Periodontal disease is caused by bacteria that live in between your gums and teeth. Healthy gums are usually firm and well adapted to your teeth, leaving only a small gap (also called a pocket) between the gums and the teeth for bacteria to live. When you brush and floss, you clean the pockets, helping your body eliminate the “bad” bacteria and allowing “good” bacteria to live.
When the “bad” bacteria begin to live and reproduce, your body detects this and tries to fight off the bacteria. Initially, this causes the gums to become inflamed, which we call “gingivitis.” Inflamed gums are puffy and reddish, tender to touch or brush, and bleeds very easily. At this point, the damage is largely reversible with proper treatment and home care.
If the “bad” bacteria is allowed to continue live and the periodontal disease progresses, irreversible destruction of the bone and tissue surrounding the tooth will occur. This causes the pockets to become deeper, creating more space for the bacteria to thrive, creating even more destruction, until so much of the bone is lost that the teeth no longer have support, become loose and abscessed, and require extraction. Bone loss around teeth make it more difficult to replace teeth with implants, as dental implants require the same bone support that teeth do.
Treatment for periodontal disease include non-surgical scaling and root planing, flap/osseous surgery, regeneration, or tooth extraction.
Scaling and Root Planing
Scaling and Root Planing (often called “deep cleanings”) is a type of non-surgical treatment for periodontal disease. First, local anesthesia is used to numb the soft tissue and teeth to be treated. After profound anesthesia is achieved, the root surfaces in the pocket exposed to the disease is thoroughly cleaned and debrided debrided of bacterial plaque and calculus (tartar build up). The roughened roots are then carefully smoothed out, and the tissue is allowed to heal and re-attach to the roots for 4-6 weeks before we can re-check the area and re-measure the pocket depths.
Flap/Osseous surgery is a type of surgical treatment for periodontal disease. It is often performed when there are residual pockets after scaling and root planing. Often, this is because the pockets are too deep to be fully treated with non-surgical therapy, and surgery is needed in order to open the gums to fully visualize the amount of destruction and treat accordingly.
First, local anesthesia is used to numb the soft tissue and teeth to be treated. After profound anesthesia is achieved, the gums are gently flapped away from the teeth and bone, exposing the bony architecture and root surfaces to be treated. With full access to the roots, the area can be thoroughly debrided and infected tissue cleaned away. The bone architecture is re-contoured to promote health, excess gum is trimmed away to reduce the pocket, and the gums are sutured back in place.
If the bony architecture is amenable, regeneration of the lost bone may be accomplished by placing a bone graft and covering the graft with a barrier membrane. Over the course of a few months, your body will dissolve the bone graft and replace it with your own bone, and the barrier membrane prevents the bone graft from being replaced with soft tissue, which heals more quickly than bone. This is often the ideal surgical solution to treating periodontal disease, as the destruction and bone loss can partially be reversed by regenerating the lost tissue.
Regardless of any treatment modality, the most important thing to prevent and manage periodontal disease is proper oral hygiene at home and professional cleanings to minimize the bacterial build up.
Dr. Richard Parris, Dr. Sepi Lee, and Dr. Cliff Lee are experts in treating periodontal disease and periodontal regeneration and have been serving the communities of Orange, Anaheim, Garden Grove, and the rest of Orange County for decades. Schedule your consultation with us today so we can help you to manage your periodontal disease.