Periodontics

Scaling and Root Planing

If you’ve developed signs of periodontal (gum) disease, regular cleaning may not be adequate. The first stage of periodontal disease, gingivitis, is usually corrected with scaling and root planing (SRP). This is a nonsurgical procedure to help eliminate gum disease by removing built-up tartar and plaque from below the gumline. With specific instruments, a scaling and root planing treatment cleans out the gum pockets, then smooths the surface of your teeth to avoid further buildup.

Is scaling and root planing painful?
The scaling and root planing procedure is not a painful process and causes little to no discomfort to the patient. Before the procedure your dentist will administer a topical anesthetic that will make the area completely numb.

What are the benefits of scaling and root planing?
Scaling and root planing offers treatment that can remove the plaque and bacteria responsible for periodontal disease and also closes any pockets that might have formed along the gums which typically allow bacteria to grow easily.

What is recovery like after scaling and root planing?
After the procedure you may notice your gums feel more tender and sensitive to hot and cold. This is normal and should subside within a few days. It is best to stick to softer foods for just a few days and you may want to limit the drinks you consume if they are hot or ice cold beverages. If you experience tooth sensitivity for an extended period of time after your scaling and root planing procedure you should call your dentist to confirm that your recovery is proceeding healthily. As with any dental procedure there is always a slight risk of infection, however this is incredibly rare.

How long does scaling and root planing take?
The entire scaling and root planing procedure can be performed in under an hour depending on the severity of your infection and the number of teeth that need to be treated. It is possible, if there is extensive gum disease and plaque buildup throughout the entire mouth, that your dentist may want to perform the procedure in two separate visits treating half of the mouth at each appointment. Only one procedure is needed to remove the infection entirely and with proper oral hygiene you should be able to avoid needing another scaling and root planing procedure in the future.

Full Mouth Debridement

Full mouth debridement is another method used in order to remove plaque from under the gumline in order to remove infection. FMD is typically performed when there is a large amount of tartar buildup that is difficult to be removed, requiring a more intensive cleaning than a standard dental appointment. This non-invasive procedure helps to correct the effects of improper oral care or lack of routine dental cleanings.

Full mouth debridement vs. root scaling & planing
When plaque and tartar are left on the teeth and around the gums it can cause them to recede creating pockets that allow bacteria to grow leading to gum disease and other conditions. Root scaling and planing would be used in these instances to protect the root of the tooth and secure it to the gums if severe gum recession has taken place. As a result it is a more intensive procedure that a typical FMD. One of the main goals of root scaling is to reattach the root of the tooth to the gums to help keep it secure.

Full mouth debridement typically takes around an hour to perform the procedure and is done using a local anesthetic applied to help numb the area as the dentist scrapes away tartar buildup along the gumline with specialized tools. If there is extensive work that needs to be done your appointment may be broken into multiple different sessions. You can plan your appointments and scheduling with your dentist after an initial consultation.

Do I need scaling and root planing if I get a full mouth debridement?
If there are substantial pockets that have been created your dentist may wish to perform a scaling and root planing procedure in order to close them to prevent further bacterial infections. Pockets in the gumline can work to both create environments prime for bacteria to grow as well as weaken the strength of the tooth which may make it feel looser in the mouth. A FMD can be the first step in a more extensive process in order to properly heal the gums to return your mouth to a healthy state and avoid further decay or potential tooth loss.

Are there any risks to a full mouth debridement?
Full mouth debridement contains very minimal risks to the patient. You may experience bleeding gums as tartar and plaque buildup is removed which is common if oral hygiene and regular cleanings have been neglected for some time. FMD is a non-invasive procedure, so the risks of avoiding a necessary FMD procedure are far greater than any risk of getting it done.

Periodontal Maintenance

encouraged to prevent future gum disease and ensure the health of the bone supporting your teeth. The Beacon Dental Health team will devise a maintenance program specifically for you.

What is the difference between a routine cleaning and periodontal maintenance?
While both routine cleanings and periodontal maintenance are intended to keep your gums and teeth healthy, periodontal maintenance is specifically targeted to promote the prevention of periodontal disease. Periodontal maintenance is performed after the dentist has recognized that the patient is experiencing some form of gum disease that requires treatment. These help to keep a proper oral hygiene routine to avoid any issues from returning.

Periodontal maintenance can also be used as a broad term to refer to the multiple types of procedures used to prevent or remove periodontal disease. In office periodontal maintenance may involve scaling and root planing as well as full mouth debridement (FMD) along with other procedures that aid in the removal and prevention of gum disease. If any pockets are present along the gums your dentist will carefully treat them to allow the gums to heal and, if necessary, bond itself back to the tooth using the aforementioned dental procedures.

