Gum Disease, Diagnosis And Treatment
How will my doctor diagnose gum disease?
If you go to your dentist and he tells you you have gum disease, he's done one of several things to find out whether or not you actually do have this disease. He's taken X-rays, and the X-rays will show the height of the bone beneath the gums that is supporting your teeth. And this height of bone will either be where it belongs or it will be much, much lower, holding your teeth in place. He also will take an instrument called a dental probe and he will poke around your teeth. When he pokes around between the gum and the tooth, that dental probe should measure anywhere from to 3 millimeters. This 3 millimeters is the magic length, because that's how deep your toothbrush can go to keep things clean. If that measurement is more than 3 millimeters, it means that your toothbrush can't get all the way to the bottom. It also means that bacteria is going to be down there, forever, eating away at the bone and causing more inflammation and more problems. So this is how the dentist finds out that you have a problem.
What treatments are available for gingivitis?
Depending upon the severity of your gingivitis, it can be treated very successfully by brushing your teeth well twice a day for five minutes, and flossing. Or, if the plaque that was there earlier has developed into calculus or hardened, you can't remove it so you then have to go to see a dental hygenist or a dentist to have that removed and treat the gingivitis. Then you can go back to your toothbrush and keep everything clean.
What treatments are available for periodontitis?
Periodontitis is not a reversible situation. It has to be handled with surgery. When the area around your tooth is measured and it's deeper than 3 mm, we call that area a pocket. And these pockets need to be eliminated. Otherwise, you can't maintain these areas by yourself. The way to handle the elimination of these pockets is with surgery. The type of surgery you have will vary depending upon how bad your condition is and the exact type of condition that you have.
What is "flap surgery" for periodontitis?
One of the types of surgeries that you can have to treat your periodontitis is flap surgery. It's called flap surgery because the surgeon will create a flap. He will create a flap by making an incision down the gum from the top towards the base of the bone on both sides of the area affected. Then he will pull back this flap of tissue and clean out all the inflammation below it. He may then have to sculpt the bone in order to end up with a situation that will be maintainable by you once the surgery has healed. He may also elect at this time to put some artificial bone to grow some bone, which up 'til about several years ago we were not able to do. After the surgery is done with the bone the flap is replaced against the tooth, usually lower down. As this happens you will see more of the tooth out of the gum then before. That was what brought about the old saying that as you got older you got long in the tooth.
What are "soft tissue grafts" for periodontitis?
A soft tissue graft is used when there isn't enough gum tissue where the surgery occurs to cover the entire area. In that case tissue is taken from another area of the mouth, usually the roof of the mouth, and then sutured on the area where the surgery was done. Soft tissue grafts can also be used to cover roots that have been exposed by major gum recession. These are very, very, successful. There is a pretty easy recovery from the area where the soft tissue graft was placed. There is often some discomfort from the site where the tissue was taken. But again, medication will work well to alleviate the pain.
What is "bone grafting" for peridontitis?
Bone grafting is used to raise the height of the bone, rather than trim the bone all the way down, to eliminate an infected area. The infection is still removed, but then rather than trim everything down, the bone is built up. During bone grafting, the bone is taken, usually, from the patient's mouth, from another area where things are fairly healthy, and then placed in the area. The bone will then cause more bone to form and fill in the area that was affected earlier. After the bone graft is placed, the gum tissue is sewn back to place with sutures, and then a packing is placed over this.
How long will it take to recover from periodontitis surgery?
The good news, after you've had surgery for periodontitis, is that you're going to keep your teeth. And this is really a very, very good thing. The bad news is you're not going to be normal. Normal being the way you were before you developed this condition. At the very least you're going to have more tooth structure above the gum than you had before. As you get this more tooth structure above the gum, you're going to have these roots exposed and they're going to be more sensitive to cold. This is going to have to be managed with some type of either fluoride or some dental covering over this so you don't have the sensitivity. In addition to that, the shape of the roots is not the same way that the crowns are shaped. So, there will be many more nooks and crannies available for food to lodge in than there were before. So it's going to present a cleaning problem for you, but, when everything is weighed, keeping your teeth, despite these problems, is still far, far better than losing your teeth.
