Periodontics

Periodontal Disease
Periodontal disease, or "gum" disease, affects four out of every five adults. This makes periodontal disease one of the most common diseases affecting mankind, and is the leading cause of tooth loss in adults. It is caused by the presence of bacterial plaque. Plaque is formed by the action of the bacteria normally found in your mouth on remaining food debris. The result of this bacterial plaque is the formation of acids causing tooth decay, and other chemicals causing gingivitis, or inflammation of the gums.

In its early stages gingivitis may result in slightly sore, red, swollen gums that may bleed when brushed. The early states of gingivitis are so mild that most of us have accepted this condition as normal. Bleeding gums are not healthy! Bleeding tissue is normally a sign of damage, and with minor exception is usually a sign of developing disease.

Determination of the extent and severity of periodontal disease is critical in deciding appropriate therapy and monitoring the outcome of that therapy.

Prophylaxis
This is the "cleaning" you are all familiar with, and is meant to preserve the existing state of health. Its purpose is to remove plaque and calculus (tartar) that has developed above the gum line. A prophylaxis is appropriate treatment for those of you who have healthy gums or mild gingivitis. Note that a diagnosis of healthy or mildly inflamed gingiva must be made before instituting prophylaxis as a definitive treatment. Prophylaxis is not effective treatment in the presence of gum pocketing or bone loss. Because the symptoms of periodontal disease are usually minimal, the absence of discomfort or overt symptoms is not an indication of relative health.

Scaling 
Gingivitis has progressed, gum pockets have developed, and some loss of tooth-supporting bone is evident. If the bone loss is substantial, loosening of teeth will be detected. The ongoing exposure of root surfaces to the disease promoting toxins found in plaque cause the root surface to become softened, thereby harboring additional bacterial plaque. Scaling and root planing is performed to remove calculus below the gum line, reduce the level of disease producing bacteria on the root surface, and smooth the root surface to promote healing.

Irrigation of the gum pocket with antibiotics is frequently performed. Localized, minor gum pocketing may successfully treated in this fashion. More severe gum pocketing may not be totally resolved solely by scaling and root planing, and may require additional therapy.

Ongoing evaluation and follow-up is essential to monitor the success of therapy. Enhanced and more frequent hygiene treatment will help to maintain the periodontal status. Issues contributing to periodontal disease, such as missing teeth, large rough restorations, and excessive mobility may require additional treatment to further insure long-term success.