Periodontal Therapy

Periodontal (gum) disease is an infection of the tissues that hold your teeth in place. The periodontium consists of three tissues: gingiva, alveolar bone and periodontal ligaments. It is typically caused by poor brushing and flossing habits that allow plaque – a sticky film of bacteria – to build up on the teeth and harden. In advanced stages, periodontal disease can lead to sore, bleeding gums, and possibly pain upon chewing or even tooth loss.

At your initial exam, we will examine your gums and x-rays for any signs of inflammation to determine the most appropriate method of treatment. We incorporate the latest technology and techniques in Kansas to provide you with the treatment necessary to control your infection, and halt your disease. This may include either surgical or non-surgical approaches with the ultimate goal of saving your teeth!

Stages of Gum Disease

Plaque-induced gingivitis is an inflammatory response of the gingival tissues resulting from bacterial plaque accumulation located at and below the gingival margin. It does not directly cause tooth loss, however, managing gingivitis is a primary preventive strategy for periodontitis.

Gingivitis is considered the most common form of periodontal disease, and may not be detected clinically. However, as plaque-induced gingivitis progresses to more established forms of this disease, the clinical symptoms become obvious and may include bleeding with tooth brushing, gingival swelling and redness, tenderness, and halitosis in the case of established forms.

There are several modifying factors that can influence gingivitis such as changes in sex steroids during puberty, pregnancy, or with the consumption of oral contraceptives. Systemic conditions such as smoking, diabetes, malnutrition, or leukemia may increase gingival inflammation. Certain medications such as calcium channel blockers, anti-seizure and immunoregulatory dugs can also influence your gingival status.

Stages

Stage I – II (slight – moderate): The middle stage of gum disease which the supporting bone and fibers that hold your teeth in place are damaged, which form pockets below the gum line which traps food and plaque.

Stage III – IV (Severe): The final stage of gum disease which then the fibers and the bone that supports your teeth are destroyed which can cause your teeth to shift or even become loose.

Patterns

Localized (<30% of teeth)
Generalized (>30% of teeth)
Molar-incisor pattern (formerly known as Aggressive Periodontitis)

Necrotizing Disease

Necrotizing Gingivitis

Necrotizing gingivitis lesions are characterized by the presence of ulcers within gingival connective tissue, surrounded by a non-specific acute inflammatory infiltrate.

Necrotizing gingivitis is an acute inflammatory process of the gingival tissues characterized by presence of necrosis/ulcer of the interdental papillae, gingival bleeding, and pain. Other signs/symptoms associated with this condition may include halitosis, pseudomembranes, regional lymphadenopathy, fever, and sialorrhea (in children).

Necrotizing Periodontitis

Necrotizing Periodontitis is an inflammatory process of the periodontium characterized by presence of necrosis/ulcer of the interdental papillae, gingival bleeding, halitosis, pain, and rapid bone loss. Other signs/symptoms associated with this condition may include pseudomembrane formation, lymphadenopathy, and fever.

Necrotizing periodontal diseases are strongly associated with impairment of the host immune system, as follows: (1) in chronically, severely compromised patients (e.g., AIDS patients, children suffering from severe malnourishment, extreme living conditions, or severe infections) and may constitute a severe or even life-threating condition; and (2) in temporarily and/or moderately compromised patients (e.g., in smokers or psycho-socially stressed adult patients).

Necrotizing Stomatitis

Necrotizing stomatitis is a severe inflammatory condition of the periodontium and the oral cavity in which soft tis- sue necrosis extends beyond the gingiva and bone denudation may occur through the alveolar mucosa, with larger areas of osteitis and formation of bone sequestrum. It typically occurs in severely systemically compromised patients. Atypical cases have also been reported, in which necrotizing stomatitis may develop without prior appearance of necrotizing gingivitis/periodontitis lesions.

Periodontitis as a manifestation of systemic disease

The pathogenesis of periodontal diseases is influenced by various host factors, including immune response, anatomical factors, and tissue structural factors. Most of these factors are determined by the genetic profile of the host and may be modified by environmental and host behavioral factors. Periodontal diseases and certain systemic disorders share similar genetic and/or environmental etiological factors and, therefore, affected individuals may show manifestations of both diseases. Hence, loss of periodontal tissue is a common manifestation of certain systemic disorders, which could have important diagnostic value and therapeutic implications.

