.
Correcting Gum Recession
Gum recession is a fairly common cause of tooth loss for adults. If you can see any part of a tooth root, you have gum recession. Many dental professionals will ignore gum recession because they view it as a normal part of aging or believe it is not a problem. If left untreated, most gum recession will get progressively worse and eventually cause the loss of the affected tooth. Depending upon the condition of the recessed tissue, treatment may or may not be needed, however it requires specialty evaluation to determine the underlying cause and need for treatment.
If a person has gum recession, it is better to have it corrected early (at the first sign of recession). We typically treat gum recession with a procedure called gum grafting. There are variations in the types of gum grafts that can be done and usually depends upon the anatomy of affected area. In general we don’t recommend freeze dried skin or other collagen membrane type grafts because they tend to reabsorb over time.
We routinely remove unsightly lip lesions (pigmented, red or blue) our soft tissue laser. This minor procedure takes a few seconds and results in a great improvement in the appearance of the lips.
Sedation for Your Comfort
It is normal to be nervous and apprehensive about medical procedures involving the mouth. That is why we offer monitored I.V. sedation for those patients that would like to have the most pleasant experience possible. Please do not hesitate to discuss any apprehension that you may have with any of our Team members or Dr. Devoll. Patient comfort is our highest priority.