I regularly get questions from patients about the different types of “cleaning” they may need. To answer those questions we’ve put together basic descriptions of both gum disease and the periodontal treatments that we recommend for each stage. You’ll be seeing more detailed articles on gum disease and how to prevent it in future blogs and newsletters.
Treatment for Prophylaxis Type 0
This is what we consider prophy – a “cleaning” – which is appropriate treatment for essentially healthy gums and bone. This is for patients who are regularly and effectively removing plaque, the sticky colorless deposit of bacteria that is constantly forming on the surface of teeth, before it can build up and become tartar, a hard deposit that bonds to teeth stubbornly, and can only be removed by a dental professional. These patients will have gums that are pinkish in color and tight against teeth and bone – no bleeding, loosening or pockets over 3mm. The hygiene treatment is preventative in nature and focuses above the gum-line. It will include scaling or smoothing and polishing your teeth to remove plaque, calculus and staining. It will be minimally invasive and relatively painless. Anything more involved than this is no longer a “cleaning”.
Treatment: Every six months
Gum disease begins when, for various reasons, (medication, smoking, genetics, fudging on your home-care, etc.) brushing and flossing are just not effective at removing plaque. As it builds, plaque produces toxins that irritate gum tissue, causing gingivitis. With gingivitis, plaque and tartar build up above and below the gum line. Your gums can be red and puffy, and may bleed when you brush or floss. Fortunately, at this level of disease, the bone and fibers holding your teeth in place have not yet been affected. With treatment, gingivitis can be reversed. At this level, you may have inflammation and minor gum pocketing due to the puffiness of the tissues. Plaque/bacteria elimination may be more complex than for a healthy-mouth cleaning. This procedure includes debridement of bacteria, smoothing of tooth surface and irrigation to clear the mouth of infection.
Treatment: Every six months
Treatment for Gum Disease Types 1 – 4
Periodontal disease is a four-stage, progressive bacterial infection that in its end-phase destroys the fibrous tissue and supporting bone that actually hold teeth in the mouth. Approximately 15 % of adults between 21-50 and 30% of adults over 50 have some stage of this disease. With the presence of gum disease, periodontal treatment becomes complicated – more, sometimes much more than just a “cleaning”.
Type 1-2: Periodontal Disease: Early to Moderate Periodontitis
With this level of periodontal disease, plaque has spread to the roots of your teeth. Infection has begun to damage supporting bone and fibers that hold your teeth in place. Gums may have begun to pull away from your teeth, forming pockets below the gum line that trap food and more bacteria (up to 4-5 mm deep pockets). Plaque hardens and multiplies. Our in-office treatment becomes disease treatment, no longer aimed solely at prevention, and will be significantly more complex. It will include irrigation to disinfect and to clear debris and plaque from shallow pockets.
Treatment: Every three to six months
Type 3: Periodontal Disease: Severe Periodontitis
Chronic periodontitis can lead to the loss of tissue and bone that support the teeth and it may become more severe over time. If it does, your teeth will feel loose and start moving around in your mouth. This is the most common form of periodontitis in adults but can occur at any age. It usually gets worse slowly, but there can be periods of rapid progression. Fortunately – even at this stage – immediate treatment can often stop further damage and prevent tooth loss.
Treatment: Multiple visits initially, followed by three-month visits thereafter
Type 4: Final Stage Gum Disease: Advanced Periodontitis
Aggressive periodontitis is a highly destructive form of periodontal disease that occurs in patients who appear healthy otherwise. Common features include rapid loss of tissue and bone and may occur in some areas of the mouth, or in the entire mouth. Research between systemic diseases and periodontal diseases is ongoing. While a link is not conclusive, some studies indicate that severe gum disease may be associated with several other health conditions such as diabetes, heart disease, auto-immune disease or stroke.
In this final stage of gum disease, the fibers and bone supporting your teeth are destroyed, which can cause your teeth to shift or loosen. This can affect your bite and, if aggressive treatment can’t save them, teeth may need to be removed. Prophylaxis will now include root planning, a scaling procedure used both above and below the gum-line to remove plaque, bonded calculus and stain. Root planing helps to smooth irregularities on the roots of the teeth making it more difficult for plaque to deposit there. Localized or systemic antibiotics may also be used at this stage to crush infection. This is active disease therapy. Periodontal scaling at this level requires surgical skill, care and judgment.
Treatment: Often the only treatment option is tooth removal
Advanced Periodontitis is a chronic disease that requires a life-long battle to control. Follow-up maintenance visits are the most important tool in controlling the disease, and in ensuring long term retention of teeth. Perio-maintenance visits are generally recommended at three-to-four month intervals. Maintenance includes removal of bacteria from pockets, root planing and polishing of the teeth, periodontal evaluation and review of patient’s home care, diet and current health.
Regular periodontal charting – examining and measuring the condition of gums – is an excellent tool for maintaining the health of your teeth and gums. Charting gives us an accurate diagnosis of gum health at every stage. Often it enables us (and you) to catch and reverse early stage problems. With aggressive treatment and home care periodontitis can often be controlled. However, prevention is far and away the best – and least expensive – medicine of all for gum disease.