Laser Therapy

Beginning its use around 1989 laser dentistry has become a common dental practice in order to treat a wide number of dental conditions from gum disease to tooth decay, and it can even be used for tooth whitening procedures as well.

In periodontal laser therapy, a laser is used to remove inflamed gum tissue from around the tooth’s root. Tartar and plaque buildup is then removed below and around the gumline. Lastly, teeth are smoothed out to remove any rough spots above and below the gumline, to mitigate the chance of future bacteria and infection.

Laser therapy typically is used in conjunction with other procedures such as scaling and root planing to increase the overall effectiveness of treatment. Most often laser periodontal therapy will not completely correct issues such as pockets in the gums on its own.

The use of lasers in dentistry has helped to improve costs for patients while also providing less discomfort and faster recovery than traditional dental treatment methods. Periodontal laser therapy is approved by the FDA but the American Academy of Periodontology (AAP) is still studying the effects and results of these treatments. As of today both traditional treatment methods and periodontal laser therapy seemingly have similar levels of efficacy in treating periodontal disease. However, studies have shown that results using laser therapy offers a promising development for future oral care

What are the advantages of laser therapy?
Laser therapy does not require anesthetic which may be appealing for some patients who prefer to avoid using it. In addition, dental treatment using lasers typically offers a faster recovery time than traditional treatment methods.

Crown Lengthening

Crown lengthening is a cosmetic periodontal procedure that can provide you with a beautiful and less gummy smile. During this procedure, gum tissue is reshaped to expose more of the teeth, providing dramatic cosmetic improvement.

Aesthetic vs. Functional Crown Lengthening

The two main types of crown lengthening include Aesthetic and Functional. If a tooth is broken beneath the gum line either through infections or trauma then a functional crown lengthening procedure is needed. This procedure involves adjusting the gum line to restore function & helps to prevent dangerous oral conditions such as inflammation and bone loss.

Aesthetic crown lengthening allows patients to get a less gummy smile that may seem unappealing to some. If there is tooth underneath the gums that have not been exposed naturally then you may be a candidate for aesthetic crown lengthening. In some cases the doctor may need to reshape around the bone as well in order to make the smile appear more natural.

During both procedures small incisions are made along the gums so they can be separated from the teeth. This allows the doctor to reach the area around the tooth or teeth to perform the procedure.

Recovery from crown lengthening

After a crown lengthening procedure it typically takes around a few days to heal. During that time it is important that you follow any post care instructions provided by your doctor. Failure to do so will result in a longer healing time and possible complications that can occur such as gum infection.

It is recommended that you do not do any strenuous or aerobic activity for up to 2 days following your procedure to avoid adding stress to the surgical area and slowing healing. For any pain, Advil or Tylenol can be taken as instructed by your doctor. Ice can be used in the first 24 hours after crown lengthening to help with any swelling around the site. After that, a warm compress such as a towel soaked in hot water can help to provide comfort to the area.

Following crown lengthening soft foods such as yogurt, bananas, applesauce, etc. should be eaten in order to avoid the chewing motion that can cause the stitches to come loose and may cause bleeding and slow healing. Normal foods can be consumed about 1 day after a crown lengthening procedure however you should only chew them on the side of your mouth that has not been worked on.

Finally, to keep the area clean, a saltwater mix should be gently used after the procedure. You can brush the teeth away from the area with a soft bristled toothbrush but you should not brush the section that is healing.

Osseous Surgery

Sometimes deep pockets can form in the gums typically as a result of gum disease that has been left untreated. When these pockets form, osseous surgery can be performed in order to clean out the bacteria that has grown and close up the pockets from further damage. Through this minimally invasive procedure, gums are pushed back, bacteria is removed and the area is repaired.

Gum disease has two different stages beginning with gingivitis. Gingivitis is a more mild form of gum disease that affects as many as 90% of people in the world and is defined when the gum disease has not yet reached the jawbone. Periodontitis can develop if gingivitis is not treated and this can have an impact on the bone and surrounding tissue leading to more severe oral complications. Receding gums are often accompanied with both forms of gum disease which can lead to small millimeter wide openings that bacteria can get into.

What to expect during surgery

Pocket reduction surgery, formally known as osseous surgery, takes about one hour to perform and reduces any pockets that have been created. Your gums will first be numbed using anesthetic making the procedure painless. Next, small incisions are made that allows the doctor to clean underneath the gums removing the bacteria that may be trapped. Lastly the gums are put back with any traces of bacteria now cleaned.

