Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means “around the tooth.” Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth.
Periodontal Disease and the “POCKET”
All categories of classical periodontal disease are primarily caused by the bacterial build-up known commonly as Plaque and Tarter. The equivalent periodontal terms are bacterial plaque and calculus. Many people believe they are removing food particles when the clean their teeth. However, proper hygiene is designed to remove the plaque. All of us have a mouth full of bacteria. The bacteria will slowly stick to any hard surface in the mouth creating a thin film, plaque. The film can be removed by making contact with it using the brush and floss. It comes off easily with contact.
If the plaque is missed or it cannot be reached, it will change in 2 ways.
The plaque calcifies or hardens into tarter or what dentists call calculus. Once hardened, brushing and flossing can no longer remove it. It has to be scraped off by a dentist or dental hygienist.
The bacteria changes the longer it remains on the tooth surface. At first, the bacteria that makeup the plaque are harmless and do not create periodontal disease or tooth decay. However, the longer it remains without being disturbed the more it is overcome by harmful types of bacteria. Basically the harmful types of bacteria are an irritant to the periodontal structures, gum and bone.
Most cases of periodontal disease occur silently.There is frequently no pain, bleeding gums, or receding gums.The most common symptom a patient might experience is bleeding gums.Pain or changes in the gum level are frequently signs of advanced periodontal disease.
The Pocket – At the junction of the gum and tooth, there is a gap. If it is normal and healthy, this crevice is called a sulcus. A Periodontist will measure the sulcus depth in millimeters. Ideal is less than 3mm. In essence, it is the distance from the gum level to the underlying bone level. With the disease, the bone is lost and the distance between the two increases and the depth increases. At 5mm or greater the gap is called a “pocket.”
Gingivitis – The strict definition of gingivitis is inflamed gums. This is the mildest form of the disease. It is inflamed gums without involvement of the underlying supporting bone. At this stage, removing the plaque and tarter followed by proper hygiene will reverse the disease without any permanent damage. The sulcus remains at 4mm or less.
Periodontitis – At this stage, the bone becomes involved. When there is deep inflammation of the gum, eventually the adjacent bone will try to retreat or escape from the inflammation. The result is a loss of the bone around the tooth from the top of the tooth towards the root tip and the pocket is formed. The deeper the pocket becomes, the harder it is to keep it clean by the patient and with routine dental cleanings. Therefore, more plaque and tarter builds up under the gum (in the pocket), which creates more bone loss and the pocket deepens further. This progressive repeating cycle continues unless treatment is performed.
Periodontitis with secondary systemic factors – There are many additional problems or general health issues that can add to the bone loss. The most common of these are: smoking, diabetes, and dry mouth (xerostomia.)
Aggressive Periodontitis – This occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss, bone destruction, and a family history.
Necrotizing Ulcerative Periodontitis – This is a relatively rare disease. It is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immuno-suppression.
The Periodontal Maintenance Recall – In insurance terminology it is Code D4910. In short, this is a routine in office dental cleaning. Periodontal treatment requires long term Recalls and they usually are necessary 3 to 4 times a year between the General Dentist and the Periodontal office. By maintaining half or more of the cleanings in the Periodontal office allows the Periodontist to examine and follow the patient. Also, in Dr. Bernstein’s office, the Hygienist is given an hour for each cleaning appointment. Most insurance companies, but not all, will allow 4 cleanings per year if the patient completed periodontal therapy.
Treatment of Periodontal Disease via the Laser – The laser has FDA approval, which means the device is safe. It DOES NOT mean it is effective. It may not be equal to or better than conventional current treatments. The laser has shown some promise, but there is limited research on the use of lasers for periodontal treatment. Both the ADA (American Dental Association) and the AAP (American Academy of Periodontics) came out with statements (2011) regarding Lasers. These two associations state there is a lack of scientific evidence that Lasers are more effective than classical periodontal treatment. Also, there are no insurance codes for laser treatment. A surgical code can be used, but it is not the same as the one used for conventional surgery and there is reduced insurance coverage. Lastly, some practitoners advertise “No Cut, No Sew” laser therapy. The use of the laser is surgery, even if “stitches” are not used. If you have questions, Dr Bernstein is glad to discuss periodontics and the laser.