Periodontal disease or gum disease is extremely common and one of the most alarming issues that dentists are concerned with. Due to a very strong oral-systemic relation, periodontal issues impact the overall health and are tied to other systemic issues such as diabetes, heart problems, and even fertility. Almost half of the US population over the age of 30 suffers from at least mild gum disease. Periodontal disease can be mild (gingivitis) or severe (periodontitis). It is important to treat periodontal disease as it is easily controllable and preventable. In the videos below, Dr. Lyuda explains in detail what causes periodontal disease, how we diagnose it, and how we treat it!
What is Periodontal Disease
Dr. Lyuda discusses that Periodontal disease is and what causes it. At VIP Dental Lounge, we take periodontal disease very seriously. A big reason is that it is easily controlled with proper care. However, if left untreated, it continues to progress into severe periodontitis that can result in the loss of teeth as well as affect the overall health of the body. For vast majority of the patients, periodontal disease can be treated non-surgically. However, beyond a point, we ultimately have to treat it using a surgical procedures such as gum grafting surgery
Dr. Lyuda: Hi, my name is Dr. Lyuda and today I’d like to talk to you about periodontal disease. First let me explain to you what periodontal disease is. It starts out with gingivitis, and you probably have heard that term before, which mean inflammation of gum. Eventually that chronic inflammation will cause bone loss. It’s essentially your own immune system trying to fight that bacteria and foreign invaders and it attacks your own bone causing destruction.
It’s a very slow progressing disease but unfortunately it’s not curable once you have it. The only way we can control it is to arrest it by doing deep cleanings. We as dentists are very concerned about anybody having a periodontal disease because it is also associated with your systemic problems. It has been linked to heart attacks, it has been linked to, not necessarily cause diabetes but making diabetes worse, and it’s a cycle where diabetes makes periodontal disease much harder to treat, as well as periodontal disease making diabetes harder to treat.
It has also been linked to fertility, for instance on average it takes five months for healthy couples to conceive a baby. If any of the partner has any oral inflammation, gum disease, the studies show that it takes an average two more months to conceive. Another very important thing for those who are already pregnant, the studies also show that it has been linked to premature birth, low birth weight babies, as well as miscarriages in the early trimester.
How is Periodontal Disease Diagnosed
Periodontal disease is fairly easy to diagnose. There are essentially two things we’re looking for: 1. Any bone loss that we can see on the x-rays and 2. The depth of your gum pockets which we measure by gently placing a thin probe to see how deep it goes. However, it is important to note that periodontal disease isn’t curable and any bone loss suffered is non reversible. Once periodontal disease has been diagnosed, then it becomes important to arrest the disease and prevent it from progressing.
Speaker 1: If you don’t know if you do have periodontal disease, it’s extremely important to come see your dentist or hygienist. Your exam will start with x-rays. X-rays are very important as they show us any deposits under the gums, and the level of your bone. The second exam that we do is called periodontal probing. It’s an instrument that’s marked in millimeters that we put under your gums to measure how far that instrument will go under your gums. You’ll hear either me, or our hygienist read out numbers. Any numbers that are 1-3 are healthy, anything above 3 signifies a disease, whether it’s inflammation, or a bone loss. Obviously, the higher the number, the worse it is.
Once we determine that you do have periodontal disease, the treatment for it is called deep cleaning, or scaling and root planing. What it entails is, we do give you local anesthesia to numb your gums, because it is not very comfortable to go deep under the gums. Especially that your gums are already irritated and are inflamed. Once you’re numb, we use ultrasonic instruments to debride any calculus, which is mineralized plaque that has built up under your gums, which hasn’t been cleaned out with a toothbrush or floss. Then we use our instruments, metal instruments to remove any minor calculus that’s been left over, and to also make your root structure smoother so that further plaque has a much harder time sticking to it.
So the rougher the surface, the easier for the plaque to adhere. The smoother surface, the much harder it is for the plaque to adhere, and plus there’s no irritation. Gums will start to heal and the pockets will start to shrink.
