Periodontics

The term “periodontics” refers to the dental specialty that pertains to the prevention, diagnosis and treatment of periodontal disease that affects the gums and jawbone. The gum tissues serve to surround and support the teeth and the underlying jawbone anchors teeth firmly in place. Periodontists have completed several years of extra dental training and are concerned with maintaining the function, health and aesthetics of the jawbone and tissues.

Antibiotic Treatment

Antibiotic treatments can be used in combination with scaling and root planning, curettage, surgery or as a stand-alone treatment to help reduce bacteria before and/or after many common periodontal procedures.

Antibiotic treatments come in several different types, including oral forms and topical gels which are applied directly into the gum pockets. Research has shown that in the case of acute periodontal infection, refractory periodontal disease, prepubertal periodontal disease and juvenile periodontal disease, antibiotic treatments have been incredibly effective.

Antibiotics can be prescribed at a low dose for longer term use, or as a short term medication to deter bacteria from re-colonizing.

Oral Antibiotics

Oral antibiotics tend to affect the whole body and are less commonly prescribed than topical gel. Here are some specific details about several different types of oral antibiotics:

Tetracycline antibiotics

Antibiotics which include tetracycline hydrochloride, doxycycline, and minocycline are the primary drugs used in periodontal treatment. They have antibacterial properties, reduce inflammation and block collagenase (a protein which destroys the connective tissue).

Tetracycline antibiotics

This group of antibiotics has proven effective at reducing inflammation, and can also reduce bacterial growth associated with periodontitis.

Metronidazole

This antibiotic is generally used in combination with amoxicillin or tetracycline to combat inflammation and bacterial growth in severe or chronic periodontitis.

Topical Gels and Strips

The biggest advantage of the direct delivery of antibiotics to the surfaces of the gums is that the whole body is not affected. Topical gels and direct delivery methods tend to be preferred over their oral counterparts and are extremely effective when used after scaling and root planing procedures. Here are some of the most commonly used direct delivery antibiotics:

Atridox®

This doxycycline gel conforms to the contours of gum surfaces and solidifies over them. Over several days, this gel gradually releases the antibiotic medication.

PerioChip®

This chip is placed into the actual gum pocket after root planing procedure. PerioChip® slowly releases Chlorhexidine, a powerful antibacterial antiseptic. PerioChip® reduces pocket depth in most cases in periodontitis sufferers.

Actisite®

This thin strip is similar to dental floss and contains tetracycline hydrochloride. The thread is place temporarily directly between the tooth and gum to kill bacteria and reduce the depth of gum pockets. Several threads are sometimes placed for around 10 days to enhance the antibiotic effect.

Elyzol®

This metronidazole antibiotic comes in gel and strip form. It is unique because it is able to destroy parasites as well as oral bacteria.

Arestin®

This Minocycline antibiotic comes in mini capsules which are delivered into the gums after scaling and root planning.

Noticeable periodontal improvements are usually seen after systemic or oral antibiotic treatment. Your Periodontist or dentist will incorporate and recommend the necessary antibiotic treatments as necessary for the healing of your periodontal condition.

If you have any questions about periodontal disease or antibiotic treatments, please ask your dentist

Bruxism

Bruxism refers to an oral parafunctional activity which occurs in most humans at some point in their lives. The grinding of the teeth and the clenching of the jaw are the two main characteristics of this condition, which can occur either during the day or at night.

It’s estimated that close to 20% of adults suffer from the negative effects of grinding and clenching their teeth, often called bruxing. The main reason people clench and grind their teeth is due to stress. Clenching and grinding not only causes excessive wear on your teeth, but the activity can also cause your facial and neck muscles to become sore.

Bruxism is one of the most common known sleep disorders and causes most of its damage during sleeping hours. The clenching and grinding which accompanies bruxism is symptomatic of a malfunctioning chewing reflex, which is turned off in non-sufferers when sleeping. For sufferers, deep sleep or even naps, cause the reflex nerve control center in the brain to turn off, and the reflex pathways to become active.

Typically, the incisors and canines (front 6 upper and lower teeth) of opposing arches grind against each other laterally. This side to side action puts undue strain on the medial pterygoid muscles and the temporomandibular joints. Earache, depression, headaches, eating disorders and anxiety are amongst the most common symptoms of bruxism; which often accompanies chronic stress, Alzheimer’s disease and alcohol abuse.

Bruxism is frequently misdiagnosed or not diagnosed at all, because it is only one of several potential causes of tooth wear. Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks and abrasive foods.

A BiteStrip® is an economical device used to diagnose bruxism at home. The device itself is a small electromyography which senses and monitors any activity in the jaw muscles during sleep. The frequency and severity of the condition can then be assessed and the best treatment plan can be formulated.

