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What is periodontal disease?

   There are many different types of periodontal disease but gingivitis and periodontitis are the most common. Gingivitis is usually due to the accumulation of bacteria on the surface layer of gum tissue, which causes inflammation depicted through gingiva redness, swelling, and bleeding on brushing. Untreated gingivitis progresses to become periodontitis, which is the chronic inflammation and destruction of the periodontal ligament and supporting bones. When the gingival fiber and periodontal ligament are damaged, the gum margin separate from the teeth forming a periodontal pocket. Pus formation can often be found in these areas. As bone destruction progresses, the periodontal probing becomes deeper and teeth become increasingly unstable.

What are the symptoms of periodontal diseases?

     Gingiva bleeding is one of the most common symptoms of gum inflammation. Gingivitis may induce little discomfort, but it progresses slowly and constantly. Many periodontal diseases are accompanied with gingiva bleeding, which is usually ignored at first place. By the time the periodontal disease get attention, the condition may have worsened and become more difficult to treat. There are also other symptoms that can indicate the presence of periodontal disease, such as loosened, flared out or spacing of teeth. The gums may begin to shrink away from the crown and teeth may appear to become longer. When pus forms in the periodontal pocket and cannot be drained out, it becomes a periodontal abscess. The above symptoms may only appear when the periodontal disease become more severe. This is why every patient should routinely have dental appointments to examine and maintain his or her periodontal condition.  

How periodontal diseases are diagnosed

  Dentists observe the color and contour of the gums, check the degree of teeth looseness, and place the periodontal probe down to the gum in order to measure the depth of the periodontal pocket. This test is called periodontal probing. This is a necessary part of a thorough dental examination for adults. If bone loss is noted, a full mouth X-ray examination is suggested for further assessment.

What causes periodontal disease?

       Plaque is easily accumulated over to the gum margin and between teeth. When patients have poor brushing habits, a bacterial film will cover most of the tooth surface. Almost every adult and child will have plaque and calculus deposition in their mouth. The plaque is mainly composed of bacteria, minerals, and water. If the biofilm layer is not removed over time, it becomes calculus, and the surface layer will continually be covered by new layers of plaque and bacteria. Inflammation of the gums is usually caused by toxins excreted from bacteria, or cells reacting to the human immune system. In addition to incomplete removal of dental plaque, residual food particles, poor dental fillings, orthodontic braces, or poorly designed fixed partial restorations can all induce gum inflammation. Personal factors including genetic predisposition and hormonal imbalances, such as diabetes, pregnancy, and thyroid insufficiency, can all contribute to one’s periodontal condition, mainly because they affect a patient’s immune system.

How to prevent periodontal disease?

       The most important step is to learn to clean your teeth effectively. Through mirrors and good lighting, food debris can be recognized and teeth can be cleaned thoroughly. But the real crisis is that the growth of bacteria around the tooth surface, which then turn to dental plaque, is easily ignored when brushing. A plaque disclosing agent can be used to reveal plaque deposition and help in oral hygiene maintenance.

       The dentist should create an oral hygiene plan for each patient. Oral hygiene instruction such as how to brush the teeth effectively without harming the teeth or gums should be informed to the patient. Use of dental floss or interdental brushes is an effective way to remove plaque between the teeth and learning to use the right tools effectively is first step to treat periodontal disease.

       Daily tooth cleaning can reduce plaque and calculus formation to a minimum level, but it cannot completely prevent them from forming. Moreover, the calculus that has already become firmly attached to the teeth below the gingival margin cannot be removed through brushing. The removal of calculus can only be completed by scaling, usually performed using a professional tool. Many dentists use ultrasonic devices to remove the calculus from the tooth surface, or use professional tools for further root planing.

What is the treatment of periodontal disease

       In early stages, most treatments include subgingival scaling and root planning at the gingival margin. Dentist use a device called a curette to remove plaque, calculus, and inflamed soft tissue in the periodontal pocket around the teeth and smooth the root surface. The purpose of the treatment is to remove the bacteria that cause inflammation.

       This usually allows the gingiva to reattach to the tooth surface or shrink to reduce the depth of the periodontal pocket. Satisfactory results can be obtained by such scaling, root planning, and cleaning of the teeth in most early cases.

       For severe cases, treatment can be complicated. If deep periodontal pockets still remain after removing the deposits, advanced surgical treatment under local anesthesia is needed. This surgical procedure is mainly to provide patients with a suitable gingiva contour for cleaning, and an environment conducive to periodontal tissue repair and reattachment.