FAQs

Periodontists typically rely on a visual assessment of the patient’s overall oral condition in addition to charting pocket depths with a periodontal probe. This visual/mechanical method of assessing periodontal disease status can only tell whether or not disease is present. Radiographs (x-rays) are also incorporated into the evaluation to determine the extent, severity and pattern of bone loss to accurately diagnose your disease and recommend the proper method of treatment. While these are the most reliable assessment tools, your periodontist will also evaluate overall systemic health to determine if you possess a unique genetic susceptibility or risk factor to periodontal disease.

Red or swollen gums
Tender or bleeding gums
Painful chewing
Loose teeth
Sensitive teeth
Gums that have pulled away from the teeth
Pus between the teeth and hums
Bad breath
Hard brown deposits that accumulate along the gumline
Changes in the way a dental appliance fits

Systemic Health Interactions “Mouth-body” concept

It’s no longer enough to simply exercise, eat well and avoid excess in order to maintain good health and a high quality of life. It’s clear that maintenance of oral, and particularly “periodontal” health, is critical to maintaining good overall health. An investment in your oral health is one that pays back over a lifetime. It pays you back at multiple levels and for years to come.

We passionately believe in the lifetime value of periodontal health and the synthesis between your periodontal and general systemic health. We pledge to always have an honest, upfront approach to discussing your treatment costs and provide optional treatments when it is appropriate.

Smoking weakens your body’s immune system (ability to fight infection). Tobacco use is the most modifiable risk factor and has enormous influence on the development, progression and treatment results of periodontal disease. Smokers show a 2- to 8-fold increase risk for attachment and/or bone loss depending on the amount smoked, and the assessment parameters for disease severity. Smoking demonstrates a synergistic effect in terms of increased risk of periodontal disease severity when combined with other systemic factors, and also demonstrates a dose-dependent relationship with periodontal severity, possibly leading to tooth loss.

One of the proposed mechanisms of smoking on periodontal disease progression is the shift in microbial flora that results in more pathogenic bacteria. Smokers harbor greater percentages of these pathogenic bacteria which may lead to lower numbers of “protective” species when compared to non-smokers.

Periodontal treatment tends to be less likely to be successful in smokers than in non-smokers. Studies evaluating the efficacy of periodontal disease control and specific periodontal procedures including regenerative procedures, soft tissue grafting procedures and implant procedures have consistently demonstrated a negative effect from smoking on success rates.

Treatment in patients with periodontal disease must be focused on understanding the relationship between genetic and environmental factors. Only through the use of individual approach can we identify your risks and achieve better results.

What does this mean for me if I am a smoker?

You have 2x the risk for gum disease compared with a nonsmoker
The more cigarettes you smoke = the greater your risk for gum disease
The longer you smoke or have smoked = the greater your risk for gum disease

Treatments for gum disease may not work as well for people who smoke

Diabetes is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Diabetes is due to either the pancreas not producing enough insulin (Type 1), or cells of the body not responding properly to the insulin produced (Type 2). Symptoms often include frequent urination, increased thirst, and increased appetite. If left untreated, diabetes can cause many complications, periodontal disease being one of many. Some serious long-term complications may also include cardiovascular disease, stroke, chronic kidney disease, nerve damage, ulcers (feet), damage to the eyes and cognitive impairment. Furthermore, the risk of cardiorenal mortality (ischemic heart disease and diabetic nephropathy combined) is three times higher in diabetic people with severe periodontitis than in diabetic people without severe periodontitis. Treatment of periodontitis is associated with HbA_1creductions of approximately 0.4%. Oral and periodontal health should be promoted as integral components of diabetes management (Wikipedia: slightly altered).

While Type 1 diabetes is an autoimmune disease that is not preventable, Type 2 may be prevented and treated or improved by maintaining a healthy diet, performing regular physical exercise, and avoiding the use of tobacco.

Diabetes has been unequivocally confirmed as a major risk factor for periodontitis showing an approximate 3-fold increase the risk for periodontitis compared to non-diabetic individuals. Periodontitis-related inflammation has been associated with poorer glycemic control in diabetics, as well as increased risk of diabetic complications, and elevated HbA1c levels in non-diabetics. People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.

