Periodontal Therapy

Periodontal therapy is suggested in presence of active periodontitis (gum disease). When a patient has active periodontal disease a Periodontal Scaling & Root Planing (Deep Cleaning) may be suggested. If you have had a recent deep cleaning, you may already be on a periodontal maintenance protocol. However, when there has been a long lapse between a deep cleaning and your maintenance cleanings, a deep cleaning may be suggested again. Please consult with your dentist and or hygienist for a proper periodontal assessment.

What is a comprehensive periodontal exam?

A comprehensive periodontal exam is conducted at each hygiene appointment to assess the status of your gum health. By evaluating your gums, your dental team can determine what type of cleaning is best for you.

The hygienist and/or dentist will measure

  • Probing depth – the level of detachment of the gum from the tooth-- also referred to as a “dental pocket.” A dental pocket is essentially the space between your gum and tooth. A dental probe (measuring tool) is used to accurately measure the detachment levels. Normal pocket measurements are 1-3mm. When measurements are 4 or above it is indicative of inflammation and disease. A higher pocket number means that the probe is deeper and thus more detachment is present.
  • Bleeding – an indication of tissue inflammation. Healthy gingival tissues do not bleed spontaneously when probed, brushed or flossed. If inflammation is present, gums may appear red, swollen and tender. This is symptomatic of gum infection called gingivitis (inflammation of gingival tissues).
  • Recession – the exposure of the roots of your teeth due to loss of gum tissue around the crown (the portion that looks like the tooth). Recession can occur from trauma, aggressive tooth brushing, periodontal disease, clenching, and grinding. The most common symptom of tooth recession is sensitivity from the exposed root surfaces.
  • Mobility – the movement of a tooth due to attachment loss, bone destruction and/ or trauma. Stable teeth will not wiggle when pressed on.
  • Furcation Involvement – a defect resulting from bone loss around the root of the tooth. This type of bone loss and destruction is quite evident by the visible gap between the roots of the teeth and is a result of periodontal disease.

By completing a comprehensive periodontal exam your hygienist and/or doctor can determine your periodontal health and detect any active gum disease. If required, they will recommend a protocol that best fits your individualized needs.

What is gum disease?

Gum disease is the leading cause of tooth loss among adults. The first sign of gum disease is gingivitis (gum inflammation). As gum disease starts to advance it can lead to periodontitis without treatment.

Gingivitis:

Gingivitis is inflammation of the gums due to bacteria in plaque building around the gums. The gums will be irritated, but at this stage no bone or attachment loss will be evident. Gingivitis is reversible with bi yearly dental cleanings, regular brushing and flossing.

Periodontitis, or periodontal disease:

Periodontitis is an infection of your gums, bone, and surrounding tooth structures. It causes inflammation of your gums, bleeding, attachment loss and bone destruction.

There are three different stages of periodontitis – mild, moderate and advanced.

Early signs of periodontitis can be stopped and maintained with proper treatment. Bone that has been lost will not grow back. However, with proper periodontal therapy, further loss can be avoided. In advanced stages of periodontitis, bone is significantly destroyed and teeth may start to wiggle/move and can fall out.

Periodontal disease can also have serious consequences to your overall health. Research has shown that periodontal disease is linked to systemic infections, such as diabetes and heart disease. This is why it is important to consult your dentist and have a proper periodontal protocol in place. This is especially true if you have been diagnosed or previously diagnosed with periodontal disease.

Periodontal Cleanings

PERIODONTAL SCALING & ROOT PLANING AKA DEEP CLEANING

What is a scaling and root planing (SRP)?

Scaling and root planing is a deep cleaning of the roots and surfaces of the teeth (above and below the gumline) to remove bacteria, plaque and calculus (hardened tartar). It is not the same as a regular cleaning. A regular cleaning can be likened to a ‘car wash,’ while a deep cleaning is similar to a ‘detailing.’

What does a deep cleaning entail?

