What is the periodontium?
The periodontium is the hard and soft tissues that connect your tooth root to your jawbone. The connective strength of these tissues can be damaged through periodontitis (bone loss) and also through gingival (gum) recession.
What is gingivitis?
Gingivitis is a type of gum disease. Its main symptom is inflamed, red, swollen, and tender gums that bleed easily. The depth of the pockets around your teeth may have increased as well. Gingivitis is caused by dental plaque (the soft white/yellow bacterial deposits that form on your teeth) but it can be made worse by other factors such as medications, diabetes, and mouth breathing. Gingivitis can often be reversed with treatment, but if it is left untreated it can progress to periodontitis. Treatment can help prevent this from happening.
What is periodontitis?
Periodontitis is a type of gum disease that involves the loss of the bone tissue that supports your teeth. The signs of periodontitis may include red, swollen, and bleeding gums that are tender to the touch, bone loss and deep pockets around the teeth. The symptoms are usually not painful. Periodontitis is normally a slow-progressing disease but it can have sudden spikes in activity.
Periodontitis is caused by dental bacteria plaque but can be made worse by smoking, diabetes, and tooth grinding. Because the bone tissue around your teeth is deteriorating and being lost, your teeth will gradually become loose. You may not notice this looseness yourself but your dentist or periodontist may detect this sign.
Early treatment is key for treating periodontitis. If the disease is left untreated tooth loss may result. Periodontitis is an inflammatory disease, and like other inflammatory diseases (e.g. diabetes, rheumatoid arthritis), periodontitis normally can’t be cured. Treatment involves management over time. Our doctors can provide you with advice and assistance with developing a management plan.
What is gum recession?
Gum recession is when the edge of your gum recedes up (or down) the root of your tooth and exposes the more of the root. As your gums receded, the bone that surrounds and supports your tooth also recedes. This can weaken the connection of your tooth and could lead to it being lost.
Gum recession can be caused by tooth brushing, genetics, tooth position, muscle attachments and orthodontic tooth movement. It’s not usually painful and you may not notice that you have it. Our doctor can measure how far your gums have receded and determine if treatment is required.
It’s not unhealthy to have some root exposure, however it is important to know how much good gum you have left around your tooth. It’s best to treat gum recession early to preserve the attachment around your teeth. Gum recession is usually treated with gum grafts.
Are you at risk for gum disease?
Visit the American Academy of Periodontology to take the Risk Assessment Test and see your level of risk.
How is periodontal disease treated?
Control of risk factors - Periodontal disease is caused by bacterial plaque or biofilm that builds up on the teeth and causes inflammation. There are several other risk factors that contribute to the development and advancement of periodontal disease as well. Treating these factors may involve a biteplane (periodontal appliance), occlusal adjustment, extraction of weakened adjacent teeth, antibiotics, smoking cessation, or medical consultation.
Non-Surgical Therapy - Treatment of periodontal disease usually begins with what has become known as a "deep cleaning". This reduces the inflammation in the gums and helps decrease the depths of pocket around your teeth. Deep cleaning involves oral hygiene education, scaling and root planing (removing tartar and root roughness under the gum line where bacteria can hide) and may also include recommendations to control risk factors (see control of risk factors).
Deep cleaning is done using dental freezing and is performed by experienced dental hygienists. The dental hygienists at Ocean Periodontal are knowledgeable about the anatomy of the roots of the teeth and have expertise in cleaning the root surfaces. Depending on your needs the deep cleaning is usually completed in two to four appointments.
You may feel mild discomfort for one or two days after your cleaning. This discomfort can include cold sensitivity (usually short-lived) and contraction of the healing gums as they heal. Without periodontal treatment, periodontal disease can progress and lead to tooth loss.
Periodontal Re-assessment - We will re-assess your teeth approximately four to six weeks after your deep cleaning to evaluate the healing of the tissues and decide if further treatment is necessary. Additional treatment may include periodontal surgery, additional root planing or maintenance therapy.
Surgical Therapy - Surgical procedures are often necessary to improve the overall health of your periodontium (supporting tissues around your teeth). They can also provide an environment that is easier for you and your dentist or dental hygienist to keep your periodontal tissues in good health.
The goals of periodontal surgery are to remove bacteria and tartar that could not be reached with non-surgical therapy, to correct soft and hard tissue deformities caused by gum disease process, or to correct defects for cosmetic purposes.
Side effects of surgical therapy can include gingival recession (and thus longer teeth), increased spaces between the teeth at gum level, possible esthetic changes, and increased cold sensitivity (usually short duration). The benefits of periodontal surgery outweigh the side effects and without periodontal surgery, periodontal disease can progress and lead to tooth loss.
Supportive periodontal maintenance - Periodontal disease can return after treatment if your periodontal health is not maintained. After the active phase of treatment (non-surgical therapy and surgical therapy), we will recommend a maintenance schedule that is tailored to your needs.
During your maintenance visits, we may scale the tartar above and below the gum line as well as perform root planing (deep clean) on any sites that are still deep. We may also apply antibacterial dressings below the gum line, provide oral hygiene instruction tailored specifically for your needs, or make occlusal adjustments and reassessments of your periodontal health. Sometimes additional treatment is required and this is recommended on an as needed basis as part of the maintenance program.