Research has suggested that the relationship between diabetes and periodontal disease goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications

Can your mouth tell if you’re at risk for heart disease? It just may!

Patients with periodontal disease are at 2-3x the risk for having a heart attack, stroke, or other serious cardiovascular event. Acute inflammation — which involves an outpouring of immune cells that attack irritants and microbial invaders — fosters healing over the short term. But long-term (chronic) inflammation is a key contributor to many health problems, especially atherosclerosis. A recent analysis shows that the potential heart disease risk for patients with periodontal disease may be even greater than for those with high cholesterol. For too many Americans, this reality hits close to home in that more than 85 million Americans have some form of cardiovascular disease (CVD), while more than 200 million American adults have some form of periodontal disease.

Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease. Scientists suspect the link between the two diseases is due to the same bacteria. The same bacteria found in infected gum tissue that results in inflammation, may enter the bloodstream during normal chewing or brushing, contributing to the formation of arterial plaque which narrow the arteries or break loose and entirely clog them, resulting in a heart attack or stroke.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures (perio.org)

To date, there’s no proof that treating gum disease will prevent cardiovascular disease or its complications. But the connection is compelling enough that dentists say it’s yet another reason to be vigilant about preventing gum disease in the first place.

Researchers have shown that periodontal disease in expectant mothers actually exposes their unborn child to many different risks; particularly if they also happen to be diabetes sufferers. Pregnancy causes many hormonal changes which increase the risk of the expectant mother to develop gingivitis (gum inflammation) and periodontal disease. These oral problems have been linked in many research studies to pre-eclampsia, low birth weight of the baby and premature birth. Expectant women should seek immediate treatment for periodontal disease in order to reduce the risk of pre-natal and post-natal complications.

There are many safe, non-surgical treatment options available for pregnant women. It is of paramount importance to halt the progress of periodontal disease in order to increase the chances of a safe and healthy delivery.

Initially, we will assess the exact condition of your mouth in order to make a precise diagnosis. Scaling and root planning (SRP) or deep cleaning is a common non-surgical procedure used to rid the tooth-root surfaces of plaque and calculus (tartar) and remove the bacteria from the gum pockets.

The advantages to the pregnant woman are plentiful. The risks of pregnancy complications caused by periodontal disease are reduced by as much as 50% and these treatments will alleviate many unpleasant and harmful effects associated with gingivitis and periodontal infection.

At Lawrence Periodontics, your dental team can provide dental education and recommendations to you on effective home care which can reduce risks that may affect her and/or her child’s health. Risks of periodontal disease can be vastly reduced by proper home care, smoking cessation, dietary changes and the ingestion of supplementary vitamins.

If you have any questions or concerns about periodontal disease and its effect on pregnancy, please ask us – we are here to help at Lawrence Periodontics.

Stress is an association of physiological and psychological reactions of a person confronted to a change of situation they cannot face. The relationship between stress and any disease is explained by hormonal modifications and behavioral changes induced by the stress. These negative life events manifested as psychological stress and depression are common in day-to-day life, emphasizing the relationship between the person and environment.

Stress is said to influence the host defenses, exerting an immunosuppressive effect, increasing one’s vulnerability to disease. Cytokines and other humoral mediators of inflammation are potent activators of the central stress response, and the glucocorticoids released via this mechanism might regulate the recruitment of immune cells into inflamed tissues in order to cope with the psychological stress and depression. When the inflammatory action is sufficiently long and profound, the systemic manifestations of the disease may become evident, as could happen with periodontitis. Clinical and epidemiological data suggest that negative life experiences events, like depression, may contribute to an increased susceptibility to periodontal disease.

Because of the better understanding of the stress dynamic and the progress made in the field of the psycho-neuro-immunology-endocrinology and also because of the impact stress has on the behavior, it is clear that stress influences periodontal disease. At which level and how exactly its influence is not fully understood, and further studies are needed. However, changes in the everyday practice can already be implemented.

