Have you been diagnosed with Periodontal Disease and told you need a “deep cleaning”? Do you have questions about what this really means and why you need it? It can be a bit of a shock to hear that you have periodontal disease and need treatment. However, you are not alone.
Periodontal disease is very common. Studies from the CDC (Center for Disease Control), ADA (American Dental Association) and the AAP (American Academy of Periodontolgy) reveal that 47.2 percent of American adults have some form of periodontal disease. The percentage rises to an astonishing 70.1 percent in adults 65 years of age and older. One out of two adults have some form of periodontal disease. A large percentage of these people go undiagnosed or untreated.
What is Periodontal Disease?
Periodontal disease, also known as “gum disease” or Periodontitis, is a bacterial infection of the gum and bone that support the teeth. This bacterial infection then causes a chronic inflammatory process which destroys those supporting structures. This chronic inflammation leads to swollen and bleeding gums, bone loss, and eventual tooth loss.
Stages of Periodontal Disease
What causes Periodontal Disease?
Periodontal Disease is initially caused by plaque, a sticky film of bacteria that forms on teeth. If it is not removed, it will cause gum inflammation. These inflamed/swollen gums can pull away from teeth, causing pockets to form, which then trap more plaque and worsen the process. If the pockets are not treated, periodontal disease will progress. Once the tartar has built up below the gums, it becomes a source for billions of bacteria to live and release toxins. Your immune system reacts to this by destroying, to the best of its ability, the bacteria. However, bone and gum tissue is destroyed as well in the process. Additonally, many other systemic diseases are linked to Periodontal Disease, read our blog on this relationship
Here you can see how plaque and calculus below the gum can lead to inflammation and a deepening pocket.
How is Periodontal Disease diagnosed?
Periodontal disease is routinely diagnosed during a periodontal evaluation during your regular dental exam. The dentist or dental hygienist uses a periodontal probe (tiny ruler) to gently measure the pocket between the teeth and gums. In a healthy mouth, this measurement is less than 3 mm. A deeper pocket (more than 3 mm) is a sign of Periodontal Disease. Additionally, we can detect bone loss on routine dental x-rays.
This shows the diagnosis of Periodontal Disease by probing the pocket depths, from healthy, mild, moderate, and severe periodontitis
How do you treat Periodontal Disease?
Treating Periodontal Disease requires removing the source of irritation and bacteria from below the gum line. Just as a wound on your body would not heal if it has a foreign object lodged in it, your gums and bone will not heal as long as the source of irritation remains below the gums. Treatment depends on how severe the disease, but the first step in most cases is usually a “deep cleaning.” The technical name for this procedure is termed periodontal scaling and root planing. The goal of a deep cleaning is to remove the plaque and tartar at the bottom of each pocket. I will explain this treatment and what to expect:
- Your treatment will be divided into two appointments to allow time for thorough treatment. Each appointment will be about an hour and thirty minutes.
- You will be receive anesthetic on one side of your mouth (upper and lower teeth), which involves numbing the area with small injections.
- Your hygienist will use specialized manual (hand-scale) and ultrasonic instruments (uses water and vibrations) to clean above and below the gum line to remove any tartar deposits. These instruments also significantly reduce the bacterial population below the gum line.
- The root surfaces are also “planed” or smoothed to allow the gum tissue to heal and reattach to the teeth.
To further reduce the bacterial population and promote healing in the tissues we will also perform a painless laser procedure (Laser Assisted Perio Therapy) below the gum line.
- You will then be given specific oral hygiene instructions and following these is paramount to the success of your treatment.
Before and After Deep Cleaning
What is Periodontal Maintenance?
The next step after completion of both of your periodontal cleaning appointments is to follow up in three months for a periodontal maintenance cleaning. At that time you will receive another cleaning to maintain the results of your periodontal scaling and root planing. Measurements will be taken of your gums to determine your progress. Laser may also be used at this appointment for any residual inflammation. You will not need to be numb for this cleaning, generally the tissues are much less inflamed and there are no hard deposits (tartar) below the gum line. We will keep you on a 3 month interval for cleanings until all of the inflammation has resolved and other clinical signs of progressing gum disease are absent. Being compliant with your oral hygiene recommendations at home on a daily basis is crucial to the success of your treatment. Since this disease is bacterial in nature, thorough daily plaque removal and use of the recommended oral rinse is necessary to control the disease. Periodontal disease bacteria can never fully be eradicated once they are present in your oral environment. However, the level of them can be controlled and the destruction to your tissues is directly related to the population of these bacteria.
This is only a very brief description of the importance of periodontal health and the methods to obtain it. For further information please feel free to ask your hygienist!
Blog written by Melissa G. Hedges, R.D.H.