Can you give me more information on the implant process at Ocean Periodontal?
How is an implant done?
Great question. There are few different scenarios that are determined by the periodontist.
Delayed approached - the implant fixture is surgically placed into the site of the missing tooth and the gum is covered over. The missing space above the implant may or may not have a temporary prosthesis/denture.
Immediate - once the implant/implants is placed, there may either be a healing abutment/metal cap or a temporary tooth/denture that is connected to the implant. This saves some healing time and possibly avoids minor surgery at the second stage. This scenario has very specific indications and so its best to discuss this possibility with your surgeon.
Do I need to be “put under” for the implant surgery?
Implant surgery has come a long way from needing dedicated operatory or surgical suites. Recognizing some patients maybe nervous or anxious, we provide different levels of sedation services as outline here (link to sedation service):
Please feel free to discuss the above options with your periodontist.
Who is involved on the implant team?
Generally we, as the periodontist, focus on the surgical aspect of the implant treatment. Together with your restorative dentist and the lab, we work in a team to make sure you get the ideal functional and aesthetic result.
Here are some of the roles on your team:
Restorative dentist - Treatment planning, temporary denture fabrication, shade selection, impressions for implant and delivery of final restoration.
Implant surgeon - Treatment planning, evaluation of radiographs, placement of implant/bone grafting, testing the implant prior to giving the green light to the restorative dentist.
Lab technician - Fabrication of temporary and final restoration, help make surgical guides for the implant surgeon as needed.
Of course, all of our treatment from start to finish involve helpful and brilliant staff members who are dedicated to making sure all of your needs are met. Our goal is to guide you through the process in a comfortable manner.
What happens after my implant is inserted?
The healing process for the implant takes about 3 to 4 months, but don’t worry - we’ll be with you every step of the way! Between 1-2 weeks after your surgery, you’ll come back to see us to remove any sutures and make sure you’re healing well. Then, around 6-8 weeks after your surgery you’ll come in to see us again so that we can make sure you’re healing well and that everything is as it should be. Finally, about 3-4 months after your surgery, you’ll come in for what we call a ‘torque test’ - this is when we make sure that the implant and the bone are fully integrated and that you’re ready to see your dentist to have your new implant restored.
What happens once my implant is restored?
Once you’ve got your restoration completed, we’ll bring you in for a few more check ups in the first year of your implant. We’ll see you at:
- 6 months
- 12 months
You’ll come in to see us annually for implant maintenance (to get it cleaned by one of our specialized hygienists) and for a check up once every 2 to 3 years.
Can an implant fail?
Yes, in rare cases implants can fail. Studies show that in 15-20 years follow up, implant survival rates are 95%. Within the 5% margin of implant failure, these cases are usually related to patients that have conditions that put them at a higher risk for implant failure. Some of these factors are:
- Smoking
- Diabetes
- HIV
- IV bisphosphonate
- Other immune compromising conditions
We take all factors into consideration when working with you to plan your treatment, not just your oral health. Our policy is to go above and beyond what’s necessary to make sure that getting an implant is a comfortable, stress-free, and easy process for you. If an implant fixture fails within a year of placement, we’ll replace the implant at no additional cost to you. However please do connect with your restorative dentist to discuss their warranty and costs for the restorative aspects.
Why choose implant therapy at Ocean Periodontal?
With a long history of providing comprehensive services in periodontics and dental implants, Ocean Periodontal remain committed to work as a team to ensure an easy, comfortable and successful treatment outcome. We recognize that implant therapy is not inexpensive and we work together with all patients to come to the right solution. As specialist in the foundation of teeth and implants, periodontists are in unique position to offer not only surgical placement of implants, but also the maintenance and the management of complications that may occur following their placement. It is our policy to continue the upkeep of implants and follow the cases with time to ensure maintenance of a successful outcome. We also work closely with other specialists and dentists in a collaborative fashion to handle complex cases.
What is a pocket?
In Gingivitis or Periodontal disease cases, bacteria can cause inflammation of gums causing swelling and bleeding. The swollen gums together with possible bone loss around teeth lead to formation of a periodontal pocket. This measurement is the basic diagnostic tool for a periodontist to assess the overall health of the periodontium (link). The A normal pocket is somewhere between 3-4 mm. The higher the number, the greater the attachment loss and indicative of severe gum disease.
How does smoking affect my gums?
Extensive literature have shows that smoking (cigarettes, marijuana, cigars, waterpipe/sheesha etc.) have significant impact on the periodontium. In smokers, there is almost 10x higher risk for losing a tooth pre-maturely compared to non-smokers. There is higher percentage of bacteria that affect the attachment and also more calculus build up. Smokers often have more gum recession around the teeth as well. Surgery in smokers can be complicated with reduced blood supply for adequate healing of graft tissue as well as mechanical disturbance of graft or flap due to the action of inhaling the smoke through the mouth. No matter the type of periodontal therapy offered, smoking cessation is an important factor for successful outcome.