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Periodontal Disease

Diagnosis

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination. This type of exam should always be part of your regular dental check-up.

A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper.

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

Gingivitis

Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.

Periodontitis

Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria and pus. The gums become very irritated, inflamed, and bleed easily. Slight to moderate bone loss may be present.

Advanced Periodontitis

The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.

Maintenance

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)! Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.

Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.

In addition to your periodontal cleaning and evaluation, your appointment will usually include:

Gingivitis

Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.

Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.

Examination of existing restorations:Check current fillings, crowns, etc.

Examination of tooth decay:Check all tooth surfaces for decay.

Oral cancer screening:Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.

Oral hygiene recommendations:Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)

Teeth polishing:Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

Treatment

Periodontal treatment methods depend upon the type and severity of the disease. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues. When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!

If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended. It is usually done one quadrant of the mouth at a time while the area is numb. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing). This procedure helps gum tissue to heal and pockets to shrink. Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

Fixed Bridges

A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.

There are several types of bridges. You and your dentist will discuss the best options for your particular case. The traditional bridge is the most popular type and is usually made of porcelain fused to metal. This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.

Ridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.

Reasons for a fixed bridge:

  • Fill space of missing teeth.
  • Maintain facial shape.
  • Prevent remaining teeth from drifting out of position.
  • Restore chewing and speaking ability.
  • Restore your smile.
  • Upgrade from a removable partial denture to a permanent dental appliance.

What does getting a fixed bridge involve?

Getting a bridge usually requires two or more visits. While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated. In addition, a temporary bridge will be made and worn for several weeks until your next appointment.

At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit. Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge. The new bridge will be permanently cemented at a later time.

You will receive care instructions at the conclusion of the procedure. Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

Inlay Restorations

An inlay restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain. It is made by a professional dental laboratory and is permanently cemented into the tooth by your dentist.

Inlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma. Inlays are an ideal alternative to conventional silver and composite fillings. Also, they are more conservative than crowns because less tooth structure is removed in the preparation of inlays.

As with most dental restorations, inlays are not always permanent and may someday require replacement. They are highly durable and will last many years, giving you a beautiful long lasting smile.

Reasons for inlay restorations:

  • Broken or fractured teeth.
  • Cosmetic enhancement.
  • Decayed teeth.
  • Fractured fillings.
  • Large fillings.

What does getting an inlay involve?

An onlay procedure usually requires two appointments. Your first appointment will include taking several highly accurate impressions (molds) that will be used to create your custom onlay and a temporary restoration.

While the tooth is numb, the dentist will remove any decay and/or old filling materials. The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an onlay restoration. A temporary filling will be applied to protect the tooth while your onlay is made by a dental laboratory.

At your second appointment, your new onlay will be carefully and precisely cemented into place. A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable.

You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new onlay.

Onlay Restorations

An onlay restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain. An onlay is sometimes also referred to as a partial crown. It is made by a professional dental laboratory and is permanently cemented onto the tooth by your dentist.

Onlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma. Onlays are an ideal alternative to crowns (caps) because less tooth structure is removed in the preparation of onlays. Onlays are essentially identical to inlays with the exception that one or more of the chewing cusps have also been affected and need to be included in the restoration.

As with most dental restorations, onlays are not always permanent and may someday require replacement. They are highly durable and will last many years, giving you a beautiful long lasting smile..

Reasons for onlay restorations:

  • Broken or fractured teeth.
  • Cosmetic enhancement.
  • Decayed teeth.
  • Fractured fillings.
  • Large fillings.

What does getting an onlay involve?

An onlay procedure usually requires two appointments. Your first appointment will include taking several highly accurate impressions (molds) that will be used to create your custom onlay and a temporary restoration.

While the tooth is numb, the dentist will remove any decay and/or old filling materials. The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an onlay restoration. A temporary filling will be applied to protect the tooth while your onlay is made by a dental laboratory.

At your second appointment, your new onlay will be carefully and precisely cemented into place. A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable.

You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new onlay.

Root Canal Therapy

Root canal therapy is needed when the nerve of a tooth is affected by decay or infection. In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.

Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed. Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth.

Root canal treatment is highly successful and usually lasts a lifetime, although on occasion, a tooth will have to be retreated due to new infections.

Signs and symptoms for possible root canal therapy:

  • An abscess (or pimple) on the gums.
  • Sensitivity to hot and cold.
  • Severe toothache pain.
  • Sometimes no symptoms are present.
  • Swellingand/or tenderness.

Reasons for root canal therapy:

  • Decay has reached the tooth pulp (the living tissue inside the tooth).
  • Infection or abscess have developed inside the tooth or at the root tip.
  • Injury or trauma to the tooth.

What does root canal therapy involve?

A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).

While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva. An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria. If tooth decay is present, it will also be removed with special dental instruments.

Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.

At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials. A filling will be placed to cover the opening on top of the tooth. In addition, all teeth that have root canal treatment should have a crown (cap) placed. This will protect the tooth and prevent it from breaking, and restore it to its full function.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.

You will be given care instructions after each appointment. Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

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