Periodontal Maintenance

Periodontal maintenance can be defined as any step you take to prevent the onset or recurrence of periodontal disease. Periodontal maintenance is essential in keeping your gums and teeth healthy and strong, and luckily, most of it can be done in the comfort of your own home.

By brushing and flossing your teeth regularly, you can prevent plaque and tartar from building up on your teeth above and below the gum line. If you do this consistently, you can prevent periodontal diseases such as gingivitis and periodontitis from occurring or coming back.

However, some diseases, such as diabetes, may make you up to 30% more disposed to the onset of periodontal disease than normal, regardless of aggressive dental hygiene. In these cases, our highly experienced family dentists can work with you and similar patients in the Lansing area to ensure you are getting as much care as necessary to keep gum disease and serious infection at bay.

What is Periodontal Maintenance?

A periodontal maintenance appointment is a cleaning that immediately follows a scale and root planing or "Deep Cleaning". In this appointment tartar and calculus are removed from both above and below the gum line. Your dental hygienist will also deep-clean specific areas, and polish your teeth.

At the end of your cleaning, an antibacterial agent will be used to flush out your periodontal pockets. Your dentist will then determine the frequency of your cleanings, usually every three or four months.

Periodontal Disease and Your Systemic Health

Periodontal disease poses a serious threat to your over all health! Research is linking periodontal disease with many health conditions such as:

• Diabetes
• Heart Attack
• Stroke
• Cardiovascular disease
• Pre-term, low birth weight babies

Further research is currently underway to determine the exact relationships between bacteria and these conditions.

How is Periodontal Maintenance different from Regular Cleaning?

A regular cleaning (prophylaxis) is exclusively for those with healthy teeth and gums, and is simply a preventative measure. Regular cleaning involves cleaning and polishing the teeth both above and below the gum line, as does periodontal maintenance, but is preventative, and not meant to treat or manage any gum disease Regular cleaning appointments are usually set on a six-month schedule.

In periodontal maintenance cleaning, a greater amount of bacteria removal is necessary, because it is only done when a person has gum disease or has in the past been diagnosed with it. This type of cleaning is recommended every three or four months.

Periodontal disease damages the supporting structures of the teeth, making the pockets deeper. These increased depths accommodate more bacteria and debris, and your dental hygienist will take great care to clean each pocket thoroughly:

• By cleaning primarily beneath the gum line
• By placing an antibacterial agent into the pockets to help decrease bacteria.

How is periodontal disease treated?

Periodontal disease is classified according to bone loss severity.

The picture above shows the progression of bone loss in periodontal disease. The gray areas indicate gum tissue. The spongy area within the soft tissue is the bone. The black areas are bacteria and tartar/calculus built up below the gum line, which become chronically irritating for the gums.

Periodontal disease is diagnosed through:

• An oral examination - visual inspection, and a pocket depth probing procedure that allows the dentist to examine and record the depth of each pocket surrounding the tooth
• X-rays - to determine the exact location of bone support around each tooth.

Using these two techniques, your dentist will classify your dental condition into a category, and determine the best course of long term treatment.

Full-mouth debridement cleaning

On occasion, an individual may have so much gross debris that the dentist can do neither an oral evaluation nor a normal cleaning. The person will require a Full Mouth Debridement cleaning to remove all the plaque and calculus above the gum line. Usually the oral evaluation will be postponed until the next cleaning, when any diagnosis of health will be more accurate.

Scaling and root planing - deep cleaning

A scale and root planing appointment is usually postponed until the oral examination, x-rays, and full mouth debridement cleaning have been done. If the oral examination has found 4-5 mm pocket depth and the x-rays have determined that the bone support of the teeth has been undermined, then a deep cleaning (scaling and root planning) is indicated. It usually takes two to four visits.

Scaling and root planing requires a local anesthetic to guarantee complete comfort. The gums will probably bleed because this is a probing procedure which cleans and smoothes the roots of each tooth.

It is always followed by a one month health check where the pockets are re-measured and any areas that have not healed thoroughly are re-scaled.

Periodontal maintenance

Once a patient has completely finished their scale and root planing appointments, and periodontal disease has been stabilized; periodontal maintenance will begin. This type of cleaning is done three or four times per year and differs from a normal prophylaxis because of the greater area of exposed root surfaces and increased pocket depths.

Before scaling 1

Periodontal disease is the body's response to a chronic bacterial attack against the gums and bone support of the mouth. Typically antibiotics and drastic cleaning techniques improve the healing and overall long term health of the individual.

Before scaling 2

 

Periodontal disease: Type I (gingivitis)

This first stage of periodontal disease is the easiest to reverse. The increased pocket depths (pseudo pockets) mainly result from gum inflammation and there is no bone loss yet. The treatment for this stage is a full mouth debridement, which allows the gingival inflammation to subside. It must be followed up by proper oral hygiene habits. If proper habits are observed this condition will not return, and the mouth will return to optimal health.

Periodontal disease: Type II

In this stage of periodontal disease there has been some bone loss. The pockets have become deeper, ranging from 4-7mm, and there is gingival inflammation. At first, this condition is treated with scaling and root planing to help reduce the gingival inflammation. Because bone loss has already occurred, the pockets will not completely return to normal depths.

At this point, regular cleanings should be done, and good oral hygiene habits maintained, including such tools as water picks, rubber tip stimulators, sonic toothbrushes, and proxa brushes.

Periodontal disease: type III (severe)

Type 3 periodontal disease is also treated with scaling and root planing in the beginning. This condition not only involves the soft tissue pocketing, but also bone pocketing (Infrabony Pocketing). The most problematic characteristic of this advanced disease is that the teeth are located in the wells of the bone, which offers little to no support. Gum disease is very advanced at this stage, and the individual will usually be referred to a periodontist (gum specialist) for additional cleanings, gum surgery, and bone grafting.

 

Periodontal Disease Bone Grafting

The ability to replace lost bone support has made steady progress in the past twenty years. It is now possible to replace or graft new bone in areas where it has been lost. Many of these bone grafts have saved teeth that were otherwise condemned to looseness and eventual loss.

Antibiotics and Periodontal Disease

Antibiotic therapy has been very effective in co-treating periodontal disease, although it is most effective after root planing and scaling and proper oral hygiene habits have been established.

Arestin
Arestin is a slow release antibiotic powder containing Minocin, that is placed in the bottom of each periodontal pocket. It allows for a 28-day germ killing cycle, giving the periodontal pocket a jump start on healing. Arestin is the most commonly used antibiotic treatment for periodontal pockets on the market today.

Peridex
Peridex is an antibacterial mouthwash that is generally prescribed for people requiring additional help in bacterial control. It contains chlorhexidine, which helps to kill plaque organisms. It is generally prescribed for short-term use.

PerioChip
A perio chip is a very small antibiotic wedge composed of chlorehexidine. It is placed deep into the periodontal pocket where its slow release lasts up to ten days.

In addition to at-home care for your gums, you should have professional teeth cleanings, or prophylaxis, every three to four months to eliminate tartar build-up that you cannot get rid of through brushing and flossing alone. If a build-up of tartar does become a problem below the gum line, a deep cleaning (scaling and root planning)can be performed to clean out the bacteria and tartar on the tooth roots and smooth the root surface so bacteria cannot adhere to it as easily.

" The dental procedures we specialize in enhance our
patients' look and their quality of life! "

If you live in the Lansing, East Lansing, Ann Arbor, Howell, or Brighton area and are concerned about your periodontal health, contact Dr. DiStefano and Dr. Nguyen today to schedule an appointment. We are committed to providing our patients with the best family and cosmetic dentistry available in Michigan.