Frequently Asked Questions

The word periodontal literally means "around the tooth." Periodontal diseases are serious bacterial infections that destroy the attachment fibers and supporting bone that hold your teeth in your mouth. Left untreated, these diseases can lead to tooth loss. There are many forms of periodontal disease: gingivitis, mild periodontitis, moderate to advance periodontitis, juvenile periodontitis.

A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including two to three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal diseases. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire. Often, dentists refer their patients to a periodontist when their periodontal disease is advanced. However, you don't need referral to see a periodontist. In fact, there are occasions when you may choose to go directly to a periodontist or to refer a family member to your own periodontist.

Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smokers are much more likely than non-smokers to have calculus form on their teeth, deeper pockets between the teeth and gums and lose more of the bone and tissue that support the teeth.

Your bone and gum tissue should fit snugly around you teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space in which bacteria can live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

Bleeding gums are one of the signs of gum disease. Think of gum tissue as the skin on your hand. If your hands bled every time you washed them, you would know something was wrong. There are a number of other warning signs of gum disease.

Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interventive treatment may help them keep their teeth for a lifetime.

Periodontal disease may be passed from parents to children and between couples, according to an article in the September 1997 issue of the Journal of the American Dental Association. Researchers suggest that bacteria causing periodontal disease are passed through saliva. This means that when a family or couple comes into contact with each other's saliva, they're at risk for contracting the periodontal disease of another family member. Based on this research, the American Academy of Periodontology recognizes that treatment of gum disease may involve entire families. If one family member has periodontal disease, the AAP recommends that all family members see a dental professional for a periodontal disease screening.

To keep your teeth for a lifetime, you must remove the plaque from your teeth and gums every day with proper brushing and flossing. Regular dental visits are also important. Daily cleaning will help keep calculus formation to a minimum, but it won't completely prevent it. A professional cleaning at least twice a year is necessary to remove calculus from places your toothbrush and floss may have missed.

Your chances of developing periodontal disease increase considerably as you get older. More than half of people aged 55 and older have periodontitis. The good news is that research suggests that these higher rates may be related to risk factors other than age. So, periodontal disease is not an inevitable part aging. Risk factors that my make older people more susceptible include general health status, diminished immune status, medications, depression, worsening memory, diminished salivary flow, functional impairments, and change in financial status.

If you value your oral as well as overall health, anytime is a good time to see a periodontist for a periodontal evaluation. Sometimes the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation may be especially important if you:

• Notice any symptoms of periodontal disease including: gums that bleed easily, such as during brushing or flossing red, swollen or tender gums gums that have pulled away from the teeth persistent bad breath pus between the teeth and gums loose or separating teeth a change in the way your teeth fit together when you bite
• are thinking of becoming pregnant. Pregnant women who have periodontal disease may be seven times more likely to have a baby born too early and too small. In addition, about half of women experience "pregnancy gingivitis." However, women who have good oral hygiene and have no gingivitis before pregnancy are very unlikely to experience this condition.
• have a family member with periodontal disease. Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.
• have heart disease, diabetes, respiratory disease or osteoporosis. On going research is showing that periodontal disease may be linked to these conditions. The bacteria associated with periodontal disease can travel into the blood stream and pose a threat to other parts of the body. Healthy gums may lead to a healthier body.
• feel that your teeth are too short or that your smile is too "gummy." Or, if you are missing one or more of your teeth and are interested in a long-lasting replacement option.
• are not satisfied with your current tooth replacement option, such as a bridge or dentures, and may be interested in dental implants.
• have a sore or irritation in your mouth that does not get better within two weeks.

During your first visit, your periodontist will review your complete medical and dental history with you. It's extremely important for your periodontist to know if you are taking any medications or being treated for any condition that can affect your periodontal care. You will be given a complete oral and periodontal exam. Your periodontist will examine your gums, check to see if there is any gum line recession, assess how your teeth fit together when you bite, and check your teeth to see if any are loose. Your periodontist will also take a small measuring instrument and place it between your teeth and gums to determine the depth of those spaces, known as periodontal pockets. This helps your periodontist assess the health of your gums. Radiographs (x-rays) may be used to show the bone levels between your teeth to check for possible bone loss.

Crown lengthening is a procedure to remove excess gum tissue to expose more of the "crown" of the tooth. Your gum line can be sculpted to give your new smile just the right look.

Soft tissue grafts and other root coverage procedures are designed to conceal exposed roots, reduce further gum recession, and protect your vulnerable roots from decay. During this procedure, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

Dental implants look and feel like your own teeth. They can help prevent the bone loss and gum recession that often accompany bridgework or dentures. In addition, they don't sacrifice the quality of your adjacent teeth like a bridge because neighboring teeth are not altered to support the implant. Implants are secure and offer freedom from the clicks and wobbles of dentures. The success rate of implants is highly predictable.

Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply.

Here are some guidelines for choosing dental care products-what works for most patients most of the time. To find out what is best for your particular needs, talk to your periodontist.