It is very important for us to understand your situation to help you maintain a healthy periodontium. People who are socially isolated, having financial problems, feeling depressed or people having a passive coping strategy may be at risk. Your stress situation needs to be registered for us to measure the level of stress and evaluate/modify your coping strategies.

Our role is to discuss your lifestyle in a broader concept than just oral hygiene, that is more psychologically oriented. At Lawrence Periodontics, we want to help reduce both your physiological and psychological stress levels, and if necessary, refer you to a psychologist or other specialists in the field of stress medicine (all needs to be reworded).

Other lifestyle factors such as obesity, physical activity and diet are also likely to affect the risk of periodontitis. One of the first studies to show an effect of obesity on periodontitis identified that obese rats with periodontitis had more alveolar bone loss compared with non-obese rats. Adiposity can be regarded as a systemic disease that predisposes individuals to a variety of comorbidities and complications, and a number of studies have reported associations between obesity and periodontitis. Analysis of NHANES III data identified that individuals with a BMI of ≥30 kg/m²had a significantly increased risk of periodontitis compared with individuals with a BMI of 18.5–24.9 kg/m². This relationship was potentially mediated by insulin resistance since, among those with a BMI of ≥27 kg/m², those who were in the highest quartile for insulin resistance had a significantly increased risk of severe periodontitis compared with those in the lowest quartile. A recent meta-analysis revealed a significant association between periodontitis and obesity, and concluded that a higher prevalence of periodontitis should be expected among obese adults.

These findings raise the question of whether increased physical activity can reduce periodontitis risk. In the US Health Professionals Follow-up Study of 39,467 health professionals, an inverse linear relationship was identified between sustained physical activity and periodontitis, independent of known risk factors. Another analysis of NHANES III data revealed that adults with higher levels of physical activity had significantly lower risk of periodontitis, with associations being strongest in non-smokers (but no association in smokers, suggesting that the harmful effects of smoking outweighed any benefit of physical activity). These various studies, while interesting, are limited in that they are generally cross-sectional/observational, and the temporal sequence of events is not clear (i.e. whether obesity precedes periodontitis). Prospective cohort studies are required to evaluate this area further.

Non-surgical Treatment Options

Everyone experiences some form of plaque buildup. The saliva, bacteria, and proteins in your mouth form a thin layer that covers your teeth at almost all times. When you eat, tiny particles, acids, and sugars from the food stick to this film, creating a buildup on the teeth known as plaque. The bacteria that lives in this plaque can cause gum disease and tooth decay. Brushing, flossing, and regular dental cleanings will help remove the plaque and prevent more serious

If you have healthy gums, the tissue will fit tightly around the tooth and keep plaque out. However, if gum disease begins to form, this tissue will loosen. Healthy gums attach to the tooth just 1 to 3 millimeters below the gumline. With gum disease, you’ll begin to develop deeper pockets. These can fill with plaque, worsening your problems and causing symptoms like bad breath. If you have pockets of 4 millimeters or more, you will most likely need dental scaling to remove the plaque beneath the gumline and help treat the gum disease.

Scaling is a common dental procedure for patients with gum disease. This is a type of dental cleaning that reaches below the gumline to remove plaque buildup by using both hand and ultrasonic instruments. The process of scaling and root planing the teeth is often referred to as a deep cleaning. This treatment goes beyond the general cleaning that you receive with your regular checkup and annual visit. Dental scaling is typically followed by a procedure known as root planing. Root planing reaches deeper to address the surface of the tooth’s root. This is done in the same manner as scaling. Root planing smooths the surface of the root so the gums can reattach properly

After the thorough cleaning of the tooth surface has been completed above and below the gumline, root planing is done in order to remove cementum and surface dentin embedded with unwanted microorganisms, toxins, and tartar. The roots of the teeth are actually smoothed, which promotes healing and also helps prevent bacteria from colonizing in the future. These improved surfaces make it much easier for the gingival (gum) tissue to reattach itself to the tooth, effectively reducing the size of the pockets that plaque and bacteria hide in. This regrowth of tissue is key in stopping a recurrence of gum disease and starts to occur quickly following the removal of calculus.

Non Surgical FAQs

Dental scaling can be uncomfortable, particularly if you have sensitive gums. You may be offered a local anesthetic to numb your gum tissue and make the procedure more comfortable. Speak with your dental team about your options for desensitizing the area if you’re concerned about pain or discomfort during the process.

