Understanding Procedures:Gum Disease

There are two main types of gum disease that can affect an individual: gingivitis and periodontitis. Gingivitis is the more basic form of disease where only the gums are inflamed. Periodontitis is the more advanced form of gum disease where, not only are the gums inflamed, but the bone and the other supporting structures around the teeth have become affected. Our dental hygienists are fully trained in the treatment of both types of gum disease.

Gingivitis is a condition that is treated by a routine cleaning (known as a dental prophylaxis). This procedure involves removing plaque, stain, and tartar from above the gumline. In gingivitis, the pockets that are normally found between the gum and the tooth are typically less than 3mm (about an 1/8 of an inch). At this depth, routine home care consisting of brushing and flossing can adequately reach the bottom of the pocket in order to keep it clean. Once this procedure is completed and good home care has been established, the inflamed gums usually get better. Even with someone with healthy gums, a dental prophylaxis is recommended every 6 months in order to prevent the occurrence of gingivitis.

Periodontitis is a more serious condition where typical findings include pockets that are deeper than 3mm and involvement of the supporting structures around the teeth leading to bone resorption and gum recession. When a pocket becomes deeper than 3mm, it becomes nearly impossible to remove the material that gets trapped despite even the best brushing and flossing. Periodontitis can affect all of a person’s teeth or just a few. Once periodontitis has been diagnosed, a routine cleaning is no longer capable of treating the disease. (Remember: a routine cleaning focuses from the gumline up; with periodontitis, the problem involves deep pockets under the gums). Treatment of periodontitis typically begins with a procedure known as a scaling and root planing (“a deep cleaning”). The differences between a scaling and root planing and a routine cleaning are that a scaling and root planing usually takes 2 appointments to complete the entire mouth, each visit lasts longer, and the procedure focuses on cleaning under the gums in order to remove all the material from the pockets. An anesthetic gel or local anesthesia, such as when you have a filling done, is used so that you are comfortable throughout the procedure. The dental hygienist will take detailed measurements of the depth of the pockets around each tooth so that they can later re-evaluate these areas to note any improvement. Often, a slow-releasing antibiotic can be placed directly in deeper pockets so that the healing process can be more successful. Also, you may be given a prescription mouthwash to help with healing or a prescription fluoride to help with sensitivity. The hygienist will look forward to having you return in 30 days so that they can remeasure the pockets and evaluate healing. At that point, you will be placed in a maintenance program. Periodontitis is a condition that cannot be cured but hopefully can be controlled (like high blood pressure or diabetes). Every 3 to 4 months, you will come in for a periodontal maintenance cleaning where a very thorough, limited deep cleaning will occur and the pockets will be re-evaluated. Sometimes, if an area does not want to heal and becomes slowly worse, you may be referred to one of our periodontists (a gum specialist).