At this stage, the infection
will be treated surgically!
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.
Signs of Advanced or Severe Periodontal disease :
gum tissue had receded even further
amount of attachment loss
is defined as the sum of the recession and pocket depth.
1-2mm of attachment loss
3-4mm of attachment loss
c. Severe- 5mm
or greater of attachment loss
and swollen gums
sore and painful
gum tissue bleeds
which is a good
indicator that you have ACTIVE disease
periodontal ligament is further destroyed
presence of pain
abscess and pus
loss of, often healthy, teeth
or more bleeding points
gingival recession with
soft tissue defects or frenum pulls
depths of 8 mm or deeper
very mobile teeth
advanced loss of the supporting bone.
or more of the original bone holding the tooth has been lost and once
the bone has been lost it does not grow back. This
condition causes tooth loss resulting in impaired
chewing, speaking, an unpleasing smile and occlusal
DISEASE IS NOW A PAINFUL PROGRESSIVE INFECTIOUS DISEASE THAT HAS
AFFECTED YOUR OVERALL WELL-BEING
disease has now severely attacked and destroyed your gums, bones and supporting structures of your teeth.
This stage requires periodontal
Professional treatments-to remove this harmful bacterial growth from you
teeth and gums. You will be
placed in the red program
which includes two sessions with us & multiple sessions with a specialist
A. Session 1:
2. Perio bag including home care
3. Oral Hygiene Instructions
B. Session 2:
Planing and Scaling and/or
2. Corrective periodontal surgery with
Surgery is indicated when deep pockets
remain underneath the gum after extensive cleaning
sessions. These pockets must be reduced. The surgery
| access for further cleaning of
the root surface|
| removal of diseased tissue|
| repositioning and shaping of
the bones, gum, and|
tissues supporting the teeth.
Surgical procedures vary depending on
the individual diagnosis and needs of the patient. In
general, the procedure follows five steps:
1. shaping gum tissue
2. lifting, or flapping, the gums away from the tooth and
3. cleaning and removing diseased root surfaces
4. contouring the remaining bone and attempting to
regenerate lost bone and gingival attachment through bone
grafts and guided tissue regeneration
5. replacing gum tissue so that there is minimal pocket
Bone Grafting. This
involves the surgical placement
of bone graft material into the defect, which stimulates
new bone growth. The material used may be commercially
prepared bone substance called decalcified freeze-dried
bone allografts (DFDBA), which is obtained from donors, or
bone from the same patient.
Guided-Tissue Regeneration. A
technique called guided tissue regeneration uses a
specialized piece of fabric, which is sewn around a tooth
to cover a crater in the bone that has been meticulously
cleaned out. The gum is then sewn over the fabric. This
fabric prevents the gum tissue from growing down into the
bone defect and allows the bone and the attachment to the
root to regenerate. After four to six weeks the fabric
must be removed using a minor surgical procedure.**
C. Session 3:
Remeasuring and updating
2. Cleaning with fluoride
3. Oral Hygiene Instructions
Three month perio maintenance visit to remove the tartar, which harbors and nurtures the growth of
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.
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
4. Daily flossing.
Start 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.
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
5. Use of
Periogard, an antimicrobial
Do not smoke or use alcoholic
beverages while your gums are inflamed.
Good dietary habits.
Cut back on foods and beverages that contain sugar.
going education about the health of your mouth.
To insure successful results following periodontal treatments, patient
cooperation in maintaining excellent oral hygiene is essential.
If left untreated,
serve periodontitis will lead to:
|Infection that can affect your overall health|
|Changes affecting your appearance|
|Poor nutrition, weight loss
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
Case Type IV Advanced Periodontitis-Diagnosis
Code 4800-Major loss of alveolar bone support usually
accompanied by an increase in tooth mobility with possible
furcation involvement. Probing depth are generalized 6mm and
Case Type V Refractory Progressive Periodontitis-Diagnosis
Code 4900-Is characterized by rapid attachment and bone loss.
There is usually a progression of the periodontal breakdown even
after aggressive intervention
Type 2 Diabetes and Gum Disease Increases
Risk of Death by Three Times
A recent study suggest people with type 2
diabetes should be be certain they are taking excellent car of
their teeth and gums. According to a study published in
the journal Diabetes Care on the effects of periodontal disease
on mortality, people with severe periodontal disease had more
than THREE TIMES the risk of dying of cardiac or renal disease.
Johns Hopkins Medical Letter Vol. 17,
Issue 2 pg 1 April 2005
* Dentistry Today pg 44 April 2001 from alpha
Omega, Vol 93, No.4. Dec 2000
Parameters of Care
( Gum ) Disease Index