Treatment Expectations
 Certainly, every patient and every disease situation is unique. However, it is possible to present a generic overview of periodontal therapy that might answer some of your preliminary questions and might blow some of the smoke away from what you heard at work or from a friend about their "gum treatment".
The Examination
During the initial examination, we collect all the data necessary to determine your specific condition and needs. Many times, several radiographs will be taken which show the particular areas of the dentition that our specialty is concerned with. All of this information will be used to formulate a plan intended to provide you with lasting dental health.
Usually, phase 1 periodontal treatment follows the examination and precedes any major decisions concerning your periodontal treatment. During this phase, you will see our Periodontal Hygienists who have been specially trained to clean your teeth above and below the gum line to remove the disease causing bacterial plaque and tartar. These procedures are called Scaling and Root Planing or in patient's terms, "deep cleanings." Your oral hygiene routine will be introduced and closely monitored to make sure that you are mastering the techniques. Your dedication to effective personal plaque control at home is the key to successful periodontal treatment.
We strongly emphasize this initial phase of therapy because our approach to treating periodontal disease is conservative. We have found, in some instances, the need for subsequent surgical intervention may be reduced.
After phase 1 periodontal treatment is complete, we will see you for a combined Re-evaluation and Consultation visit. We will evaluate your tissues' response to the special cleanings as well as the effectiveness of your personal oral hygiene. We will then discuss any further periodontal therapy that is necessary and any restorative dentistry (fillings, caps, etc.) that should be pursued in your General Dentist's office. Your spouse or a family member is more than welcome to participate in this discussion. We will then communicate in writing with your General Dentist about our findings, our treatment to date and any recommendations for further treatment to resolve your periodontal condition.
Whether your periodontal disease is corrected surgically or non-surgically, you are normally seen at three-month intervals for Maintenance Therapy visits. Those visits usually alternate between our office and your General Dentist's. We thoroughly scale and root plane (deep clean) the repaired problem. At each maintenance visit, the Periodontal Hygienist will examine for any areas that might be recurring so we can make appropriate recommendations.
We will perform a complete periodontal examination at an interval determined by your specific periodontal disease activity so that we can monitor your situation and be aware of any tends that should be addressed. This maintenance phase is the key to retaining your natural teeth for as long as possible.
We have a staff of experienced dental professionals that we are very proud of. All of us are dedicated to your comfort and successful treatment. Someone will always be available to address your questions or concerns. Please do not hesitate to take advantage of that.
Treatment Methodology
Non-Surgical Services
It is very important for patients to understand that a diagnosis of periodontal (gum) disease by no means destines them to surgical intervention! Our practice has grown large because of our reputation for approaching periodontal therapy in a conservative fashion that is based on sound biological principles. Many patients are best served by surgical intervention, but a multitude are managed successfully for many years with non-surgical care.
Even in severe cases of periodontal disease, non-surgical periodontal therapy most often precedes surgical therapy. This is done so that the overall tissue quality is improved prior to surgery and it also limits the areas requiring surgery.
We also find that non-surgical therapy can add time to the life of teeth that are beyond surgical help and can sometimes prolong the life of teeth that have been labeled hopeless. Because the bacteria in deep pockets can get in the bloodstream, however, we must not allow infections that are not controlled to remain in the mouth.
Treatment Methods
Non-surgical treatment methods depend upon the type of disease and how far the condition has progressed. The first step is usually a thorough deep cleaning that may include scaling to remove plaque and tartar deposits beneath the gumline. The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment. This phase of treatment is called phase 1 periodontal treatment.
Our Periodontal Hygienists accomplish these tasks with ultrasonic instruments as well as hand instruments. The ultrasonic devices allow them to slip a thin instrument between the tooth and gum to effectively remove the bacterial deposits that are growing on the root and residing in the pocket. This is routinely accomplished comfortably with anesthetics (topical or local).
Root Planning.
Smoothing The Tooth Root.
Antibiotics or irrigation with antimicrobial (chemical agents or mouthrinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, Dr. Gholson or the Periodontal Hygienist may place antibiotic fibers or antibiotic gels in the periodontal pockets after scaling and root planing. This is done to control infection and to encourage normal healing. Many exciting things are happening in this area of local delivery of antibiotics and antimicrobial agents.
Subgingival Scaling.
Cleaning The Tooth Below The Gum.
A great deal of research has been done and more is in progress to develop medications that can assist us with non-surgical management of patients. We don't have a vaccine yet but we do have evidence that periodic professional cleaning below the gumline stimulates our immune system to be more effective in fighting periodontal disease.
Already we have a medication that can block an enzyme that allows the disease to spread. Other so-called "designer" antibiotics are on the horizon that will help. Perhaps by the time our children are facing this problem, the periodontist will be able to eliminate or modify the gene that predisposes us to this disease. The future is bright for conservative, non-surgical management!
Surgical Treatment
Periodontal Surgery for Pocket Reduction
Periodontal pockets in moderate to severe periodontitis are most times too deep to keep free of plaque accumulation. Periodontal surgery can reduce pocket depth significantly. Surgery allows access to thoroughly remove bacteria and toxins from diseased root surfaces and to reshape damaged bone. It also allows for repair and / or regeneration procedures to increase the attachment level for greater support of the teeth.
Usually, periodontal surgery is an office procedure using local anesthetic to make the areas numb that are treated. Dissolving or nondissolving sutures (or stitches) are used. This will cause the area to be uncomfortable for a few days and there will be very specific instruction for care of the area to facilitate good healing. There may also be increased sensitivity to cold. This increased sensitivity, if it occurs, should resolve to previous levels in a few weeks. Also, there is tissue shrinkage as a result of the surgery. This is desired effect in order to reduce pocket depth.
Periodontal surgery is designed to resolve periodontal infection, stabilize or improve attachment levels, and improve your ability to keep your teeth clean and healthy.
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