Periodontal Disease |
Periodontal disease is the leading cause of tooth loss in adults. The main cause of periodontal disease is plaque, the sticky, colorless film that forms on your teeth. Other causes may include smoking and/or tobacco use, genetics, pregnancy, puberty, stress, taking certain medications, grinding your teeth, diabetes, poor nutrition, and other diseases that interfere with the body's immune system.
When plaque forms on your teeth, the bacteria in it are in irritation to your gums. The mildest form of periodontal disease is gingivitis. Gingivitis is completely reversible as it is generally caused by poor brushing and flossing habits. Symptoms of gingivitis may include redness, swelling, or bleeding in your gums. Left untreated, gingivitis progresses to periodontitis, which is when the plaque spreads below the gumline resulting in inflammation within the supporting tissues of the teeth. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.
Most of the time, periodontal disease can be prevented. Good oral hygiene is the most effective way of keeping your gums healthy. Regular visits to your dentist for professional examinations and cleanings and at least twice daily brushing and flossing of your teeth will have give you the best defense against periodontal disease.
Procedures that Dr. Pannullo performs
Cosmetic Periodontal Surgery
These procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of periodontal procedures by Dr. Pannullo and cosmetic dentistry by your dentist.
Gum Grafting Procedures
(Subepithelial connective tissue grafts)
When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem gum reconstruction using grafting techniques is an option.
When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost.
In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. Also, gum recession, when significant, can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging.
A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth, or gently moved over from adjacent areas, to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root.
The gingival graft procedure is highly predictable and results in a stable healthy band of attached tissue around the tooth.
When decay occurs below the gumline, it may be necessary to remove a small amount of bone and gum tissue. Your dentist may ask for this procedure before he or she makes a new crown for your tooth.
Reshaping the gum and supporting tissues: This will allow your general dentist adequate room to place a quality final restoration.
Final Restoration: Another indication for crown lengthening is when the front teeth are too short or of uneven length.
Traditionally, gum disease is treated by eliminating the gum pockets. The infected gum tissue is trimmed away, and uneven bone tissue re-contoured. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are used routinely today.
Guided Tissue Bone Regeneration
This surgical procedure "regenerates" the previously lost gum and bone tissue. Most techniques utilize membranes, which are inserted over the bone defects. Some of these membranes are bio-absorbable and some require removal. Other regenerative procedures involve the use of bioactive gels.
Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
We now have the ability to grow bone where needed. This gives us the opportunity to place implants of proper length and width, and it also gives us a chance to more effectively restore esthetic appearance and functionality.
Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and a better cosmetic outcome of tooth replacement.
We can use modern techniques to help rebuild lost bone support. The emphasis in Dr. Pannullos practice is conservative periodontal therapy. Many times, the early stages of periodontal disease are best treated with non-surgical periodontal therapy. This usually consists of placing a fine ultrasonic tip in between the tooth and gum tissue to remove any plaque and calculus below the gum line. This procedure is called root planing. Four to six weeks later, periodontal pockets are eliminated due to gum shrinkage. Then the patient can personally maintain these areas with routine brushing and flossing.
Even in most severe cases of periodontal disease, non-surgical periodontal therapy most often precedes surgical therapy. This is done so that the overall tissue quality is improved prior to surgery and also limits the areas of required surgery.
Treatment methods depend upon the type of disease and how far the condition has progressed. The first step is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gumline. The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.
Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, Dr. Pannullo may place antibiotic fibers in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.
When deep pockets between teeth and gums are present, it is difficult for Dr. Pannullo to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.