How is gum disease(periodontitis) treated?

Treatment Overview

Early treatment of gum disease is very important. The goals of treatment are to prevent gum disease from permanently damaging tissues, control infection, and prevent tooth loss. For treatment to be effective, you will need to:

• Keep your teeth clean by brushing twice a day and flossing once a day.
• See your dentist regularly for checkups and cleanings.
• Avoid all tobacco use. Tobacco decreases your ability to fight infection, interferes with healing, and makes you more likely to have serious gum disease that results in tooth loss.

Treatment for early-stage gum disease

If you have early-stage gum disease (gingivitis), you may be able to reverse the damage to your gums:

• Brush your teeth twice a day, in the morning and before bedtime.
• Floss your teeth once a day.
• Use an antiseptic mouthwash, such as Listerine, or an antiplaque mouthwash.

Your dentist will want to see you for regular checkups and cleanings. Professional cleaning can remove plaque and tartar that brushing and flossing missed. Once you have had gum disease, you may need to see your dentist every 3 or 4 months for follow-up.

Your dentist may prescribe antibiotics to help fight the infection. They can be applied directly on the gums, swallowed as pills or capsules, or swished around in your teeth as mouthwash. Your dentist may also recommend an antibacterial toothpaste that reduces plaque and gingivitis when used regularly.

Treatment for advanced gum disease

Early-stage gum disease (gingivitis) that is not treated promptly or that does not respond to treatment can progress to periodontitis. Periodontitis requires prompt treatment to get rid of the infection and stop damage to the teeth and gums, followed by long-term care to maintain the health of your mouth.

• Your dentist or dental hygienist will remove the plaque and tartar both above and below your gum line. This procedure, called root planing and scaling, makes it harder for plaque to stick to the teeth.
• Your dentist may give you antibiotics to kill bacteria and stop the infection. They may be applied directly on the gums, swallowed as pills or capsules, or inserted into the pockets in your gums.
• You may need surgery if these treatments don't control the infection or if you already have severe damage to your gums or teeth. Surgery options may include:
• • Gingivectomy, which removes and reshapes loose, diseased gum tissue to get rid of the pockets between the teeth and gums where plaque can accumulate.
  • A flap procedure, which cleans the roots of a tooth and repairs bone damage.
  • Extraction, to remove loose or severely damaged teeth.
• After surgery, you may need to take antibiotics or other medicines to aid healing and prevent infection.

After treatment, you will need to keep your mouth disease-free by preventing plaque buildup. You will need to brush carefully and thoroughly after all meals and snacks and floss daily. Your dentist will probably prescribe an antibacterial mouthwash.

Your dentist will schedule follow-up appointments every 3 to 4 months for cleaning and to make sure that the disease has not returned.

Last week my 17 yr. old son went to the dentist and was informed that he has enamel erosion which caused him to have 6 new cavities. The dentist said that the loss of enamel was most likely caused by his braces, which he had removed last year, and that the erosion will continue to spread and get worse. Is enamel erosion common after removal of braces? What should we do?

P.S. Thanks for serving our country!!

Good question and the answer is yes and no. It is very common to see teenageers come out of braces and have cavities that have developed in the process. To describe it as "enamel erosion" is a little ambiguous however. Typically there are 2 common areas to see cavities when a patient has their braces removed:

1. Lip/cheek side surface of the teeth where the brackets were bonded on the teeth.

2. Also occur between the teeth where you normally floss but very difficult when in braces.

Back to your question...erosion and cavities are two different things. I would ask the dentist to clarify what has happened. Erosion can lead to cavities but they are 2 separate situations. There is a chance he will need fillings where the erosion/cavity occurred. I would have him focus on their hygiene and also consider getting on a Fluoride prescription until everything stabilizes. The other question I would ask the dentist would be were any of these present during the past couple recall/cleaning appointments as cavities don't typically occur that quickly unless it had been a while since his last checkup. Hope this helps!

