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Periodontal Dentistry

Periodontal Maintenance is an important consideration for future gum health

Individuals with periodontal (gum) problems, current disease, or a history of previous disease require special attention and care in the form of periodontal maintenance.  Once gum issues have started in an individual, he/she will be prone to relapsing back into a state of active gum disease for the remainder of his/her life.

Because of this, we will often suggest that patients with gum issues maintain their periodontal health with more frequent and gum focused cleanings.  These cleanings are called Periodontal Maintenance cleanings and differ from a ‘regular’ cleaning in that they have an additional focus on evaluating the gum and bone health for changes. They involve cleaning the deep pocketing around teeth that patients with gum disease typically have. Depending on the individual, we will typically do Periodontal Maintenance cleanings on a 3 or 4 month basis versus the typical 6 month cleaning interval.

It is important to keep the teeth in a patient with gum disease extremely clean, because periodontal disease is caused by the body’s inflammatory response to tartar (calculus) buildup and bacteria on the teeth.  This calculus can be caused by dental neglect, or an individual might simply deposit calculus at an accelerated rate.  Some health factors, like diabetes and other conditions that interfere with the body’s defenses, cause an individual to be more prone to this inflammatory gum disease response, and family history can play an important role.

Gum disease does not just affect the tissues that hold in the teeth — it also affects the rest of the body.  Periodontal disease has been linked to many health conditions outside of the mouth such as heart disease.  It is therefore important to treat gum disease not just to keep the mouth healthy but the entire body.

Periodontal Disease Transcription

“Hi, my name is Dr. Andy Carmosino, and I’m the periodontist here at Madison Family Dental.

A periodontist is a dental specialist who is charged with evaluating and treating people that may have gum disease. And many people aren’t aware of this, but gum disease is a chronic inflammatory condition that a lot of adult patients in the US presently have, and this is something that can oftentimes go untreated because people aren’t aware that they have a problem.

Just like diabetes or blood pressure problems, oftentimes this is a silent disease. Some symptoms that patients may notice are bleeding gums, gum tissue that’s puffy, oftentimes you can have loose teeth or bad breath — these are things that may be present, but not necessarily all the time.
We’re able to do a comprehensive exam of a patient’s gum health, and this helps us determine whether or not there’s disease, and how severe it is, and what type of treatment may be necessary.

Most people that have gum disease don’t end up losing teeth due to gum disease, but not only do we want everyone to keep their teeth — we also want their mouth to be healthy, because we know from many studies the last couple decades that the health of our mouth does influence the health of our heart, and it does affect things like diabetes, so these are things that, like we said, not only do we want people to have a good smile and be able to chew properly, but we want their mouth to be healthy.

So when we’re talking about the treatment of gum disease, oftentimes our first plan of attack is to really do a deeper, more thorough cleaning. This is done comfortably by numbing the gum tissue and the hygienist or the periodontist will clean below the gum line to remove the plaque and the calcified tartar on the roots. We would re-evaluate following this to make sure that things are getting healthier. For the majority of patients, this is the only treatment that’s necessary in addition to very good home care with the specialized instructions that we would be giving you, and then probably a shorter interval for your cleaning — maybe every three to four months instead of six months. This is very important because it not only allows us to clean your teeth more frequently, but also to carefully monitor for changes that might happen.

In addition to this, there are situations where people might have cosmetic concerns from some of the damage that’s caused by gum disease, whether it be recession of the teeth or spacing, so these are procedures that can electively be done to cover root surface by doing something like a gum graft to improve a person’s smile and also improve the health of the area.”

Patient Annual Comprehensive Periodontal Evaluations are routine at Madison Family Dental, whether you are at a high risk or a low risk for periodontal disease

One out of every two American adults aged 30 and over has periodontal disease, according to recent findings from the Centers for Disease Control and Prevention (CDC).  The recent research has indicated the prevalence of periodontal disease in the US may be significantly higher than originally estimated.  This means that all adults should thoroughly assess the state of their gums to receive accurate information about the health of their mouths.

Periodontal disease is a chronic inflammatory disease that affects the gum tissue and bone supporting the teeth.  If left untreated, it can lead to tooth loss.  Research has shown that periodontal disease is associated with other chronic inflammatory diseases, such as diabetes and cardiovascular disease.  It is therefore very important to treat the inflammation that causes periodontal disease as soon as possible to ensure that your entire body stays healthy.

