Periodontal Disease

Periodontal disease is an infectious process classified according to how much damage has been done to the structures surrounding the teeth, namely the gingiva (gums) and bone. It is an infection in your mouth. It can happen anytime, around any teeth, affecting some or many of your teeth to varying degrees. There are genetic predisposing factors to periodontal disease, and our immune systems play a role in gum health, but it is usually related to how well you are able to keep your teeth clean through proper oral self-care. The better you clean your teeth to remove all the plaque bacteria, the less likely you will be to develop periodontal disease.

Progress of the Disease: The bacteria that cause this disease first cause the gum tissue to become inflamed and pull away from the teeth. As the problem becomes more serious, the bone that supports the teeth also becomes infected and begins to break down and dissolve. The teeth then become loose. Once the bone disappears, it is extremely hard, if not impossible, for new bone to be rebuilt. The damage is permanent and your teeth, the surrounding bone, and your general health will be compromised.

Periodontal disease is classified into several types. The mildest form of this infection will show up in red and swollen gum tissue that bleeds easily. There is seldom any pain involved at this stage. You may notice also that your breath becomes offensive and you feel the need to use mouthwash. Our sense of smell does become immune to the same odors, so we can lose our ability to detect our own offensive, diseased breath. As the disease progresses, the gum tissue becomes more red and swollen, more bleeding can be seen, and the teeth begin to become loose. This tooth mobility is a sign that there is a severe problem. There may still be no pain at this advanced stage.

As more and more bone is lost and more teeth become involved in the infection, it becomes harder to treat. At this point, many times, the management of your problem will involve periodontal surgical procedures. If this is the case, you may be referred to a periodontist (gum specialist) for further treatment. Most of the time, periodontal disease starts and continues because of neglect. Brushing and flossing of teeth are not being done effectively on a daily basis. You may have been neglectful in getting your teeth checked and cleaned within the time frame intervals you need. Once we have diagnosed this disease, we will inform you of the problem and suggest treatment. If treatment is not completed, however, the disease will continue to progress.

Unfortunately, the disease is quite invisible to most people until severe and possibly irreversible damage has occurred. Solution If it has been diagnosed in the early stages and has not progressed to bone loss, a proper cleaning (prophylaxis) will solve the problem. Scaling and root planing over multiple appointments may be needed for more advanced cases. In the most advanced cases, periodontal surgery and tooth loss are inevitable. You will receive an estimate of fees for the recommended treatment. Periodontal disease is a condition that must be treated quickly. We believe that if the infection is aggressively treated in its early stages, conservative periodontal treatment may be possible and effective.

Although we do not automatically rule out periodontal surgical intervention, we hope you can either avoid it or reduce the amount you will need. Successful treatment of your periodontal problem will depend on several factors.

But the most important of these is your ability to perform excellent oral self-care brushing, flossing, and use of periodontal aids on a routine, daily basis. Without this, periodontal treatment will fail, and the disease will return.

Informed Consent for Periodontics non Surgical Treatment

Diagnosis: Following oral examination and evaluation of your oral condition, you have been informed that you have some form of periodontal (i.e., gum) disease. Your particular condition may involve gingivitis (bleeding, puffy gums) or mild, moderate and/or advanced periodontitis (jaw bone and root deterioration), with or without noticeable gum recession. We recommend periodontal therapy to treat the condition(s) affecting your gums, roots and underlying jaw bone to slow down or stop disease progression and to attempt to regenerate tissues destroyed or lost due to the disease process and/ or treatment of the disease process.

Use of Medications: A local anesthetic agent may be given to numb the gums. If needed, sedative agents may be administered. Antibiotics may be required to get the disease process under control. Pain medication may be necessary following some treatments.

Deep Scalings (cleanings) or root planning: This is an extensive scraping of the infected roots below the gumline. Usually deep cleanings are necessary to remove gross plaque, tartar and food accumulation on the affected roots, and also to reduce gum swelling. Deep cleaning may be the final treatment or be preliminary to periodontal surgery.

Principal Risks and Complications: Although most individuals respond favorably to periodontal treatment, each patient's condition is unique so that there is no sure way to predict how any particular condition(s) will respond. There is no cure, at present, for periodontal diseases and this means that periodontally-diseased teeth may be lost during and even after treatment. There also is no guarantee that periodontal treatment may preserve oral function or appearance. It may be necessary to have some or all involved areas re-treated in the future if initial results are not satisfactory.

The success of periodontal treatment can be affected by inadequate oral hygiene, other dental or medial medical conditions, drugs, smoking, alcohol consumption, nutritional problem and unknown conditions. Periodontal procedures are invasive and have the potential for certain complications to develop. These complications include, but are not limited to post-treatment infection; bleeding; swelling; and pain.

Alternatives to Suggested Treatment: 1) no periodontal treatment 2) periodontal treatment less than recommended; or 3) extraction of periodontally involved teeth. These alternatives may result in premature loss of teeth, may not adequately reduce infection or inflammation, and may require more frequent professional care, time commitment and additional cost of treatment.

Necessary Follow-up Care and Self Care: There is a responsibility on your part to clean your mouth, restorations and/or prosthesis daily to maintain them in a clean, hygienic manner. It is necessary to adhere to your doctor's recommended hygiene/check-up schedule after your treatment is completed.