A deep cleaning is typically completed under local anesthetic to provide the most comfort to the patient. The hygienist or doctor will use an ultrasonic scaler – an instrument that vibrates and introduces water at a high frequency to remove the hardened deposits in the dental pockets. Dental scalers are used to refine areas and to ensure all surfaces of your teeth are clean.

Your dentist may also recommend an antibacterial rinse or placement of an antibiotic medication (such as Arestin) into the pockets to eliminate bacteria that may cause further damage. Please consult with your dentist and hygienist to see if antibiotic therapy is needed.

Do I need a deep cleaning every year?

No. A deep cleaning is not something you need on a regular basis unless a significant amount of time has passed or if active disease has not been cured. If you have had a deep cleaning and did not visit your dentist for a significant period of time- bacteria, plaque and tartar is likely to have reaccumulated and a deep cleaning may be necessary again.

Does a deep cleaning hurt?

A deep cleaning does not hurt during the procedure. Your hygienist or dentist will administer local anesthetic so you are comfortable throughout the entire process. After a deep cleaning you may experience some gum soreness and sensitivity. Everyone is different and perceives pain at varying degrees, therefore it is recommended to take over the counter medications (such as Tylenol or Ibuprofen) if needed. If symptoms are present, they will usually resolve in a few days.

Laser Assisted Periodontal Therapy

Laser assisted periodontal therapy is a minimally invasive treatment option in removing inflamed gum tissue, bacteria, plaque and hardened tartar above and below the gumline. Many times, it is used in conjunction with traditional scaling and root planing procedures. It allows the greatest opportunity for tissues to return to a healthy state with faster healing and results. Please consult with your dental office for recommendations.

Periodontal Maintenance

What is a periodontal maintenance?

A periodontal maintenance is not another deep cleaning, but is a tooth cleaning that is performed on patients who have gum disease. The hygienist and/or dentist will continue to clean underneath those “deep pockets” (space of detachment between gum and tooth) removing any excess plaque, tartar and bacteria that continues to accumulate.

How many times do I need a periodontal maintenance?

Periodontal cleanings are typically recommended for patients who have gum disease every 3 to 4 months. After a deep cleaning is completed a periodontal maintenance is followed within 4-6 weeks. This is necessary so we can re-evaluate the gums and put you on a proper protocol to avoid another deep cleaning. The gums are still detached after a deep cleaning and can easily accumulate plaque, tartar and bacteria. They will need manual assistance until the gums start to reattach. This is crucial to avoiding another deep cleaning.

How long will it take for my gums to become healthy again?

This is a hard question to answer. This depends on both you and your dental advocates. You will both have to work as a team and make sure you are on a proper maintenance protocol and are practicing good oral care at home. This means increasing flossing to everyday, using a waterpik and an electric toothbrush, and making sure you are making it to your maintenance cleanings within the recommended timeframe. If you skip and/or delay an appointment, bacteria and plaque will accumulate causing a potential relapse.

Periodontal Protocol

At Clear Dental Studio we believe that a proper periodontal protocol should be in place to get your gums and teeth back to health. Our goal is to do a deep cleaning once and never look back. Each situation is different and treatment plans may need adjustments according to the patient. However, below is our general protocol in presence of periodontitis.

  • Scaling Root Planing (Deep Cleaning) – deep cleaning is completed by hygienist or dentist and/or with laser therapy.
  • 4-6 weeks Re-evaluation (Periodontal Maintenance Cleaning) – once deep cleaning is completed, patient is to come back with hygienist for a maintenance cleaning and re-evaluation. At this appointment we are cleaning the teeth, re-evaluating the progress of the gums and teeth, and determining how often you should come in.
  • Periodontal Maintenance Cleaning (3-4months) – scheduled maintenance cleaning with hygienist with re-evaluation of gums. To be continued until gums are back to health and ready to move into bi-yearly cleanings.

In order to achieve periodontal health, we need help from our patients as well. Good oral hygiene practices at home and in combination with proper periodontal therapy will help you achieve success.