Dental scaling can take several visits, each one addressing a different portion of the mouth. Usually your treatment will be divided into two appointment to address one-half of the mouth at a time. If you’re nervous about the process, ask your dentist if you can schedule your scaling for a single visit. Though this isn’t an option for all cases, it may be available if you have only moderate gum disease and are willing to sit for a lengthy procedure.

Your mouth may feel sore and sensitive after your dental scaling and root planing. Some patients experience swelling or bleeding for a few days following the procedure. Your dentist may suggest a desensitizing toothpaste to help ease this discomfort. You might get a prescription mouthwash to use after the procedure, as well, to help keep the gums clean. It’s crucial that you use proper brushing and flossing procedures after your scaling to stop plaque from forming again in the same areas.

A second visit after your final dental scaling will be schedule ~4-6-weeks after to examine the gums, measure the depth of your gum pockets, and make sure your mouth is healing properly. If the gum pockets have deepened since your scaling, you may need to explore additional treatment options to help you maintain a healthy smile.

Dental scaling is a very common treatment for patients with gum disease. Nearly half of American adults have gum disease, so you’re not alone if your dentist recommends this procedure. Scheduling dental scaling as needed can help you battle unseen plaque and maintain a cleaner mouth. If your dentist indicates that you need a deep cleaning, don’t hesitate to schedule this appointment. The result is a fresher smile that you’re sure to enjoy.

With either of these procedures, your periodontist may prescribe you either local or systemic antibiotics to aid in the reduction of bacterial growth.

Surgical Treatment Options

When gums are healthy, there are only small, shallow spaces around each tooth. When bacterial plaque is left at the tooth/gum junction, the resulting infection (periodontitis) causes these spaces to become deeper. As the “pockets” (spaces) deepen, the bacteria grow in number resulting in red, swollen, bleeding gums and frequently bad smelling breath, with the potential to lead to bone loss. As these spaces increase down the tooth, a procedure of pocket reduction may be useful. The procedure removes the bacteria and infected tissue, cleans and smooths the root surfaces, and reshapes the bone and gums surrounding the teeth. All this promotes an environment for the gums to heal resulting in shallower, more cleansable areas in and around your teeth.

Osseous surgery is generally safe, but in some cases, it can cause:

Tooth sensitivity
Mobility
Gum recession
Tooth loss

Osseous surgery is typically performed in the office under local anesthetic. In most cases, patients are able to return to normal activity the following day. The periodontist may give you specific recommendations about dietary changes you make while recovering and a prescription for antiseptic mouth rinse to aid in plaque control.

Gum disease has traditionally been treated by eliminating the gum pockets by trimming away the infected gum tissue and re-contouring the uneven bone. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are routinely used today. One of these advancements is guided tissue regeneration (GTR). This procedure is used to stabilize endangered teeth that have deep bone defects around them.

As periodontal disease progresses, pockets of degenerated bone develops in the jaw. These pockets can promote the growth of bacteria and the spread of infection. To address these pockets, Dr. Shelby may recommend GTR. During this surgical procedure, the bone defect created by the bacteria is cleaned thoroughly, a bone graft is placed to fill the defect, a regenerative protein is added to enhance healing and a resorbable membrane is installed between the soft tissue and the pocket in the bone to “guide” healing. The membrane covers the bone defect so that fast-growing soft tissue is blocked and slower-growing bone can begin to grow and regenerate itself.

Surgical Procedure.

The gum is opened with a procedure known as a flap. The area under the gums is cleaned out to remove all bacterial deposits and infection soft tissues. Then a membrane (with or without the bone graft material) is placed over the damaged bone.

Compartmentalizing tissues

Once in place over the bone and below the gums, the membrane provides necessary space and time for the bone to heal and start regenerating itself (defect fills in).

After healing

The stitches and membrane dissolve or are removed. In about 6 months, new attachments and bone regenerate to support the tooth or teeth.

Better life through better dentistry!

Request your appointment at Lawrence Periodontics. Conveniently located in Lawrence, KS. Discover complete health dentistry and start your smile makeover today!

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