Periodontal disease is thought to be one of the most prevalent non-communicable chronic diseases in our population. A dental profession should examine each tooth above and below the gum line, and a visual examination alone is not enough. The American Academy of Periodontology recommends that every patient receive a comprehensive periodontal evaluation on an annual basis.

A Comprehensive Periodontal Evaluation is way to assess your periodontal health by examining:

  • Your teeth
  • Your plaque
  • Your gums
  • Your bite
  • Your bone structure
  • Your risk factors

What measurements are taken during a Periodontal Evaluation?

The periodontal exam and probing include taking measurements of the spaces between your teeth and gums.  This space is known as the sulcus.  When the gums are healthy, the sulcus is usually about 3 millimeters deep.  Healthy gums cling tightly to the tooth.  Diseased gums tend to swell and detach from the tooth.  In advanced forms of periodontitis, the pocket can be more than 10 millimeters deep.

Taking the measurements once a year at your dental visit helps your dentist track the progress of treatment.  A common treatment for periodontal disease is scaling and root planing.

Commonly Asked Questions About Periodontal Maintenance

I have heard there is a connection between gum disease and heart disease. Is this true? Where can I find more information?

There is plenty of research that indicates a connection between periodontal disease and heart disease. There are links being studied between gum disease and other diseases such as obesity and stroke. Additionally, women who have gum disease are more susceptible to having a low birth weight baby.
The American Dental Association’s patient website, has some great resources to view. If you prefer to read peer-reviewed scientific research, here’s a good review article in the Journal of the American Dental Association.

Both of my parents have periodontal disease, and I’m worried that it may be genetic. Is there a way to determine my risk for developing gum disease?

There are some genetic links to gum disease in addition to a bacterial link. Some studies indicate that up to 30% of the population has some genetic risk of periodontal disease. In addition to genetic susceptibility, we also get a significant portion of the bacteria in that naturally live in our mouth and digestive tract from our parents. The particular spectrum of bacteria that we get in our mouth can greatly affect our susceptibility to periodontal disease in addition to genetics.

Nothing hurts so do I really have a problem?

Unfortunately, periodontal disease, like many other serious diseases such as diabetes, high blood pressure, and heart disease, has symptoms that often only become apparent after much damage is done. The fact that symptoms are often not obvious is why we take annual measurements of your gum tissue and record bleeding so we can closely monitor changes and treat areas early in the disease process.

What can I do at home to prevent periodontal disease?

There are two big things you can do to best improve periodontal health. The first is what you do at home every day: brushing, flossing and other forms of interproximal (between the teeth) cleaning such as the use of soft picks and proxy brushes. The second most important thing you can do is to have more frequent teeth cleaning intervals. It is critical to remove the bacterial plaque from your teeth every day to prevent the bacteria from organizing and forming colonies that secrete toxins that destroy your gums and the bone supporting your teeth. By coming in for more frequent teeth cleanings we are insuring that the bacterial cycle is interrupted and areas that are not accessible to your typical cleaning aids get flushed out. We are also able to keep close track of any areas that are not responding.

  • thoroughly brush your teeth twice a day
  • clean between your teeth with floss or another interdental cleaner once every day
  • visit your dentist for a checkup and professional Periodontal Maintenance cleaning regularly
  • If you smoke or chew tobacco, stop. Tobacco use greatly increases the risk of developing periodontal disease.
  • eat a healthy balanced diet

Other than diagnose and treat gum disease, what else have periodontists been trained to do?

Periodontists are dentists who have additional residency training in all things related to gum health. This can also involve treating defects in healthy gums, cosmetic gum issues, gum infections, medical complications that result in gum problems, placing implants into bone to replace teeth, and managing growths and sores on the tissues of the mouth.

Why do I need a periodontal maintenance cleaning?

Your toothbrush can only reach 2-3 millimeters below the gum tissue to effectively clean it out. Virtually all patients on periodontal maintenance have pockets over 3 millimeters. A pocket over 3 millimeters needs the help of our instruments to remove bacteria. This process requires specific skills and extra time beyond what a normal teeth cleaning requires.

What will happen if I don’t have more frequent teeth cleaning appointments?

