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The term “periodontics” refers to the dental specialty that pertains to the prevention, diagnosis and treatment of periodontal disease that affects the gums and jawbone.  The gum tissues serve to surround and support the teeth and the underlying jawbone anchors teeth firmly in place.  Periodontists have completed several years of extra dental training and are concerned with maintaining the function, health and aesthetics of the jawbone and tissues.

Common Signs & Symptoms

It is extremely important to note that periodontal disease can progress without any signs or symptoms such as pain.  This is why regular dental checkups are exceptionally important. Described below are some of the most common signs and symptoms of periodontitis.

If you have any of these signs or symptoms, the advice of a general dentist or periodontist should be sought as soon as possible:

  • Unexplained bleeding – Bleeding when brushing, flossing or eating food is one of the most common symptoms of a periodontal infection.  The toxins in plaque cause a bacterial infection which makes the tissues prone to bleeding.
  • Pain, redness or swelling – A periodontal infection may be present if the gums are swollen, red or painful for no apparent reason.  It is essential to halt the progression of the infection before the gum tissue and jaw bone have been affected.  It is also critical to treat the infection before it is carried into the bloodstream to other areas of the body.
  • Longer-looking teeth – Periodontal disease can lead to gum recession.  The toxins produced by bacteria can destroy the supporting tissue and bones, thus making the teeth look longer and the smile appear more “toothy.”
  • Bad breath/halitosis – Although breath odor can originate from the back of the tongue, the lungs and stomach, the food we consume, or from tobacco use, bad breath can also be caused by old food particles that sit between the teeth and underneath the gumline. The deeper gum pockets are able to house more debris and bacteria, causing a foul odor.
  • Loose teeth/change in bite pattern – A sign of rapidly progressing periodontitis is the loosening or shifting of the teeth in the affected area.  As the bone tissue gets destroyed, teeth that were once firmly attached to the jawbone become loose or may shift in position.
  • Pus – Pus oozing from between the teeth is a definitive sign that a periodontal infection is in progress.  The pus is a result of the body trying to fight the bacterial infection.

Treatment of Periodontal Disease

It is of paramount importance to halt the progression of periodontal disease before it causes further damage to the gum tissues and jawbone.  The dentist will initially assess the whole mouth in order to ascertain the progress of the disease.  When a diagnosis has been made, the dentist may treat the bacterial infection with antibiotics in conjunction with nonsurgical or surgical treatment or both.

In the case of moderate periodontal disease, the pockets (under the gumline) of the teeth will be completely cleared of debris using a procedure called scaling and root planing.  The pockets may be filled with antibiotics to promote good healing and kill any bacteria that remain.

Severe periodontitis can be treated in several different ways, such as:

  • Laser treatment – This can be used to reduce the size of the pockets between the teeth and the gums.
  • Tissue & bone grafting – Where a considerable amount of bone or gum tissue has been destroyed, the dentist may elect to graft new tissue by inserting a membrane to stimulate tissue growth.
  • Pocket elimination surgery – The dentist may choose to perform “flap surgery” to directly reduce the size of the gum pockets.

Reasons for Periodontal Treatment

Periodontal disease is a progressive condition which begins with mild gum inflammation called gingivitis.  It is the leading cause of tooth loss in adults living in the developed world, and should be taken very seriously.  Periodontal disease (often called gum disease) is typically signified by red, swollen, painful, or bleeding gums, but in some cases has no noticeable symptoms.

Periodontal disease generally begins when the bacteria living in plaque cause an infection in the surrounding tissues of the teeth, causing them to become irritated and painful.  Eventually, this infection will cause the jawbone to recede and the tooth to become loose.

There are several reasons why periodontal treatment may be necessary:

  • Moderate/advanced gum disease – This occurs when the gums are bleeding, swollen or red around most teeth and the jawbone has begun to recede.
  • Localized gum recession – The infection which propagates moderate or advanced gum disease often begins in one area.  Gum recession may also be caused due to over brushing with a hard bristle brush, or due to a tooth that is not positioned properly.  Immediate treatment is required to prevent further spreading.
  • Before crown lengthening – The periodontist may lengthen the crown of the tooth by removing surrounding soft tissue to provide more tooth exposure.
  • Ridge augmentation – This procedure, often called “recontouring” may be required to correct an uneven gum line.  Before embarking on treatment, a periodontist needs to treat any bacterial infections and periodontitis.

In the case of mild/moderate periodontal problems, the focus of the periodontist will be on curing the underlying bacterial infection and then providing advice on the most appropriate home cleaning methods.

Sometimes a deep scaling is needed to remove the bacterial plaque and calculus (tartar) from the teeth and tissues.  Where periodontal disease is advanced and the jawbone has regressed significantly, more intensive cleaning may be recommended and loose teeth that cannot be saved will be removed.