Dr.G

What are the different things that can cause sensitive teeth?

The common and most obvious ones are cavities and infections which is directly due to the cavity(tooth decay) getting close to the nerve. Fractures in the tooth, or the filling or both can also cause sensitivity in regards to cold, sweets, and biting.

The one that I see even more than these are sensitive teeth due to root exposure. 4 out of every 5 patients have at least one area where they have root exposure and cold or sweets will create what I call a "zinger". Patient will often report an area on a tooth and state that it is sensitive when they touch the surface with their fingernail or toothbrush bristles.

So what causes root exposure? Several things but the most common are periodontal(gum) disease, receding gums, aggressive toothbrushing, and heavy grinding of the teeth. All of these can cause root surfaces to become exposed and cause a great deal of sensitivity. While it typically is a "tolerable" discomfort, it can be very frustrating and self limiting.

What are the the treatments for sensitivity due to root exposure? It can range as simple as a fluoride topical application to a root surface filling to a gum surgery to help cover up the root surface. The newest type of treatment that I use on a daily basis is called "Laser Desensitizing". Using a special laser, I can "zap" the root surface with laser energy and totally eliminate the cold and sweet sensitivity in a matter of minutes. The advantages of this treatment is that you get instant results(i.e. instant pain relief) and is virtually pain free. Patients have great results from laser desensitization and it is becoming the most cost efficient/conservative treatment available?

Ask your dentist about sensitive teeth and what the causes are and what the recommended treatment is!

Dr.G

What is a crown?

A crown is a restoration that I prescribe to fix badly broken teeth or a tooth that has been root canal treated. A crown is cemented over top of the tooth after it has been prepared. Badly broken teeth can result from large cavities, root canal treatment and trauma as well. Sometimes crowns are placed on teeth that are cosmetically unacceptable by the patient. By doing a crown, I can alter the shape, contour, color and bite of the original tooth so that patients are happy with its function as well as its appearance.

Crowns also sometimes require additional procedures based on the existing condition of the tooth such as a root canal, crown lengthening surgery, and teeth buildups. Please consult me if you have any questions about crowns or bridges. Crowns can be made of gold, porcelain, or metal/porcelain which is called a porcelain fused to metal crown(PFM). The decision on the material is based on the position of the tooth, the demand for esthetics, and what type of chewing forces the crown would be subjected to. Ask your dentist about the benefits of crowns and well as what is most suitable for your situation!

I have wisdom teeth that are beginning to hurt and I am worried about feeling pain and having a bad experience. Do I need them out? What do you recommend?

Wisdom teeth, often times, have to be removed for several reasons such as inability to keep clean, more prone to getting cavities, can cause shifting of teeth, can develop unusual pathology such as tumors, and can cause diffuse pain in the jaw as well as the jaw joints. Wisdom teeth can fully erupt through the gums, or partially erupt, or never erupt (called an impacted wisdom tooth). Depending on the level of eruption, a general dentist may be able to take the wisdom teeth and often times I refer to an oral surgeon who specializes in taking out more difficult teeth.

Because wisdom teeth are typically more difficult to take out, one can experience more discomfort and pain following. Again the level of eruption will determine how difficult it will be to remove which further determines how much discomfort afterwards. I typically recommend sedation for wisdom teeth in 3 different options:

1. Nitrous oxide (laughing gas during procedure)
2. Oral sedation(oral medication before procedure)
3. IV sedation ("put to sleep" with medications through an IV). Ask your dentist what is most appropriate for you.

The advantage to oral and IV sedation is also that it can cause amnesia which prevents the patient from remembering the procedure. Most patients wake up without any recollection of what happened, how long it lasted and how the procedure went. So yes I would recommend removing wisdom teeth ~85% of the time and I would recommend sedation for the procedure.

Its too bad that wisdom teeth are most likely the most "unintelligent" teeth in the mouth. How's that for irony!