Reasons for the treatment of bruxism

Here are some of the main reasons why bruxism should be promptly treated:

Gum recession and tooth loss

Bruxism is one of the leading causes of gum recession and tooth loss; firstly because it damages the soft tissue directly, and secondly because it leads to loose teeth and deep pockets where bacteria can colonize and destroy the supporting bone.

Occlusal trauma

The abnormal wear patterns on the occlusal (chewing) surfaces can lead to fractures in the teeth, which may require restorative treatment.

Arthritis

In severe and chronic cases, bruxing can eventually lead to painful arthritis in the temporomandibular (TMJ) joints (the joints that allow the jaw to open smoothly).

Myofascial pain

The grinding associated with bruxism can eventually shorten and blunt the teeth. This can lead to muscle pain in the myofascial region and debilitating headaches.

Treatment options for bruxism

There is no single cure for bruxism, though a variety of helpful devices and tools are available. Here are some common ways in which bruxism is treated:

Mouthguards

An acrylic mouthguard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep. Mouthguards should be worn on a long-term basis to help prevent tooth damage, damage to the temporomandibular joint and help to stabilize the occlusion.

NTI-tss device

This device is fitted by a health professional and only covers the front teeth. The goal of the NTI-tss is to prevent the grinding of the rear molars by limiting the contraction of the temporalis muscle.

Botox®

Botox® can be injected into the muscles to relax and weaken them. Botox® is an excellent treatment for bruxism because it weakens the muscles enough to prevent the grinding, but not enough to interfere with everyday functions like chewing and speaking.

Other methods of treatment include relaxation exercises, stress management education and biofeedback mechanisms. When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts and crown lengthening that can restore a pleasant aesthetic appearance to the smile.

If you have questions or concerns about bruxism, please ask your dentist.

Crown Lengthening

Crown lengthening is generally performed in order to improve the health of the gum tissue, or to prepare the mouth for restorative or cosmetic procedures. In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue. Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue. This treatment can be performed on a single tooth, many teeth or the entire gum line, to expose a pleasant, aesthetically pleasing smile.

Reasons for crown lengthening

Crown lengthening is a versatile and common procedure that has many effective uses and benefits. The vast majority of patients who have undergone this type of surgery are highly delighted with the results.

Here are some of the most common reasons for crown lengthening:

Restoration of damaged teeth

Periodontal disease can cause severe damage to the teeth, as can trauma and decay. Where teeth have been broken beneath the gum line, crown lengthening can be used to prepare the area for a new restoration to correct the damaged teeth.

Cosmetic uses

Extra gum tissue can make teeth look unnaturally short, and also increase susceptibility to periodontal infections. Removing excess gum tissue can restore a balanced, healthy look and thus improve the aesthetic appearance of the smile.

Dental crowns

Crown lengthening serves to provide more space between the supporting jawbone and dental crown. This prevents the new crown from damaging gum tissues and bone once it is in place.

What does crown lengthening involve?

Crown lengthening is normally performed under local anesthetic. The amount of time this procedure takes will largely depend in how many teeth are involved and whether a small amount of bone needs to be removed, in addition to the soft tissue. Any existing dental crowns will be removed prior to the procedure, and replaced immediately afterwards.

The dentist will make a series of small incisions around the soft tissue in order to separate the gums away from the teeth. Even if only one tooth requires the re-contour, neighboring teeth are usually treated to provide a more even reshaping. Separating the gums provides the dentist with access to the roots of the teeth and the underlying bone.

In some cases, the removal of a small amount of tissue will provide enough tooth exposure to place a crown. In other cases, the dentist will also need to remove a small amount of bone from around the teeth. The bone is usually removed using a combination of special hand instruments, and rotary instruments. The rotary instruments roughly resemble the drill that is used in cavity treatment.

When the dentist is satisfied the teeth have sufficient exposure, the wound will be cleaned with sterile water and the gum tissue will be sutured with small stitches. The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.

The dentist will secure the surgical site using an intraoral (periodontal) bandage, which serves to prevent infection. Prescriptions may be provided for pain medication, and a chlorhexidine (antimicrobial) mouth rinse may be given to help reduce any bacteria attempting to re-colonize. The surgical site will be completely healed in approximately two to three months.

If you have any questions about crown lengthening, please ask your dentist.

Gum Treatments

Periodontal gum treatments needed 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.

If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone).

Gum Grafting

Gum grafting (also known as a gingival graft or periodontal plastic surgery), is the surgical periodontal procedure aimed at covering an exposed tooth root surface with grafted oral tissue.

Exposed tooth roots are usually the result of gingival recession due to periodontal disease. There are other common causes, including overly aggressive brushing and trauma.

