Prior to the 1960’s, it was common in rural America to have all of your teeth pulled and receive a complete set of dentures for your high school graduation present. It was thought that since complete tooth loss was “inevitable,” why not avoid the pain, suffering, and expense along the way. The major cause of this tooth loss was periodontal (gum) disease. Today, we know that gum disease is a bacterial infection, which is preventable and treatable in most cases.
Keeping your own teeth for life is our primary goal.
Periodontal disease is caused by a group of bacteria that stick to the tooth under the gum line between the teeth. This is because they do not like oxygen (they are anaerobic bacteria). This film (plaque) is a biofilm with many layers containing different species of bacteria and their by-products. The bacteria live in an ecosystem supporting each other, actually communicating, and utilizing one another’s by-products. If the biofilm (plaque) is not disrupted regularly it becomes more organized and the body begins to make chemicals in response to it. These chemicals break down gum tissue and bone. Preventing gum disease involves disrupting the biofilm’s (plaque) organization on all surfaces of the teeth at the gum line. This is primarily done once a day with tooth brushing and flossing. In addition, regular tooth cleanings (prophylaxis) by a dental hygienist are necessary. Once periodontal disease develops, treatment is more complicated. In early gum disease, treatment involves a procedure called scaling and root planing. In more severe gum disease scaling and root planing is necessary as well as gum surgery. Home care is more complicated since getting to the biofilm is harder due to defects caused by the gum and bone destruction.
Non-Surgical Gum Treatment
Treating periodontal disease non-surgically involves a procedure called scaling and root planing. It usually involves a series of visits. At the visit, tartar (calculus) and plaque (biofilm) is removed from the root surfaces using special instruments. It is done in sections of the mouth using local anesthesia. The areas are also irrigated with an antibacterial rinse. Since the biofilm is disrupted the bacteria can be reached by the antibacterial rinse. Tartar is the hard calcified material that forms on teeth from plaque (biofilm) buildup. This tartar irritates the gums and is an obstacle to plaque removal. After tartar removal, it becomes easier for you to remove the plaque during your regular cleaning at home. At your first visit, we provide you with a Braun™ 7000 electric toothbrush to use at home. The dental hygienist who performs the scaling and root planing will educate you in using the Braun™ for plaque (biofilm), flossing, and other home care devices.
Laser Gum Treatment
Delmarva Dental Services use a special type of Dental Laser called a Waterlase®. The laser beam activates a water stream which does the work. It can be used for nonsurgical and surgical treatments. Non-surgically, the Waterlase can be used to sterilize infected pockets. Surgically, it can be used to remove tissue. It is more precise than traditional methods of gum surgery, and can decrease healing time.
Gum disease destroys bone and gum tissue around the tooth. The primary goal of periodontal surgery is to keep the patient from losing a tooth. This goal is achieved in one of two ways: by either replacing some of the lost gum and/or bone, or by making it easier for the patient to clean their teeth. The majority of the time, our dentists at Delmarva Dental Services recommend nonsurgical gum treatment and medications as the primary treatment for periodontal disease. The deeper the pockets and the more bony craters present, the more likely periodontal surgery will be needed as well. Our patients will receive a thorough examination and treatment plan as well as alternatives prior to initiating any treatment. Delmarva Dental Services also reevaluates results and modifies treatment as situations change.
- Resective Surgery
This is one of the oldest forms of gum surgery. “Resect” means to cut away. Resective surgeries primary goal like all gum surgery is to retain the tooth. Periodontal disease deepens pockets and creates bony craters in the jaw bone that supports the teeth. After nonsurgical gum treatment, pockets and bony craters may remain and it is not possible for patients to reach these areas to remove the bacterial biofilm with brushing and flossing. Therefore, the pockets continue to deepen and bone loss continues. At this point, removing some of the gum and recontouring the bone creates better access. Delmarva Dental Services believes regenerative surgery (bone and gum grafts) to be the surgical treatment of choice; however, sometimes resective surgery is indicated. With all our patients we will customize a treatment plan that fits their specific situation and discuss all of their options.
- Regenerative Surgery
Replacing missing gum tissue is called gum grafting. Replacing lost bone is called bone grafting. Many times grafts will make it easier for the patient to clean their teeth as well.
- Gum Grafting
Gum (gingival and connective tissue) grafts are designed to replace missing tissue in the mouth due to gum disease, gum recession, or tooth loss. The donor tissue is obtained from another area adjacent to the defect, the roof of the mouth, or cadaver tissue. Today, there are also synthetic graft materials available. The several goals of gum grafts are to preserve tooth support, reduce cold sensitivity, or improve cosmetics.
- Bone Grafting
Bone grafting is one type of periodontal surgery. It is also used for extractions and dental implants as well. Thirty years ago there was very little bone grafting done around teeth in dentistry. Most treatment for gum disease was resective in nature. The goal of bone grafting is to place a substance in an area that has insufficient bone and stimulate the body to make bone. Insufficient bone can occur from periodontal disease and after tooth extraction. Various materials can be used in bone grafting. Some are used separately and others can be combined. Most materials are similar in nature, allowing them to dissolve gradually by your body. They differ in their ability to stimulate the body to make bone. Some of the substances used today are: bone taken from another part of your body like the jaw, cadaver bone, cow bone, fetal pig embryonic cells, calcium compounds, glass, and acrylic. Your dentist at Delmarva Dental Services will discuss your options with you and determine the best method for your situation.