• Begin with the right equipment-a soft bristled toothbrush that allows you to reach every surface of each tooth. If the bristles on your toothbrush are bent of frayed, buy a new one. A worn-out brush will not clean your teeth properly.
• In addition to manual toothbrushes, your choices include automatic toothbrushes and "high tech" electronic toothbrushes. These are safe and effective for the majority of patients.
• Oral irrigators (water spraying devices) will not remove plaque from your teeth unless used in conjunction with brushing and flossing.
• Another aid is the rubber tip, often found on the handle end of a toothbrush used to massages the gums after brushing and flossing.
• Other options include interproximal toothbrushes (tiny brushes that clean plaque between teeth) and interdental cleaners (small sticks or picks that remove plaque between teeth). If used improperly, these dental aids can injure the gums, so it is important to discuss proper use with your periodontist.

Fluoride toothpaste and mouth rinse used in conjunction with brushing and flossing can reduce tooth decay as much as 40%. So, using products with fluoride is a good idea. However, mouth rinses are not recommended for children under six. Children should use only pea-size dab of fluoride toothpaste on the brush to avoid fluoride overdosing. Tartar control toothpaste will reduce tartar (a buildup of hardened plaque) above the gum line. Anti-plaque rinses approved by the American Dental Association contain chemical agents that may help bring early gum disease under control. These rinses can be a helpful addition to brushing and flossing.

Depending on how far your periodontal disease has progressed, treatment can vary widely. If the disease is caught early, simple procedures can be done that will remove the plaque and calculus from below the gum line and eliminate the infection-causing bacteria. If the disease has advanced to the point where the periodontal pockets are deep and the supporting bone is lost, surgery might be necessary.

LANAP™ is a laser based technique for the treatment of periodontal disease using the Millennium Dental Technologies, Inc., PerioLase" Laser. Fear of periodontal treatment vanishes when patients find out no scalpel or sutures will be used. Patient friendly laser treatment gets patients to agree to the treatment they need and continue with the follow-up care that is prescribed. Our office is one of the first in the area to offer LANAP™ for the treatment of gingivitis and/or periodontitis. Following are commonly asked questions about this technology.

Tartar, associated with inflamed and bleeding gums, is removed form the root surface of the tooth using an ultrasonic scaler and small instruments. Then, a small amount of light energy from a laser is directed through a tiny fiber, which is gently placed between the gum and tooth. This light energy removes a tiny amount of diseased tissue and aids in reducing the bacteria associated with the disease. After the area is thoroughly cleaned, the body can heal the area naturally.

Although the procedure itself can be virtually painless, we may anesthetize the area for the patient's comfort. In this way we can precisely direct the laser for treatment. Post-procedure discomfort is typically minimal and of short duration.

Initial treatment is focused on scaling and the use of small instruments to remove the tartar. Then, the laser portion of the treatment is performed and normally only takes a few minutes. Depending on the severity of the patient's periodontal disease, treatment may be accomplished in one office visit or in multiple visits. The estimated treatment time is reviewed with patients when we discuss their treatment plan.

Typically we use the same billing codes as traditional gum surgery and the laser treatment is generally no more expensive than traditional surgery. There are other factors which may affect the cost, such as the severity of the periodontal disease, and how many teeth are involved. Many insurance plans pay only for a portion of this treatment. Patients should discuss their payment options with the dental office personnel as we offer financing for this treatment. The dramatically increased comfort for our patients made the new system attractive to our office. We do encourage patients to take care of the need now to reduce further damage to their gums, teeth and bone.

Many insurance plans pay a portion of periodontal services. Your periodontal health is important, so talk to your periodontist about payment options. Often the office staff will work with your insurance company to secure maximum benefits.

Maintenance or supportive periodontal therapy is an ongoing program designed to prevent periodontal disease from recurring in patients who have undergone periodontal treatment. This ongoing phase of treatment will allow your periodontist to assess your periodontal health and make sure infections stays under control. During maintenance therapy, your mouth is examined, new calculus and plaque are removed, and, if necessary your teeth are polished and your bite is checked.

The answer varies from person to person. Your dentist or periodontist will recommend a schedule that is best tailored to protect your periodontal health. The intervals between visits may range from every few weeks to four times per year, in addition to checkups by your general dentist.

More research is needed to confirm how periodontal disease may put people at increased risk for respiratory disease. What we do know is that mouth infections like periodontal disease are associated with increased risk of respiratory infection. An analysis of research has revealed that periodontal (gum) disease may be a far more serious threat to your health than previously realized.

Several theories exist to explain the link between periodontal diseases and hear t disease. One theory is that oral bacteria can affect the heart when they enter the bloodstream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks. Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Pregnant women who have periodontal disease may affect pregnancy outcomes. What we do know is that periodontal disease is an infection and all infections are cause for concern during pregnancy because they pose a risk to the health of the baby. If you are thinking about becoming pregnant, be sure to include an evaluation with a periodontist as part of your prenatal care.

For years we've known that people with diabetes are more likely to have periodontal disease than people without diabetes. Recently, research has emerged suggesting that the relationship goes both ways-periodontal diseases may make it more difficult for people who have diabetes to control their blood sugar. Though more research is needed, what we do know is that severe periodontal diseases can increase blood sugar, putting diabetics at increased risk for complications. If you are among the 16 million Americans who live with diabetes of are at risk for diabetes or periodontal disease, see a periodontist for an evaluation.