Periodontal Disease

There are two main ways a person can lose their teeth, if neglected; through caries or through periodontal disease. Tooth loss due to caries/cavities is quicker, and more localized; however, periodontal disease is an irreversible chronic infection/disease that usually affects all of the teeth. Consequently, periodontal disease occurs following the neglect of gingivitis; reversible inflammation of the gums.

Periodontitis is a periodontal disease of the periodontium; tissue, ligaments, and bone surrounding each tooth. Main onset of the periodontitis is the bacteria buildup underneath the gums, better known as plaque biofilm and calculus, which then exacerbates the inflammatory host response. Plaque biofilm is a thin layer of film accumulated on teeth due to an inadequate and infrequent brushing and flossing after each meal. Moreover, calculus is that initial plaque biofilm which, after time, evolved into the cement-like layer after prolonged lack of oral hygiene. Furthermore, once the inflammatory host response, also known as the immune system, is exacerbated by such bacteria, additional unintentional damage is done to the surrounding tissue, ligaments, and bone. In other words, as the immune system is aiding in destruction of bacteria, it is also destroying the healthy periodontium. The relationship between the bacteria and the periodontal disease is directly proportional; as the quantity of bacteria increases, the severity of inflammatory host response also increases, ultimately resulting in a severe and very destructive periodontal disease. The initial stage of the periodontitis is characterized by the increase in bleeding upon brushing and flossing, and the change in color from healthy pink to dark red. Over time, gums start to loose their integrity and continue to recede towards the root of the tooth. At this moderate stage of the periodontal disease, patients are noticing more sensitivity throughout the oral cavity due to an increased root exposure. If neglected or inadequately treated, this chronic disease is yet to cease. As the gums recede, bone starts to diminish and the ligaments holding teeth in place tear. This final and severe stage of periodontitis accounts for extremely loose and helpless teeth.

Periodontitis is best treated shortly after the initial diagnosis. In order to successfully diagnose a periodontal disease, dental hygienist is required to take a full mouth series of radiographs and to conduct a periodontal probing exam. With the use of x-rays, both the doctor and the dental hygienist are able to see subtle changes in the bone level and the appearance of calculus indicating onset of periodontitis. In addition to the x-rays, periodontal probing is an important exam because it depicts information on the following; exact depth of pockets around each tooth, tooth mobility, feel for the calculus, and visualization of bleeding areas upon probing. Depending on the periodontal exam, periodontal disease is categorized into a mild, moderate, or severe stage.
In order to successfully treat periodontitis, patients are required to undergo a more intense cleaning called periodontal scaling and root plaining, also known as deep cleaning. Deep cleaning enables the dental hygienist to completely remove all of the calculus and plaque biofilm by instrumenting as deep as the pocket depth. The importance of cleaning deep underneath the gingiva is because anaerobe bacterias colonize where there is less oxygen and cause more tissue damage. If sub-gingival, bellow the gum-line, calculus and plaque is left untreated, then the periodontal disease is still ongoing. For the best results and the highest comfort, deep cleaning is broken down into three appointments. Complete periodontal exam and x-rays are conducted during the first exam, followed by the two deep cleaning appointments. During the second appointment, a certified dental hygienist will administer a local anesthetic to one side of the mouth, top and bottom, followed by a thorough deep cleaning. Furthermore, last deep cleaning appointment is conducted the same way as the second appointment, except it is on the other side. Lastly, patients are recommended to return approximately four to six weeks after their last deep cleaning appointment for evaluation of the gums and re-probing of the pockets; this will evaluate their home oral hygiene and the success of the deep cleaning.

Nevertheless, patients are continuously educated and encouraged to brush, floss and mouthwash daily, and to return for their maintenance cleanings every three to six months, because healthy mouth will not persist without effort on both sides.