Periodontal Disease and Treatment

Background and Diagnosis

Periodontal disease is a bacteria-related inflammatory disease of the gums, the cementum that covers the root, the periodontal ligament and the bone around the tooth. Periodontitis can lead to pain, smell and tooth loss; in addition, it has been linked to heart disease and several other dangerous systemic conditions.

To determine if you have periodontal disease, and the extent of its progression, we begin by using a dental instrument to measure the pocket depth between your gums and your teeth. Ideally, the pocket depths around the teeth will range between 1 and 3 millimeters (mm). Gingivitis will appear as swollen gums and reveal pockets up to 4 mm.  Both can be remedied by a simple cleaning.

Periodontitis, however, will be accompanied by red, irritated, bleeding, sometimes sore gums or pus and pockets deeper than 5 mm. Xrays of periodontitis will often show hardened calculus around the teeth and may even show the bone loss itself. A more detailed cleaning is in order to address periodontitis.

A great deal more is learned about the specific causes and circumstances surrounding each patient’s condition during the treatment itself.

Treatment

To treat periodontitis, we remove the deposits of calcified plaque called calculus or tartar and any other bacterial toxins which become ingrained under the gumline and into the root surfaces. The process, known as scaling and root planing (“SRP”), utilizes ultrasonic and hand scaling instruments, ideally while the patient is under local anesthesia. Just a few areas are focused on at a time until a “deep” cleaning is achieved.  

In addition, the placement of a medicine called Arestin into pockets 5mm or greater is recommended. This medicine eliminates the harmful bacteria for 45 days following SRP.

Immediately following SRPs, it is recommended that patients use a Chlorhexidine Rinse, an antibacterial mouthwash that helps to control and kill the bacteria in your mouth that cause gum disease. We recommend that you rinse with chlorhexidine after brushing your teeth for one week following SRP and after future dental visits.

Existing bone loss related to periodontitis will not return with SRP.  But, SRP’s and a few changes to your routine cleaning protocol described below will help you keep your teeth for life.

After Care

Instead of a simple cleaning (“Adult Prophylaxis”), Periodontal Maintenance describes the type of routine office cleanings following SRP.  It is considered a basic service by insurance.

Periodontal Maintenance removes plaque and tartar from above and below the gumline, down the length of each tooth to where the root, gum and bone meet. Rough areas of the roots are maintained smooth, pocket depths are carefully monitored, and inflamed pockets are irrigated with antibacterial medicines if necessary.

After SRP treatment, most patients choose to have their teeth cleaned every 3 or 4 months to match the complexity of their dental condition that led to the periodontitis in the first place.  These factors include their natural plaque and tartar accumulation, bleeding, inflammation, pocket stability, the quality of their anticipated home care and their overall health risk factors.

Lastly, with a few meaningful changes to your at-home cleaning routine, periodontitis can be kept under control.  Brushing for two full minutes twice daily with an Philips Sonicare toothbrush and flossing once a day is usually adequate.  For difficult areas, christmas tree brushes (“proxy brushes”), enlarged floss (“super floss”) and Philips Airfloss are excellent aids. Consistent behavior change is the most important element in maintaining long term periodontal health.  Smoking has also been shown to contribute to periodontitis.

Related Pricing

*Dental insurance plans will often cover all or part of these costs.

More Information

Have more questions? We want you to have a complete understanding of your oral health and how to best maintain or improve it. You may want to do some research on your own.  Here are several internet search terms to help you get started:

• Periodontitis
• Gum disease
• Link of periodontitis to systemic health
• Scaling and Root Planing
• Periodontal Maintenance
• Arestin
• Chlorhexidine rinse
• Philips Sonicare
• Philips Airfloss
• Scaling and root planing and insurance
• Reasons for tooth loss
• Cause of bleeding gums
• Risk of deep periodontal pockets
• Periodontal surgery
• Options for missing teeth
• Dentures
• Implants
• Implants with periodontitis

Gum Disease? Meet Your New Best Friend: Arestin®

Regular brushing and flossing are essential parts of oral home care. But gum disease won’t go away on its own. Because it’s an infection, it needs to be treated professionally. In our office, we often combine scaling and root planing (SRP) with application of an antibiotic medication called Arestin®.

Because of the way gum disease progresses, the longer you wait to take action, the greater the chance you may need painful and expensive surgery to get it under control. Arestin® is a locally administered antibiotic (LAA) in powder form that we place directly into the infected areas—or pockets—in your gums. Arestin® powder is made up of 100,000 tiny microspheres, invisible to the eye. These microspheres contain the antibiotic drug minocycline, which is released over time into the infected pocket. This means Arestin® keeps working to kill bacteria long after you’ve left our chair. 