Causes of Gum Recession

Gum recession is an incredibly widespread problem that dentists diagnose and treat on a daily basis.  It is important to thoroughly examine the affected areas and make an accurate diagnosis of the actual underlying problem.  Once the cause of the gum recession has been determined, surgical and non-surgical procedures can be performed to halt the progress of the recession and prevent it from occurring in the future.

The most common causes of gingival recession are:

  • Overaggressive Brushing – Over-brushing can almost be as dangerous to the gums as too little. Brushing too hard or brushing with a hard-bristled toothbrush can erode the tooth enamel at the gum line and irritate/inflame gum tissue.
  • Poor Oral Hygiene – When brushing and flossing are performed improperly or not at all, a plaque buildup can begin to affect the teeth.  The plaque contains various bacterial toxins which can promote infection and erode the underlying jawbone.
  • Chewing Tobacco – Any kind of tobacco use has devastating effects on the entire oral cavity, chewing tobacco in particular.  It aggravates the gingival lining of the mouth and causes gum recession when used continuously.
  • Periodontal Disease – Periodontal disease can be a result of improper oral hygiene or caused by systemic diseases such as diabetes.  The excess sugars in the mouth and narrowed blood vessels experienced by diabetics create a perfect environment for oral bacteria.  The bacterium causes an infection that progresses deeper and deeper into the gum and bone tissue, eventually resulting in tooth loss.

Treatment of Gum Recession

Every case of gum recession is slightly different, therefore many treatments are available. The nature of the problem which caused the recession to begin with needs to be addressed first.

If overly aggressive brushing techniques are eroding the gums, a softer toothbrush and a gentler brushing technique should be used.  If poor oral hygiene is a problem, prophylaxis (professional dental cleaning) may be recommended to rid the gum pockets of debris and bacteria.  In the case of a severe calculus (tartar) build-up, scaling and root planing will be performed to heal gingival inflammation and clean the teeth.

Once the cause of the gingival recession has been addressed, surgery of a more cosmetic or restorative nature might be recommended.  Gum tissue regeneration and gum grafting are two excellent ways to restore natural symmetry to the gums and make the smile look more aesthetically pleasing.

The periodontist is trained in all aspects of dental implant procedures, which can restore functionality to the mouth when teeth have been affected by periodontitis.

Because periodontal disease is progressive, it is essential to remove the bacteria and calculus build up to halt the spread of the infection. 

Reasons for scaling and root planing

Scaling and root planing can be used both as a preventative measure and as a stand-alone treatment.   These procedures are performed as a preventative measure for a periodontitis sufferer.

Here are some reasons why these dental procedures may be necessary:

  • Disease prevention – The oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body.  Research has shown that lung infections and heart disease have been linked to periodontal bacteria.  Scaling and root planing remove bacteria and halts periodontal disease from progressing, thus preventing the bacteria from traveling to other parts of the body.
  • Tooth protection – When gum pockets exceed 3mm in depth, there is a greater risk of periodontal disease.  As pockets deepen, they tend to house more colonies of dangerous bacteria.  Eventually, a chronic inflammatory response by the body begins to destroy gingival and bone tissue which may lead to tooth loss.  Periodontal disease is the number one cause of tooth loss in the developed world.
  • Aesthetic effects – Scaling and root planing help remove tartar and plaque from the teeth and below the gumline.  As an added bonus, if superficial stains are present on the teeth, they will be removed in the process of the scaling and root planing procedure.  
  • Better breath – One of the most common signs of periodontal disease is halitosis (bad breath).  Food particles and bacteria can cause a persistent bad odor in the oral cavity which is alleviated with cleaning procedures such as scaling and root planing.

What do scaling and root planing treatments involve?

Scaling and root planing treatments are only performed after a thorough examination of the mouth.  The dentist will take X-rays, conduct visual examinations and make a diagnosis before recommending or beginning these procedures.

Depending on the current condition of the gums, the amount of calculus (tartar) present, the depth of the pockets and the progression of the periodontitis, local anesthetic may be used.

Scaling – This procedure is usually performed with special dental instruments and may include an ultrasonic scaling tool.  The scaling tool removes calculus and plaque from the surface of the crown and root surfaces.  In many cases, the scaling tool includes an irrigation process that can also be used to deliver an antimicrobial agent below the gums that can help reduce oral bacteria.

Root Planing – This procedure is a specific treatment which serves to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar.  The root of the tooth is literally smoothed in order to promote good healing. Having clean, smooth root surfaces helps bacteria from easily colonizing in future.

Following these deep cleaning procedures, the gum pockets may be treated with antibiotics.  This will soothe irritation and help the gum tissues to heal quickly.

During the next appointment, the dentist or hygienist will thoroughly examine the gums again to see how well the pockets have healed.  If the gum pockets still measure more than 3mm in depth, additional and more intensive treatments may be recommended.

Your dentist will be happy to advise you on effective cleaning methods and treatment options.

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