Periodontal disease is an inflammatory disease of the tissues around the teeth, which gradually destroys the support of your natural teeth. The primary cause of this infection is certain types of bacteria found in dental plaque. These specific bacteria produce toxins, which irritate the gums, resulting in inflammation, which is seen as red, swollen, tender and/or bleeding gums. If this irritation remains unaddressed, it can lead to a worsening of the problems with the gums separating from the teeth and the formation of deep pockets. Deep pockets often indicate the loss of the bone supporting your teeth. Thus, as periodontal disease progresses, the supporting gum tissue and bone that holds teeth in place, deteriorates. If left untreated, this leads to receded gums, loose or drifting teeth and even tooth loss.
Before treatment begins, time is spent gathering information on your condition, its history, and the effect it has had on your quality of life. This information gathering is completed at the initial visit appointment. During the appointment we are able to ascertain a diagnosis and cause for your problems. Subsequently, a treatment plan can be developed that will address your periodontal condition while also considering your personal desires or concerns.
Most periodontal treatment plans can be divided into phases: hygienic phase, surgical phase and maintenance phase. The first phase, hygienic phase, comprises of a thorough scaling and root planing of the teeth to clean off the tartar or calculus (hard mineral deposits on the roots) and plaque (soft deposits comprised of the harmful bacterial colonies). For your comfort, you can have local anaesthetic to ‘numb’ the gums. We will also instruct and review your oral hygiene or home mouth-care.
The hygienic phase aims to significantly reduce the amount of bacteria and hard deposits on your teeth. Doing so should reduce the inflammation of your gums. The results of this therapy are evaluated a few weeks later at the re- evaluation appointment. This second evaluation (the first being the initial visit) not only allows the doctor to evaluate how your gums have healed after the scaling appointments, but it also allows us to review your home mouth-care. It is also at this appointment that we assess the next phases in your periodontal rehabilitation. The final two phases of a treatment plan are the surgical phase and the maintenance phase. These phases are used to support the results achieved in the hygienic phase. After scaling and root planing, many patients do not require any surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain periodontal health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgical therapy may be utilized to restore periodontal anatomy damaged by periodontal diseases and to make oral hygiene practices easier.
Surgery may be useful if deep pockets persist after the initial, thorough scaling appointments. When deep pockets between the teeth and gums are present, it is difficult to thoroughly remove plaque and tartar. Despite your best efforts and those of the hygienist it is difficult to get these pockets clean and free of the harmful bacterial colonies that result in periodontal disease. Even if most of the bacteria is cleaned off, these deep pockets are a niche or environment that is favourable to harmful bacteria, thus, soon after a cleaning or scaling appointment, the bacteria grow back.
To interrupt this cycle of scaling followed by re-growth of bacteria then scaling and so forth, a surgical phase may be indicated. The primary purpose of surgery is pocket depth reduction. By reducing or eliminating the deep pockets three main objectives are achieved: the niche or environment favoured by harmful bacteria is eliminated, the resulting shallow pockets are easier for the hygienist to scale and the shallow pockets are more easily kept clean by good home-care.
The final and some say, most critical phase, is the maintenance phase. It is comprised of regular scaling visits at a regular interval, customized to your specific disease process. The time between visits can be 3, 4, 6 or 12 months and is decided after we have determined how far you have come since the initial visit and how many cleaning visits would be required yearly to maintain or improve upon the results achieved thus far. At these visits we will evaluate your oral hygiene, re-assess your inflammation and pocket depths, complete a deep scaling (with local anaesthetic if necessary) and discuss your periodontal condition with you. Maintaining these regular appointments is critical to your long-term periodontal health.
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