       Patients with periodontal disease should accept preventive treatment regularly, such as the removal of newly formed calculus, polishing the teeth, checking the occlusion, and re-examining the periodontal condition. These allow patients to keep their oral hygiene and to maintain the results after periodontal treatment.

Who should you go to for periodontal disease treatment?

       General practitioners can detect or treat periodontal disease early. In stage of prevention of periodontal disease, general practitioners play an important role in education and oral hygiene instruction. After examination, patients diagnosed with periodontitis can be referred to periodontal specialists with extensive professional training for further treatment.

       After a series of periodontal treatments, periodontal specialists will refer the patient back to their family dentist for continued follow-up in order to maintain periodontal health. About 90% of patients can maintain their teeth and periodontal health after rapid and correct treatment and care.

Maintenance of periodontal health

       If you have just completed full mouth therapy of periodontal disease, now it’s the time to enter the maintenance phase to maintain your periodontal health. Regarding this maintenance treatment, you may have some questions. The following list may be able to answer your questions. If you have further questions after reading this list, you can ask your periodontist for more information.

I. What is the maintenance phase?

The maintenance phase is a plan to keep your periodontal health including periodontal tissues and alveolar bone. Once periodontal treatment is completed, the status of periodontal health may be in a state of inactivity, but must be continuously followed up to prevent recurrence.

II. Why is it important to have the maintenance phase?

       If you are a patient susceptible to periodontal disease, the bacteria caused periodontal disease may often appear in your mouth and constantly invade your teeth and periodontal tissue. It’s important that you need to do something to prevent recurrence of your periodontal disease.

       However, you should make the effort to uphold your daily oral hygiene routine such as brushing and flossing. Periodontal pathogens usually appear in two to four months after the last session of professional tooth cleaning. If you want to maintain your periodontal health, book appointments for professional check-ups regularly. Removal bacteria and calcified deposits regularly is important. During the check-ups in the maintenance phase, dentists can also detect for possible dental caries (cavities) and provide an opportunity to update your dental health.

3. Who will perform the care during the maintenance period?

       This answer depends on the severity of the patient and the disease complexity diagnosed during the first phase. In general, the more serious the initial situation, the more you need a periodontist to supervise your oral hygiene care. If you received surgical treatment during the treatment of your periodontal disease, a periodontal specialist is suggested to continue the follow up appointments.

4. What is examinations or treatments are performed during the maintenance phase?

1. Check for changes in your general health

2. Check for abnormal changes your oral cavity

3. Check the periodontal condition and remeasurement of clinical attached tissue; probing of gums may be required

4. Check the plaque control level; further oral hygiene instructions may be required

5. Check for presence of dental cavities; X-ray examination may be required

6. Calculus deposits, plaque, stains, and rough surface of teeth or under gum

7. Use or prescription of medicine

8. Check and adjust occlusion

9. Inform you and your general dentist about your periodontal and dental health

5. How often do I need to see a doctor during the maintenance phase?

This depends on the results of your periodontal condition. The maintenance interval can be from every few weeks or every six months or even once a year. Each one’s situation is different, and the times of consultations during the maintenance phase will be affected by the following factors:

  1. Different types of periodontal disease
  2. Patient responses to periodontal disease and treatment
  3. Different types of periodontal treatment
  4. Different growth rates of dental plaque
  5. Oral hygiene condition

6.Will periodontist inform my general dentist after routine check within maintenance phase?

It’s necessary for periodontists to communicate with general dentist for prognosis during the maintenance phase. Additional dentition care may be discussed for teeth rehabilitation.

7.Will the periodontist notice my caries? If found, what will he do?

Periodontal maintenance will not replace general dental check, and only focus on clinical attachment and alveolar bone situation. Therefore, a general dental check, such as new caries, replacement of filler, prosthesis problem and other dental problem still need to be checked regularly. Once new caries are found, periodontist will refer you to your general dentist for further evaluation.

8. I am afraid of intake of radiographic dose. As I am in maintenance phase, how often should I take radiographic film?

Radiographic film is only taken if necessary. In general, the patient should be taken full mouth radiographic film every 2-4 years. Additional radiographic film will be taken if necessary. After periodontal treatment, it’s dangerous and harmful for you to assume that periodontal disease will not recur. About 70-90% population have a history of periodontal disease. Now that you have the knowledge of periodontal disease and treatment process, please refer your friends or family to the periodontal department for further evaluation. Thank you.

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