Periodontal Disease in Saratoga Springs, NY

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About Periodontal Disease

Periodontal disease is a very serious condition. In its early stages, it is often painless, characterized by red or swollen gums, and occasional bleeding with brushing. In its advanced stage, it is the #1 reason for tooth loss and can result in painful periodontal abscesses and has been linked to serious systemic illnesses such as heart attack, stroke, diabetes, bacterial pneumonia, Alzheimer’s, preterm birth in pregnant mothers, and low birth weight of children born to mothers with advanced periodontal disease. Our staff is dedicated to maintaining your periodontal health. Using a team approach of highly skilled hygienists and periodontally conscious dentists we strive to improve your gum health and consequently your overall health. From frequent screenings to thorough cleanings, we will help you to maintain your teeth for a lifetime.

Signs and Symptoms of Periodontal Disease

  1. Bleeding Gums – gums should not bleed even with brushing and flossing
  2. Loose Teeth
  3. New Spacing between Teeth
  4. Persistent Bad Breath
  5. Pus around the Teeth and Gums
  6. Receding Gums
  7. Red and Swollen Gums
  8. Tenderness and Discomfort

Diagnosis

Our dentists take several factors into consideration when diagnosing periodontal disease. First is the review of periodontal pocket depths. All teeth, both healthy and diseased, have a sulcus or a pocket around the entire tooth. Around a healthy tooth, this pocket has a depth of less than 3mm. Your dentist or dental hygienist will determine this depth for 6 spots around every tooth with an instrument known as a periodontal probe. If the pocket depths exceed 3mm for any spot around the tooth, it indicates bone loss; the deeper the pocket, the worse the bone loss. Eventually, pockets will get very deep, indicating very little bone support remaining around the tooth, the tooth will typically be loose and may require removal if untreated.

However, periodontal pocketing is not the only means of diagnosing periodontal disease. Your dentist or dental hygienist should also measure areas of recession. The recession of the gum tissue exposes the softer, less cavity resistant, and highly sensitive root structure of a tooth. Additionally, severe recession reduces the hold on the tooth and can cause the tooth to become loose. The dentist will add the recession and the pocket depth together for any one spot of concern to gain a measure of the true attachment loss – the higher the number the worse the prognosis for that tooth.

The dentist will also use the patient’s radiographs to diagnose periodontal disease. Bone loss is very evident on x-rays; it can be generalized (throughout the whole mouth) or localized (around one or two teeth). Radiographs will also be used to see if the root morphology of a specific tooth may be influencing the condition or effect eventual healing.


Perhaps the most important part of this diagnosis is the amount of bleeding around the tooth upon exploring with the periodontal probe. Bleeding is a direct indication of gum inflammation. Gum inflammation releases specific cellular mediators that affect a person's overall health. Our goal is to not see any bleeding with probing. Your dentist will use pocket depths, amount of bleeding, inflammation, tooth mobility, and x-rays to make a diagnosis of either one of the following categories:

  1. Gingivitis: the first stage of gum disease. Plaque left on the teeth has begun to release toxins, irritating the gums and making them tender and inflamed. Gums with gingivitis are likely to bleed with brushing.
  2. Early-Moderate Periodontitis: Plaque has now hardened on the tooth to form calculus (tartar). The amount of toxins increases as does the physical irritation of the gums from this calcified bacterial colony on the tooth surface. The gums begin to recede, bleeding increases and bone loss is becoming evident on the radiographs.
  3. Advanced Periodontitis: Calculus is often so thick at this point that it has begun to bridge from one tooth to the next making proper oral hygiene impossible. The teeth lose more support as the gums, bone and periodontal ligament continue to be destroyed. Bleeding may be heavy with brushing. The teeth may be very loose and moderate to severe bone loss may be seen on x-rays. The patient may have pain and often complain of severe “bad breath”.

Treatment

Periodontal treatment methods depend upon the type and severity of the disease. Our dental team will evaluate each patient individually, assess their periodontal condition, their risk factors such as diabetes or tobacco use, and personalize an appropriate treatment plan. Good oral hygiene, a balanced diet, and regular dental visits will also help to reduce your risk of periodontal disease.

If the disease is caught in the early stages of gingivitis, it is likely the patient will receive a thorough cleaning, be counseled on home care, receive a snack index and dietary review, and be asked to return every 6 months for recalls.

If the disease has progressed to more advanced stages, a special periodontal cleaning, known as scaling and root planing (deep cleaning) would likely be recommended. Typically, the patient is brought in for a gross debridement, removing the majority of the calculus above the gum line and the superficial calculus below the gumline. The intention of the gross debridement is to remove the majority of the pathologic bacteria allowing improved healing and less chance of infection spread during the next phase of the cleaning. The scaling and root planing follows the gross debridement and is typically performed in two visits, one side of the mouth at a visit, always with anesthesia to achieve adequate patient comfort. In this procedure, tartar, plaque, and toxins are removed from below the gum line (scaling) and rough spots on root surfaces are made smooth (planing). This procedure helps gum tissue to heal and pockets to shrink. Systemic medications, special medicated mouth rinses, site-specific antibiotic therapy, and an electric toothbrush may all be recommended to help control infection and promote healing.

Since periodontal disease is never cured and the bone and gums can not return without surgical intervention, we recommend our periodontal maintenance patients have cleanings every 3-4 months. This helps keep the disease arrested. If pockets do not heal after treatment, periodontal surgery may be needed. Our staff recognizes the importance of referring our patients for the care they deserve and we work closely with specialists to help resolve particularly difficult cases.

Maintenance

Periodontal disease is never cured -- it is only restrained and maintained. Without surgical intervention, the damage done by moderate to advanced periodontal disease will not resolve. However, through diligent homecare and frequent periodontal maintenance visits, the disease should remain stable. Once your periodontal treatment has been completed, our staff recommends that you have regular dental cleanings four times per year. During your recall exams, periodontal pockets will be carefully checked to ensure that they are healthy. Plaque and calculus that have been difficult for you to remove on a daily basis will be easily removed from above and below the gumline, and areas of refractory disease will be addressed.


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