If the bacterial plaque is not controlled and is allowed to colonize and multiply, there will be an increase in gum irritation and the potential for hard deposits (calculus/tarter) to form. Once the plaque forms a sticky biofilm or hardens into calculus it is difficult to have effective homecare, which leads to increased bleeding and pocket depths, which leads to poor oral hygiene, which leads to more plaque, and so on — a vicious cycle begins.

In addition, extra time is spent on education and proper home oral hygiene technique. With good oral hygiene at home and a 3-4 month periodontal maintenance schedule, the bacteria can be controlled and the cycle can be broken.

Can children be at risk for developing periodontal disease?

Children can get generalized gum disease. Gingivitis, the beginning stages of gum disease, is very common in kids and can be characterized by red, puffy gums. The best way to prevent gingivitis in kids is to be sure they are doing a good job brushing twice a day and flossing once a day. There are also specific forms of juvenile periodontal disease that children and teens are susceptible to. Kids with underlying medical issues, such as diabetes or Down syndrome, can be more prone to periodontal disease.

What is the difference between plaque and calculus?

Plaque is a sticky film that is always forming on the teeth. There are bacteria in plaque that secrete toxins that can irritate the gums. Plaque can be cleaned off with a toothbrush but hardens into a rough substance called calculus (tartar) if not cared for. Because it is harder than plaque, tartar can only be cleaned off with special instruments or sonic cleaners at the dental office.

Is a topical antibiotic treatment necessary in conjunction to scaling and root planing?

Scaling and root planning is the deep cleaning that is used to treat gum disease. This is how we remove the calculus and bacteria that cause gum disease. Because bacteria are involved in periodontal disease, antibiotic treatment can sometimes assist in treatment. Your dentist or periodontist will let you know if you would benefit from the use of antibiotics for your condition.

Is periodontal disease treatable?

Periodontal disease is treatable, but the condition can do lasting damage to the gums and bone in the mouth which can sometimes result in tooth loss despite treatment. It is always best to catch periodontal disease or any changes in gum health early.

What products or procedures will help my periodontal condition?

1. Toothbrush — we recommend an electric toothbrush if at all possible. The brand we carry is Oral B, but there are other acceptable options available. The brush should ideally have a two-minute timer and we recommend a minimum of two minutes of twice daily brushing.

2. Flossing — see-saw the floss to get it between the teeth; try not to snap the floss through the contact point. Wrap the floss around the tooth (like you are hugging the tooth) and then take the floss up and down. You need to go down until you feel the resistance of the gums. We recommend a waxed flossor dental tape . The “glide” type of floss (very thin floss) does not have enough surface area and is too slippery to clean effectively. Flossing should ideally be done once daily. Flossing is a difficult habit for most people to establish. Try committing to at least 2-3 times per week and work form there. We recommend finding a specific time to work the flossing into your routine — if you like to watch the news at night in your favorite chair, put the floss on your table next to the remote. Some people find that putting the floss in the shower works well into their routine. Find something that you can be consistent with.

3. Other interproximal tools — we highly encourage the use of soft picks or a proxy-brush to aid in cleaning between the teeth. We find that our patients who do a combination of flossing and soft picks/proxy-brush have a greater level of oral hygiene than flossing alone.

4. Water picks — we consider water picks an additional adjunct that can be beneficial, but they should never be considered a substitute for flossing and other interproximal cleaning tools. The water pick is like trying to wash your car with just a stream of water: the water is sprayed on the surface but there is still a film of dirt on the car. Plaque/bacteria is like the film on the car because the sticky biofilm needs to be physically rubbed off the surface of the tooth.

Will my insurance cover my periodontal treatment?

Everyone’s insurance plan is different in what it does and does not cover. It is best to consult your particular insurance plan’s explanation of benefits or contact your insurance carrier about your particular coverage.

Will I need surgery?

Conservative treatment options will always be considered first, but sometimes gum surgery is necessary, especially in more advanced stages of the disease. This is why it is best to prevent and treat the disease in earlier stages to avoid reaching the point of surgical treatment.

Here’s what one can expect from Periodontal Surgery.

If you have been referred to a periodontist to undergo some surgery, here’s what you can expect from that surgery.

Periodontal Pre-operative Care > Periodontal Surgery

Prior to surgery day:

  • If the procedure was to be preauthorized and you haven’t received any information from us or the insurance company after four to six weeks, please call our business office at (608) 274-5970.
  • If there is partial insurance coverage or no coverage, please be prepared to make payment the day of the surgery.
  • If you need to cancel, please do so seven days in advance.
  • We have a CD headset, so feel free to bring a CD to listen to during surgery.

