Periodontal
Therapy: Where Do I Start?
If
you've recently been diagnosed with periodontal disease, you probably
hve some questions about where your treatment begins. If you're
looking for answers to your questions - or have a friend or family
member who is - today is your lucky day. Read on to learn about
effective means that may keep your periodontal disease under control
and discover treatment options that may be right for you... You'll
likely uncover a pleasant surprise.
What
are Periodontal Diseases?
The
word "periodontal" literally means "around the tooth."
Periodontal diseases are chronic bacterial gum infections that destroy
the attachment fibers and supporting bone that hold your teeth in
your mouth. The main cause of these diseases is bacterial plaque,
a sticky, colorless film that constantly forms on your teeth, as
well as your body's response to this plaque. Daily home oral care,
including proper brushing and flossing, is a must to prevent plaque
buildup.
If
plaque is not removed, it can turn into a hard substance called
calculus (tartar). Calculus is so hard it can only be removed during
professional cleaning. If calculus develops below the gums onto
the tooth root, it makes plaque removal impossible, leaving you
at increased risk for periodontal diseases.
Toxins
(or poisons) produced by the bacteria in plaque irritate the gums,
causing infection. These toxins initiate the inflammatory process,
which destroys the supporting tissues around the teeth, including
the bone. Some patients have an overreaction to the bacteria, the
body's immune response, which causes further damage. Bacteria and
your immune response to the bacteria can cause the gums to separate
from the teeth, forming pockets that fill with even more plaque
and more infection. As the diseases progress, these pockets deepen,
more gum tissue and bone are destroyed, and the teeth eventually
become loose. If periodontal diseases are not treated, the teeth
may need to be removed. In addition, accumulating research links
periodontal diseases to general health conditions such as heart
disease, diabetes, respiratory disease, and preterm low birthweight
babies.
Does
traditional therapy mean that I need surgery?
As
you can see, good periodontal health may be a key component of a
healthy body, so it's important to understand treatment options
that can help you achieve this level of health and keep you smiling.
Some
patients think of "traditional periodontal therapy" as
surgery. Fact is, the American Academy of Periodontology treatment
guidelines stress that periodontal health should be achieved in
the least invasive and most cost-effective manner. You may not be
aware that this is often accomplished through non-surgical treatments.
Periodontal
Examination
Periodontal
diseases, as well as a patient's individual risk factors for the
diseases, are often diagnosed through a comprehensive periodontal
examination. During this exam, the periodontist will discuss your
chief complaint, review your medical and dental histories, and perform
a clinical examination and radiographic (x-ray) analysis. In some
cases, microbiologic, genetic, biochemical, and other diagnostic
tests may be performed. This is the time to discuss with your dental
team other factors that might contribute to periodontal diseases,
such as smoking/tobacco use, pregnancy and puberty, stress, medications,
clenching or grinding your teeth, diabetes, poor nutrition, and
other general health conditions.
Oral
Hygiene Instruction
The
first step toward periodontal health begins with oral hygiene. If
you've been diagnosed with periodontal diseases, you may be more
susceptible to the diseases. For this reason, you may need to keep
your teeth cleaner than most people. Be sure to review your at-home
oral hygiene routine - including toothbrushing and flossing techniques
and the use of special oral hygiene aids - with your dental team.
Good oral hygiene and professional cleanings can go a long way toward
preventing certain forms of periodontal diseases, and reversing
early stages of the diseases like gingivitis.
Scaling
and Root Planing
Scaling
and Root Planing (SRP) is a careful cleaning of the root surfaces
to remove plaque and calculus from deep pockets and to smooth the
tooth root to remove bacterial toxins. This cleaning is more in-depth
than a routine prophylaxis, or polish, with which you may be familiar,
and may require more than one appointment. For comfort, your periodontist
may wish to numb the area prior to treatment. Research has consistently
demonstrated that SRP reduces gingival inflammation and probing
depths, and shifts the bacteria composition living in these pockets
from one associated with disease toward one associated with health.