Moft of the time, our patients are pleasantly surprised to find that their medical insurance's prescription coverage applies to Arestin®. It is typical that a $30 copay will enable our patients to receive $1,000 worth of this medicine. 

How Arestin + SRP Works:

01. Your dental professional removes plaque and tartar above and below the gumline with SRP. 

 02. ARESTIN® microspheres are placed into infected pockets using a special plastic applicator. 

  03. The antibiotic is released over time, helping to reduce bacteria as your gums heal.

If you have any questions regarding gum disease or how Arestin® can help, let us know! We're happy to share some insights or schedule an appointment to help evaluate your unique needs and oral health. 

Images and content courtesy of Arestin®.

Q&A Spotlight: Periodontal Maintenance vs. Prophylaxis

Often times, we get asked by patients, “What’s the difference between a normal cleaning a periodontal maintenance, and why does it cost more?” This is a great question and the answer has a few parts to it. 

First, let's establish that a “normal” cleaning (prophylaxis) is for a healthy mouths. This includes procedures that address plaque, calculus and stains on the coronal portion of the tooth. “Coronal” means relating to the crown of the tooth, above the gumline. The typical patient who should receive prophylaxis comes to routine (every 6 months) hygiene appointments, exhibits excellent home care habits and has healthy tissues with no bleeding when probed or flossed. When they have a periodontal evaluation and charting session, probings are measured at 4mm or less. 

Next, let’s cover periodontal maintenance and scaling. This is an ongoing therapeutic procedure to treat periodontitis, which is a chronic and incurable (but controllable) bacterial infection. The primary objective is below the gumline - removal of dentin that is rough and/or permeated by calculus and contaminated with toxins and microorganisms. Some soft tissue removal also occurs. This type of procedure requires more skill and expertise than a prophylaxis. 

Periodontal disease overwhelms a patient’s defenses and spurs the immune system to initiate a breakdown of supporting tooth structures (bone loss). It is also episodic. These type of destructive episodes can be triggered by stress, disease or other problems unbeknownst to the patient. The three-month interval recommendation for perio maintenance is not arbitrary. It is based on the behavior of the bacteria. After periodontal maintenance therapy, periodontal pathogens aggregate on the biofilm and become the predominant species of bacteria again in three to 12 weeks. This means that by the 12th week, or 3 months, the periodontal “bugs” are flourishing again. That’s when we should reduce their numbers again. After discovery of periodontal disease, it is important to stay vigilant in controlling and monitoring through periodontal therapy. 

To value a periodontal maintenance it is necessary to understand that it is different from a regular cleaning because you are controlling disease with therapy versus simply cleaning teeth. 

The Link Between Gum Disease and Prostate Issues

Ashland, OR – For many years now, we’ve known about the unique link between gum disease and other ailments such as increased risk of heart disease. A new discovery points to the likelihood that treating gum disease may also lessen symptoms of prostate inflammation.

“Western Reserve University School of Dental Medicine recently released research that this may be the case,” says Ashland dentist Dr. Aron Kivel. “In the report, participants who suffered from prostatitis experienced fewer symptoms while also seeking periodontal (gum) treatment.” 

This isn’t the first time the correlation between the two have been studied. Previous research also proved the link between prostatitis and gum disease, but this new study shows proves the effectiveness of treatment in helping patients with prostatitis.  For those with inflammation of the prostate, urinating can be painful and laborious.  27 men with both prostate inflammation and gum disease were studied and after gum disease treatment. Even though these men received treatment for their gum disease only and not for their prostate issue, most showed significant improvement. Specifically, 21 of the 27 participants displayed decreased prostate specific antigen (PSA) levels, which indicate a lessened likelihood of inflammation. Men with the highest levels of inflammation also exhibited the most improvement following periodontal treatment.

So How are the Two Linked?

Gum disease develops when plaque and calculus isn’t properly removed and with time, the bacteria can spread and grow below the gum line. This toxic bacteria can then stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. If left untreated, the bacteria can also spread to the bone, causing further infection and possible bone loss.

Our bodies’ systems are intimately related. The bacteria that cause periodontitis can travel to other organs of the body. While a definitive answer has not been reached for why gum disease is linked to so many other issues, inflammation is the strong common denominator.

Research continues to be conducted around the world exploring the link between gum disease and other serious medical issues, but the consensus is obvious – even without an exact reason why, the evidence points to the fact that periodontitis has an effect on your body as a whole. Undergoing proper treatment for gum disease can very well improve people’s overall health and well-being.

You can prevent gum disease before it becomes and issue by following a thorough home hygiene routine which includes daily brushing and flossing, and regular check ups at your dental office. Because periodontitis is often painless, you might not even be aware you have it until it is too late. By discovering and treating gum disease as soon as possible, your dentist can lessen its effect on your gum health as well as the rest of your body. If you’d like a thorough evaluation of your own gum health, make an appointment with us today.