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                                                        DR. DAN PETERSON

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Moderate Periodontitis: Pockets are 6-7 mm deep. At this stage, the infection may still be treated non-surgically. However, up to one-third of your bone has been lost and once the bone has been lost it does not grow back


     The difference between gingivitis and periodontal disease is that in gingivitis the infectious disease attacks the connective tissue around the tooth. The bacteria release toxins in the pockets or sulcus which trigger the infection but destruction is caused by the body's own immune system.  Cytokines (chemical machetes) cut their way through healthy tissue and release PMNs like collagenase, prostaglandins and interleukin which destroy healthy connective tissue.  In periodontitis the infectious disease has gone PAST the tissues into the supporting bone of the tooth causing tooth motility leading to permanent tooth loss if not professionally treated by your dentist. 

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     Blood on your toothbrush or dental floss is one of the most common signs of moderate periodontal disease. Other signs of moderate periodontitis are:

bulletirritated gum tissue
bulletswollen gums
bulletsore gums
bulletgum tissue that bleeds easily which is a good indicator that you have ACTIVE disease
bulletsix or more bleeding points
bulletgums that are puffy and soft
bulletred instead of pink gum tissue
bulletbad breath
bulletpockets depths of 6-7 mm
bulletweaken, mobile teeth
bulletloss of clinical attachment due to destruction of the periodontal ligament
bulletpartial loss of the supporting bone
bulletgingival recession with soft tissue defects or frenum pulls
bulletamount of attachment loss is defined as the sum of the recession and pocket depth.
a.        Slight- 1-2mm of attachment loss
b.        Moderate- 3-4mm of attachment loss
c.        Severe- 5mm or greater of attachment loss


Infectious calculus buildup around the gum line

Your gums should never bleed while brushing or flossing.

     You can never completely get rid of all the bacteria in your mouth but brushing and flossing make sure the number of bacteria you do have is in a safe range. A common mistake most people make is to brush but not floss. This allows bacteria to build up to dangerous levels between your teeth where brushing alone cannot reach. When any one group or family of bacteria begin to dominate their levels of toxins increase to a point where they cause an infection.  

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     The good news is that moderate periodontitis can be:

bulletStopped from progressing
bulletReattached gum tissue to a spotlessly clean root surface
bulletPossibly treated in a non-surgical manner that allows for natural healing if treatment is started at this stage or earlier
bulletLess costly to treat at this stage than its advanced stage

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1.  Professional treatments-to remove this harmful bacterial growth from you teeth and gums. You will be placed in the blue program which includes five sessions:

A. Session 1:
 1.   One quadrant of Root Planing 
        and Scaling to remove contamination
        above and below the gum line
 2.   Irrigation with medications
 3.   Perio bag including home care 
 4.   Oral hygiene instructions

B. Session 2: 

      1.  One quadrant of Root Planing 
       & Scaling to remove contamination
       above and below the gum line
 2.  Irrigation with mediations
 3.  Oral hygiene instructions

C. Session 3: 

      1.  One quadrant of Root Planing
       & Scaling to remove contamination 
       above and below the gum line
 2.   Irrigation with medications
 3.   Oral hygiene instructions

D. Session 4:

       1.  One quadrant of Root Planing
       & Scaling to remove contamination
       above and below the gum line
  2.   Irrigation with medications
  3.   Oral hygiene instructions

E. Session 5:

     1.   Remeasuring and updating 
        perio charting
2.   Cleaning with ultrasonic scaler and medications are placed.

2.  Three month perio maintenance visit to remove the tartar, which harbors and nurtures the growth of undesirable bacteria. You need to be seen every 3-4 months because that's about how long it takes for the biofilm to re-establish causing bacteria infection.

3.  Good brushing for a minimum of twice a day and after meals (if possible) using your soft bristled perio instrument (Rota-dent) for at least two minutes.

4.   Daily flossingStart cleaning BETWEEN your teeth.  Periodontal disease begins between the teeth.  The area between the teeth are more prone to infection than facial or tongue gum tissue surfaces simply by anatomy.  This tissue is not keratinized like tissue found on the facial and tongue surfaces.  Non-keratinized tissue is more susceptible to breakdown.  It is also a very protected area, NOT reached by brushing or rinsing. 

     Since the disease starts between the teeth, it makes sense to start cleaning in between the teeth and than brush.  You can clean this area with interdental brushes, picks, sticks, oral irrigation, and automatic flossers remember this disease needs to be treated both in the office and at home.++

5.   Use of Periogard, an antimicrobial medicated mouthrinse.

6.   Daily fluoride treatments.

7.   Do not smoke or use alcoholic beverages while your gums are inflamed.

8.  Good dietary habits.  Cut back on foods and beverages that contain sugar.

9.  On Going Education about your dental health.

     To insure successful results following periodontal treatments, patient cooperation in maintaining  excellent oral hygiene is essential.


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    Remember: If left untreated, moderate periodontitis will develop into the last stage of periodontitis which will lead to:  

Periodontitis leads to recession and bone loss   

bulletInfection that can affect your overall health
bulletSore bleeding gums
bulletCostly periodontal surgery
bulletBone loss
bulletTooth loss
bulletChanges affecting your appearance
bulletPoor nutrition

Delaying treatment is a risky decision because gum disease never goes away on its own. It is an ongoing destructive bacterial infections of gums and bone that can have systemic effects.


Case Type III Moderate Periodontitis-Diagnosis Code 4700- Moderate stage  of periodontitis exhibiting increased destruction of the periodontal apparatus with noticeable loss of bone. Probing depth is 4-5mm with localized 6 and 7mm pockets possible in no more than four areas.

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The clinical course of chronic periodontitis

The purpose of this study was to assess the long-term influence of gingival inflammation on tooth loss.

The data originated from a 26-year longitudinal study of Norwegian males, who practiced adequate daily oral home care and received "state-of-the-art" dental care. The initial examination in1969 included 565 individuals aged between 16 and 34 years. Subsequent examinations took place in 1971, 1973, 1975, 1981, 1988 and 1995. Thus, the study covers the age range of 1659 years.  At baseline (1969), out of possible 15,820 teeth (565 28), 15,383 teeth were present. Four hundred and thirty-seven teeth had already been missing for unknown reasons. Teeth with Severity Group yielded an odds ratio for tooth loss that was 46 times higher

Teeth surrounded with inflammation-free gingival tissues were maintained for a tooth age of 51 years, while teeth consistently surrounded with inflamed gingivae yielded a 46-times higher risk to be lost. Only two-thirds of such teeth were maintained throughout the 26-year observation period. This documents the role of gingival inflammation as a risk factor for future tooth loss.

J Clinical Perio Volume 31: Issue 12 article Type: Original Article Page range: 1122 - 1127

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                     *AAP Parameters of Care

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PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
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