There are a number of options for treating periodontal disease, (gum disease, pyorrhea) depending on the severity and type of the problem. Some of them are mentioned below.
ORAL HYGIENE INSTRUCTIONS: There is no treatment that we can perform that will compensate for poor home care by the patient. Our video shows the patient how to clean more effectively and safely. We will give you personal instruction on how to best clean your teeth and gums if requested.
ROOT PLANNING: Also known as deep cleaning or "non-surgical periodontics" is aimed at removing toxic buildup on the tooth root. Removal of this hard buildup, also called calculus or "tartar" helps make soft tissue around the teeth less tender and bleed less. This procedure (performed in 2-4 appointments) helps shrink the gum tissue so that pocket depths are reduced. We have altered and improved our techniques and procedures to reduce the pain associated with non-surgical periodontal therapy.
BACTERIAL CULTURE: If we suspect that a patient has more aggressive and destructive kinds of bacteria than usual, we will send a sample to a lab for analysis. If pathogenic bacteria are present, we may need to put you on antibiotics in an attempt to eliminate them. However, the mouth cannot be sterilized and antibiotics are not a cure-all for periodontal disease or pyorrhea.
BITE ADJUSTMENT: The pressure exerted when the teeth bite down is about 200 to 500 lbs/square inch. If all of the teeth are hitting this force would be spread out and would be tolerable. If only one or two teeth are hitting, this would be concentrated in a small area and would be enormous. If an area 1/10 of an inch square is hitting, the force would be equivalent to 20,000lbs/square inch; much like comparison of the force of a woman standing on your foot with flat shoes versus spike heels. The occlusal (bite) adjustment, also called "equilibration" assures that the biting forces are spread out as much as possible (equalizing forces on the teeth), minimizing or eliminating excessive pressure on the bone.
We estimate that the auto pictured hit with about 90lbs/sq inch of force. This is much less then "normal" occlusal forces. If someone is clenching or grinding the force on the teeth can be 1000lbs/sq inch (psi) or even as much as 1500lbs/sq inch.
Bite adjustment (occlusal equilibration) is controversial. Some dentists feel that it is not important. One of the country's most respected dental lecturers, Gordon K. Christensen, DDS, MSD, PhD wrote in the april, 2005 issue of JADA (Journal of the American Dental Association) "...treatment of occlusal conditions is the most neglected area of dentistry.." He said the most frequent symptoms "will be pain in the affected tooth..and eventual ...death [of the] tooth if the occlusal trauma is allowed to continue." If high spots on the teeth "have existed for months or years, the bone will be reduced..." (Dead teeth usually abscess, requiring an extraction or root canal therapy)
BITE GUARD: Many patients report considerable improvement or even stopping of a clenching or grinding habit following a bite adjustment in our office. However, if someone persists in having trouble controlling a grinding or clenching habit, we may recommend a bite guard to help protect teeth and bone. Grinding pressure on the teeth has been reported to be a thousand pounds or more. Researchers have found contact stress to reach a maximum of 1,650lbs/sq inch in the jaw joint. In comparison scrap metal and junk auto balers exert about 2500lbs/sq inch. We usually prefer hard acrylic bite guards that help loosen and relax tense facial muscles.
SOFT TISSUE MANAGEMENT: Some patients, because of fear of severe medical problems, are prevented from having definitive treatment performed when required, namely pocket elimination surgery. In this case, regular deep cleanings, bacterial cultures and other procedures may need to be performed in order to slow the advance of the disease.
RE-EVALUATION: This is a pre-probing to determine pocket shrinkage, reduction in mobility of the teeth and re-growth of the bone, if any. At this time, we would determine and discuss what additional treatment is necessary.
PERIDONTAL SURGERY: If "non-surgical" treatment has not resulted in sufficient shrinkage of the soft tissue pockets around the teeth, surgical removal of sick tissue under the skin may be needed to eliminate the pockets around the teeth, surgical removal of sick tissue under the skin may be needed to eliminate the pockets. Other forms of therapy such as bone grafting may also be necessary.
Some other frequent surgical procedures are:
Crown Lengthening: Sometimes a tooth is damaged or broken so that there is not enough tooth sticking out above the gums to put a cap or crown on. In that case we need to remove a small amount of bone so that your dentist has enough tooth to do an adequate restoration. Some people have very short teeth. The appearance of the teeth can be significantly improved by increasing the height or length of the tooth above the gum.
Soft Tissue Grafts: Sometimes people inadvertently cut off some of the firm gum right around the base of a tooth. If there is not enough firm or "hard" gum, the force of food hitting the gum can push it away. This makes the tooth look longer and weakens the tooth. Usually, gum can be added to repair the defect. In our office, this procedure is usually not very painful. Most patients do well with just over the counter pain medications.
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