One important thing is to follow up after your deep cleaning. I often hear patients say, yeah, I had a deep cleaning 2 years ago, and I haven’t seen a dentist since then. Now they have to do a repeat deep cleaning. It’s extremely important to come back for follow-ups, and make sure that you are compliant about all the instructions we have given you to maintain your health, as well as see us every 3 months. It is very important to see us every 3 months for maintenance. If after a while we notice that you’re doing great, and your disease has arrested, you no longer have any bleeding, your pockets have shrunk, and you’re having an easy time maintaining, we can put you back on a 6 months recall.
Deep Cleaning Simulation
This simulation shows one of the gum disease is diagnosed (x-rays are also used to assist in diagnosis) and then the eventual treatment. One of the non-surgical methods to treat gum disease is called Scaling and Root Planning otherwise also known as ‘Deep Cleaning’ as the layman term. As the words ‘Deep Cleaning’ indicate, the cleaning is done underneath the gums and not just the visible surface of the tooth.
Dr. Lyuda: Let me show you a simulation of what the deep cleaning might entail. So, on this picture we see a tooth and very irritated gingiva around it with some pocketings due to the calculus deposits that are on the root surface of this tooth. So, we use a peridontal probe to check how deep that instrument is going to go underneath your gum. Again, the healthy numbers are one, two, three. Anything above three signifies a disease. Once we determine the deep cleaning is needed, we use our hand instruments called scalers to scale off the hard deposits on your tooth structure, which is called calculus. And then we also smooth the root, which is called the planing of the root for the healing process to begin right after. When we see you for reevaluation, we should see a lot less inflammation, or none at all and a reduction in pockets.
Deep Cleaning Post Op Instructions
Once you’ve had a deep cleaning done, it is important to understand what to expect. In this video, Dr. Lyuda shares what you can expect to feel right over the procedure as well as over the next few days.
Speaker 1: Hi. So you just had a deep cleaning. A few things that I want to warn you about is if you are experiencing any discomfort and sensitivity, it is completely normal. What a deep cleaning entails is that we have to scrape off a little bit of your minerals of your tooth structure, which will make your tooth very sensitive to cold and sweets, and even cold air if it’s winter outside. It is completely reversible. Your tooth will remineralize, and will feel as good as new again. Just get through that week of either taking some ibuprofen. We can also offer you some fluoride varnish at the office right after the cleaning, or we can give you a prescription for fluoride that you can use for the next week or two to reduce that sensitivity.
Otherwise to help out with sensitivity, also avoid any drastic temperatures to drink or to eat, and try not to use your mouth to breathe when it’s cold outside. If your hygienist have given you a prescription for antibacterial rinse, it’s probably called chlorhexidine, or a brand name which is Peridex. Make sure to use it. It’s definitely going to help control that bacteria and decrease the inflammation. Do not use it for more than 10 days if you’re using it twice a day because it will stain your teeth. The stain is removable if you do end up using for more than that. It is okay. We can certainly remove that, but it will stain a kind of brownish/grayish/bluish color on your teeth and it’s not very attractive.
The advice we usually give is for the next five days or for the next seven days to use it twice a day in the morning and in the evening. When you do rinse with that, we want you to do that after you brush and after you floss, and do not rinse with water after. We want that to stay in your mouth for about one hour, so nothing to drink, nothing to eat for one hour after. Another option some of our hygienists prefer is some iodine and salt water. That’s for a little bit easier cases if you do not need such a big control of bacteria, then you can have something milder such as iodine and salt water to decrease that inflammation.
Otherwise, make sure to keep it clean because plaque is only going to make things worse. It causes sensitivity to become worse. It causes inflammation to become worse. Even though your gums might be sore after all that scraping, keep on brushing, keep the plaque off. That’s the only way things will start healing, and your gums will be a nice pink color, firm texture, and they will not bleed again.