Thus, SRP is usually the first mode of treatment recommended for
most patients. Most periodontists agree that after SRP and oral
hygiene instruction, many patients do not require any further active
treatment, including surgical therapy.
Systemic
Antibiotics
In
some cases, systemic antibiotics (antibiotics taken orally) are
prescribed at the time of SRP procedures. Antibiotics are drugs
that fight infections caused by bacteria. However, each time you
take an antibiotic, you increase your chance of developing drug
resistant bacteria. Therefore, it is really important to take antibiotics
only when necessary. Systemic antibiotics are different from locally
delivered antimicrobials or host modulators. Both of these treatments
may be used without fear of resistance.
Local
Delivery Antimicrobials and Host Modulators
Damage
from periodontal diseases is caused by bacteria and your body's
response to these bacteria. New products are available that may
be recommended as part of your periodontal therapy to help your
body eliminate the infection or decrease its negative effects. These
drugs are called either local delivery antimicrobials or host modulators.
In general, these medications do not lead to antibiotic resistance.
Local
delivery antimicrobials that are delivered directly into periodontal
pockets to suppress or eradicate periodontal bacteria. Local delivery
antimicrobials may contain an antibiotic agent such as tetracycline,
minocycline or metronidazole that's released into the pocket over
time. They can be delivered directly to the pocket through several
means, including a:
- Fiber
that's placed and removed after 7 to 10 days
- Gel
or powder that is applied with special syringes and absorbed over
time
- Tiny
"chip" that's pushed into the pocket and absorbed over
time
Host
modulators are drugs that are taken orally for a period of time
to offset the body's presponse to periodontal bacteria. They can
be anti-inflammatory medications, such as Non-Steroidal Anti-Inflammatory
Drugs (NSAIDs), or what's called a sub-antimicrobial class of antibiotics,
which means that the dose of antibiotics contained within the drug
dose does not contain a high enough concentration to fight the bacteria;
rather, it may work by helping the body's response to the bacteria.
Occlusal
Modifications
"Occlusal"
means, "pertaining to the contacting surfaces of opposing teeth."
When tooth surfaces are not in harmony between the upper and lower
teeth, an "occlusal adjustment" may be necessary. That's
because teeth that do not fit together properly can affect the rate
of progression of periodontal diseases or contribute to other oral
health problems. Perhaps your periodontist has recommended an occlusal
adjustment because periodontal diseases have damaged your teeth's
supporting structures and caused them to shift - or maybe you've
recently had restorative work that has slightly changed the way
your teeth fit together. These and other reasons - from genetics
to teeth clenching or grinding - can require an occlusal adjustment
to help you achieve occlusal harmony and create a bite that's functional
and healthy.
During
an occlusal adjustment, your periodontist may take a mold of your
teeth or ask you to bite down on a tape-like substance called "articulating
paper" to identify the areas of occlusal concern. Teeth with
less than optimal contact will be reshaped. In addition, your periodontist
might prescribe an "occlusal guard" or "night guard"
to be worn at certain times during the day or night to minimize
the effects of teeth grinding or other occlusal concerns.
Reevaluation
of Treatment
Following
adequte time to respond to your treatment, you will be asked to
return to the periodontist's office for a reevaluation to determine
if further active therapy is indicated.
If
the answer is "yes," then your periodontist will develop
a treatment plan to help restore your smile to a state of health.
This may require surgical treatment to remove any remaining infection
and decrease residual pocket depths to reduce your risk for disease
in the future.
If
the answer is "no," then you'll enter into a "maintenance"
phase, or specialized treatment for patients who have already been
diagnosed with and treated for periodontal diseases. These appointments
tend to be more thorough than traditional six-month cleanings, can
be more often, and will help protect the health of your teeth and
gums.
Destruction
caused by periodontal disease takes away a person's ability to speak,
eat, and smile with comfort and confidence. The good news is that,
when caught early, many options are available to treat the diseases
and restore health. Surprise - your happy, healthy smile is closer
than you thought!
©
2003 The American Academy of Periodontology
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