Here are some of the most common types of gum grafting:

Free gingival graft

This procedure is often used to thicken gum tissue. A layer of tissue is removed from the palate and relocated to the area affected by gum recession. Both sites will quickly heal without permanent damage.

Subepithelial connective tissue graft

This procedure is commonly used to cover exposed roots. Tissue is removed fairly painlessly from the outer layer of the palate and relocated to the site of gum recession.

Acellular dermal matrix allograft

This procedure uses medically processed, donated human tissue as a tissue source for the graft. The advantage of this is procedure is that there is no need for a donor site from the patient’s palate (and thus, less pain).

Reasons for gum grafting

Gum grafting is a common periodontal procedure. Though the name might sound frightening, the procedure is commonly performed with excellent results.

Here are some of the major benefits associated with gum grafting:

Reduced sensitivity

When the tooth root becomes exposed, eating or drinking hot or cold foods can cause extreme sensitivity to the teeth. Gum grafting surgery permanently covers the exposed root, helps reduce discomfort, and restores the good health of the gums.

Improved appearance

Periodontal disease is characterized by gum recession and inflammation. Gum recession and root exposure can make the teeth look longer than normal and the smile to appear “toothy.” Gum grafting can make the teeth look shorter, more symmetrical and generally more pleasing to look at. In addition, adjacent tissue can be enhanced and augmented during the procedure for aesthetic purposes.

Improved gum health

Periodontal disease can progress and destroy gum tissue very rapidly. If left untreated, a large amount of gum tissue can be lost in a short period of time. Gum grafting can help halt tissue and bone loss; preventing further problems and protecting exposed roots from further decay.

What does gum grafting treatment involve?

Once the need for gum grafting surgery has been determined, there are several treatments the dentist will want perform before gum grafting takes place. First, the teeth must be thoroughly cleaned supra and subgingivally to remove calculus (tartar) and bacteria. The dentist can also provide literature, advice and educational tools to increase the effectiveness of homecare and help reduce the susceptibility of periodontal disease in the future.

The gum grafting procedure is usually performed under local anesthetic. The exact procedure will depend much on whether tissue is coming from the patient’s palate or a tissue bank.

Initially, small incisions will be made at the recipient site to create a small pocket to accommodate the graft. Then a split thickness incision is made and the connective tissue graft is inserted into the space between the two sections of tissue. The graft is usually slightly larger than the recession area, so some excess will be apparent.

Sutures are often placed to further stabilize the graft and to prevent any shifting from the designated site. Surgical material is used to protect the surgical area during the first week of healing. Uniformity and healing of the gums will be achieved in approximately six weeks.

If you have any questions about gum grafting, please call our Palo Alto dental office for further information.

Reasons for periodontal treatment

Periodontal disease is a progressive condition which begins with mild gum inflammation called gingivitis. It is the leading cause of tooth loss in adults living in the developed world, and should be taken very seriously. Periodontal disease (often called gum disease) is typically signified by red, swollen, painful, or bleeding gums, but in some cases has no noticeable symptoms.

Periodontal disease generally begins when the bacteria living in plaque cause an infection in the surrounding tissues of the teeth, causing them to become irritated and painful. Eventually, this infection will; cause the jawbone to recede and the tooth to become loose.

There are several reasons why periodontal treatment may be necessary:

Moderate/advanced gum disease

This occurs when the gums are bleeding, swollen or red around most teeth and the jawbone has begun to recede.

Localized gum recession

The infection which propagates moderate or advanced gum disease often begins in one area. Gum recession may also be caused due to over brushing with a hard bristle brush, or due to a tooth that is not positioned properly. Immediate treatment is required to prevent further spreading.

Before crown lengthening

The periodontist may lengthen the crown of the tooth by removing surrounding soft tissue to provide more tooth exposure.

Ridge augmentation

This procedure, often called “recontouring” may be required to correct an uneven gum line. Before embarking on treatment, a periodontist needs to treat any bacterial infections and periodontitis.

In the case of mild/moderate periodontal problems, the focus of the periodontist will be on curing the underlying bacterial infection and then providing advice on the most appropriate home cleaning methods.

Sometimes a deep scaling is needed to remove the bacterial plaque and calculus (tartar) from the teeth and tissues. Where periodontal disease is advanced and the jawbone has regressed significantly, more intensive cleaning may be recommended and loose teeth that cannot be saved will be removed.

The periodontist is trained in all aspects of dental implant procedures, which can restore functionality to the mouth when teeth have been affected by periodontitis.

Because periodontal disease is progressive, it is essential to remove the bacteria and calculus build up to halt the spread of the infection. Your dentist will be happy to advise you on effective cleaning methods and treatment options.