Dental Questions: What is Periodontal Disease?

Periodontal disease follows tooth decay as the most prevalent condition effecting the oral cavity. In fact, over half of all Americans have some type of problem with their periodontal tissues. It is important to understand the differences between the two main categories of periodontal disease- gingivitis and periodontitis.

The word "periodontal" identifies the tissues surrounding the teeth: the gums, bone, connective tissue and ligaments. These structures live in a delicate balance with the bacteria that exist naturally in our mouths. Over time, poor oral hygiene can allow the bacteria to colonize and grow around the teeth, leading to inflammation of the gum tissue. This first stage in periodontal disease is known as gingivitis. At this point, you might notice puffy, red gums that bleed during brushing or flossing. 

As the inflammation progresses and the bacterial colonies grow, the jaws start to undergo bony changes. Our bones will begin to grow away from the source of infection, leading to recession, pocket formation and loose teeth. These changes are associated with the more advanced form of periodontal disease known as periodontitis. 

Fortunately, there are a number or dental procedures aimed at stopping or reversing the effects of periodontal disease. It all starts with a dental exam to determine the extent of damage and assign an appropriate cleaning regimen. Patients with healthy tissue might just need a simple preventative cleaning, while others may benefit from a more intense procedure- such as scaling and root planing. If you would like to know more about periodontal disease, what causes it and how we can treat it, please contact our office!

Cleanings and Periodontal Maintenance

The most common and essential function of our office (and any dental office) is the administration of routine cleanings and exams. These are critical steps to your long term tooth preservation, decay prevention and gum care. However, many patients would likely be surprised to learn that there are an array of services offered under the “realm” of cleanings. In this article, we will uncover the different types of dental cleanings, who gets them, and their overall “goals” in terms of your oral health.

Before going into the different types of cleanings, it is important to understand a few key terms in diagnosing and treating gum disease. Please consider the following:

Plaque- A biofilm created by bacteria to allow it to better attach and anchor itself to the tooth.

Tartar/Calculus- The result of plaque hardening on tooth structure. This substance can cause rapid tooth decay and progression of gum disease. Additionally, it is very difficult to remove with home hygiene techniques.

Periodontal pockets- The depth of space between teeth and gums as measured by a “perio probe.” Pockets ranging between 1-3mm are considered healthy and maintainable with normal brushing. Anything deeper is the result of plaque/calculus irritating the gum tissue away from the tooth root.

Bone Loss- The loss of bone height around a tooth as a result of the body’s immune response to the long term presence of plaque and calculus.

A perio probe- The indentations show 1mm and 5mm intervals for measuring pocket depths. 

The majority of patients that come to our office receive what is called a prophylactic cleaning (or “prophy”). This is typically considered a standard cleaning that you would receive twice a year on a 6 month recall. The word “prophylactic” indicates that this type of cleaning is strictly preventative care. Here, the patient’s gum tissue is considered to be within the healthy spectrum- mild plaque and calculus, shallow periodontal pockets and no bone loss. Our hygienists will remove any buildup you have incurred since your last visit and make sure there is no progression of gum disease. The purpose of this appointment is to “prevent” your healthy gum tissue from progressing into the spectrum of periodontal disease.

Some patients fall within an in-between state of periodontal disease. While they do not have aggressive bone loss, their levels of calculus, gum recession and periodontal pockets are not within a healthy spectrum. For these patients, we usually recommend a periodontal recall cleaning. This service, usually administered in three month intervals, is a more aggressive maintenance of the teeth and gums. We are no longer preventing periodontal disease; widespread calculus inflammation and tissue detachment marks the clinical presence of disease. These patients are receiving dental scaling for multiple pockets over 4mm- much deeper than a toothbrush can clean. The ultimate goal of this appointment is to prevent moderate disease from progressing further, with the hopes that you will soon be back to normal “prophy” cleanings.

A diagram visualizing the difference between healthy and diseased gum tissue and bone. 

A final category of cleanings exist for individuals who typically have not seen a dentist in a number of years. These patients have excessive calculus, periodontal pockets greater than 4mm on almost every tooth and excessive bone loss over the entire mouth. Not only will home hygiene be insufficient to keep up with the progression of disease, but standard cleaning techniques will fall short as well. Here, we provide scaling and root planing for the the most invasive levels of calculus and plaque removal. The entire mouth is cleaned over two or four appointments, usually with an anesthetic. This type of procedure is usually recommended once to give your mouth a complete, thorough evaluation and cleaning. The goal is to set a healthier baseline for your mouth, so that it can be better managed by regular scheduled cleanings and your personal home care routine.

We recommend all of these periodontal services to a number of our patients for a number of reasons. Sometimes, unique situations will require a combination of approaches, the expertise of specialist or even surgical intervention. Only a thorough evaluation by Dr. Kari or one of our skilled hygienists will give us a true picture of your gum health. If you would like schedule an exam or cleaning, please contact our office. We are here to listen to your concerns and guide you every step of the way!