Recovery from pocket reduction

Recovery after Osseous surgery is similar to the recovery process for other oral surgery procedures. For the first few days after surgery it is recommended that you stick to primarily soft foods that don’t require heavy chewing which can irritate the surgical site. Ice can be placed outside the mouth where the surgery was performed to help manage swelling that may occur. It is also important that you avoid heavy exertion activity in order to help prevent additional bleeding. Lastly, a saltwater rinse should be used in order to sanitize the mouth and keep it clean to avoid any infection.

Proper oral care is crucial to avoiding the need for osseous surgery. Brushing twice per day, flossing, and rising using mouthwash can all reduce the risk of contracting gum disease which can lead to pockets in the gums.

Gum Grafting

Gum grafting provides both cosmetic and medical benefits. Gum grafting is a solution for a receding gum line, or if you feel your smile has too much exposed tooth. Tissue from the roof of the mouth is placed over the receding gum line, which helps the appearance of your smile, prevents bacteria overgrowth and helps to prevent further gum and bone tissue loss.

What causes gum recession?

There are two main causes that may lead to gum recession, most commonly gum disease. Gum disease will actually dissolve the gums causing them to appear as though they are getting lower or revealing more of your teeth.Gum disease can start due to neglect of oral hygiene including brushing, regular cleaning appointments, and using mouthwash.  Brushing your teeth too aggressively is another way that gum recession can occur. Consider using soft bristled toothbrushes or upgrading to an electric toothbrush. If you find the bristles on your toothbrush consistently getting warped or bent quickly, it is typically a sign you are brushing too hard and should be more gentle.

How is gum grafting performed?

Gum grafting is a two part procedure that involves taking a piece of healthy gums from one spot of the mouth and integrating it into the current gumline where heavy recession has taken place.The procedure itself is fairly quick. First a local anesthetic is used to numb the mouth, then incisions are made around the tooth experiencing gum recession to both clean and prepare the site for the graft. Because gum recession is typically caused by gum disease, a deep cleaning is an important step of the process. Properly cleaning the area of any bacteria prevents any infection that could occur.

After the site is prepared, the graft is taken, typically from the roof of the mouth, by small incisions that allow them to harvest a small wedge of the inner tissue needed to complete the graft. The incision site is then closed. Next the graft is placed at the site and is sutured into place after being properly positioned. The stitches used will likely dissolve or fall out on their own over time.

The gum graft procedure typically takes about an hour’s time per graft needed. If multiple areas of the mouth need to be treated for gum recession then the procedure can take longer.

Benefits of gum grafting

Gum grafting may be necessary if the recession is severe enough to be causing the roots of the tooth to become exposed which can cause severe issues to your oral health. The gums help to provide a level of stability to the tooth as well as protection from bacteria and infection reaching the bones underneath. However, gum grafting can also be performed for cosmetic reasons. In addition to strengthening the tooth and improving oral health a gum graft can also improve a patient’s smile making them more confident in daily life. You may also find that after gum graft surgery you are less sensitive to extreme hot or cold food and drink.

How long is recovery from gum grafting?

After a gum graft procedure it will take about one week to fully heal. Swelling and mild discomfort may be experienced during recovery from a gum graft. This should subside within a few days and tylenol or Advil can be taken in order to help with any pain that you might be experiencing after the procedure. The stitches must also fall out or dissolve over time.

After your surgery, avoid heavy chewing by sticking to mostly soft foods such as yogurt, oatmeal, and bananas. Strenuous activity should also be avoided as this can cause bleeding or additional swelling that will slow down the healing process and cause additional

Flap Surgery

Flap surgery is needed for those with severe gum disease where the issue cannot be controlled with root planning or antibiotics. Through this procedure, teeth roots are cleaned by pulling back sections of the gum. Damaged bone caused by gum disease can also be addressed during this procedure.

Sinus Lifts

If periodontitis goes untreated for extended periods of time it is possible that bone degradation may occur. A sinus lift can restore lost or degraded bone density if they wish to receive dental treatments such as implants. In other cases, patients may have limited height in the upper jaw, or their sinuses are too close to the law line. In those cases, a sinus lift is a good option.

During sinus lift surgery an X-ray or CT scan is used to determine the bone that should be utilized for the sinus lift. During the procedure an incision is made along the jaw in order to place the bone graft creating a space between the sinus membrane and the jaw. Over time this graft bone substitute will heal, becoming part of your natural bone structure.

Several anesthetic options are available for the procedure depending on your level of comfort. Local anesthesia is commonly used and allows patients to feel comfortable without pain during the surgery. Sinus lift surgery has great success in supporting implants after the procedure.

After the procedure, it may be between 4 and 12 months for the bone to develop before implants can be placed. Sneezing hard or blowing your nose forcefully can open up the stitches or displace the graft if you are not careful. Your personal situation will be evaluated with your doctor to determine how long your full recovery should be. In some instances, implants can be placed the same day depending on your situation.