Day of surgery:

  • Please eat as you normally would. You will not be put to sleep. We use a local anesthetic. If you will be using nitrous (a gas to help you relax) in conjunction with the anesthetic, eat at least one to two hours before the procedure. Do not overeat.
  • Wear comfortable clothing. We will be taking your blood pressure, so please wear a shirt that offers easy access to your arm.
  • Be prepared to update us of any medication or medical changes that have occurred. Herbal remedies should also be shared. If you are pregnant, please contact us so we can plan accordingly.
  • If a bone graft was mentioned as a possibility, be prepared to decide which type you wish to use: freeze-dried human donated material or synthetic man-made material. We have information on both. You may have already received pamphlets, and the differences between the two types can be discussed on the day of the procedure.
  • Be prepared to take the rest of the day off after the procedure. We recommend light or no physical activities the day of the surgery. You should be able to return to work the next day. Use your best judgment on physical activities.

After surgery:

  • We will see you about one week after the procedure to remove any remaining sutures and check on tissue healing.
  • There will be no charge for follow-up visits for up to three months, so we may continue checking on the healing process. After the three months there will be a re-check fee.

Periodontal Post-operative Care > Periodontal Surgery

The operation that has been performed on your gums will help you keep your teeth. Please read these instructions carefully.

  • When the anesthetic wears off, you may have slight discomfort. Before the anesthetic wears off, it is advisable for you to take a mild analgesic, like Tylenol or ibuprofen, for discomfort.
  • Follow a soft dietary regimen for the first week post-surgery. Sticky, harsh, hard, brittle, crumbly, spicy, or highly-seasoned foods should be avoided. The diet should be nutritive and bland. It is advisable to do most of your chewing in an area of the mouth that did not have surgery. The surgical area may be covered with a pink dressing. If it falls out, just throw it away. We will remove whatever is left when you return in a week.
  • Oral hygiene measures should be maintained in the non-operated areas of your mouth. Do not try to use a toothbrush or floss in the area where the surgery was performed.
  • Starting the night of your surgery, you may rinse. Slight bleeding or oozing is not unusual and will correct itself. If bleeding is persistent, please call the office. Do not try to stop the bleeding by rinsing. Bleeding may be controlled by taking a piece of damp gauze, holding it in the thumb and index finger, and applying firm pressure to both sides of the area. Hold it in place with pressure for twenty minutes.
  • Immediately following the procedure, apply ice wrapped in a towel on the outside of the face over the affected area. Use fifteen-minutes-on then fifteen-minutes-off to help prevent development of excessive swelling and discomfort. This should be continued for a minimum of two hours.
  • No smoking or drinking through a straw. Smoking delays healing, and smoking or drinking through a straw creates suction which promotes bleeding. The longer you refrain from smoking post-surgery, the better for the healing response.
  • Relax. Healing after periodontal surgery is usually uneventful.
  • Please call the office with any questions or concerns. We are here to help you.

Periodontal Post-operative Care > Soft Tissue Grafts

  • The donor site, or palate where the graft was taken, may be uncomfortable but will heal over time. We have placed a perio packing over the wound to help protect it. This packing may fall off on the day of the surgery or several days after. Do not be concerned about this. If the donor site is sore after the packing has come off, use the topical we gave you to help with any discomfort you may have.
  • The graft site will also have a packing to help protect the graft and remind you to stay away from the area. We would like this packing to stay in place until you come in for the post-op. If it falls out before that appointment, call our office in case we want to replace it.
  • Try to be gentle with the graft area when washing your face or shaving. Please check with us first before playing sports or wind instruments.
  • If the graft was placed in the front area of your mouth, do not bite into foods. Use a fork and knife and cut your food up into reasonably-sized pieces. Smaller bites will make it easier to chew.
  • Unless a prescription rinse is advised, you may use a warm salt water rinse: one teaspoon table salt added to eight ounces of warm water. Rinsing should be done gently so as not to dislodge the packing.
  • Most importantly, leave the graft area alone. Do not pull at the lip or cheek to check the graft, as this may disrupt the blood supply and interfere with the graft taking.
  • Some of the sutures (stitches) we used are dissolvable. You may notice some coming undone. Do not worry about this.

Please request an appointment online for a dental treatment consultation with one of our dental professionals.




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