Reasons for treatment
- Periodontal infection is a chronic disease that can have periods of no signs of disease activity and periods of disease progression.
- If not treated the bone that keeps the tooth in the jaw vil dissapear and the tooth will be lost.
- Some factors that can speed-up your periodontal disease are: Lack of regular dental cleanings, poor oral hygiene, dental plaque, smoking, genetic factors, stress, pregnancy, diet, illness and medications.
It is likely that you have been referred to Dr. Hoffmeyer because your general dentist has noticed an increase in infection activity that needs to be addressed.
Protecting your periodontal health gives many benefits such as keeping your dental costs down, feeling a healthy mouth, smiling and speaking with confidence, eating with comfort and avoiding a possible contribution to other medical diseases (cardiovascular, diabetes, pre-term low birth weight babies, e.t.c.)
How do I prevent periodontal disease?
- Remove plaque from your teeth and gums every day by brushing and flossing.
- Use an electric toothbrush and interdental brush
- Regular dental visits are important (interval is commonly 3-6 months, but can vary).
- Other sicknesses should be well treated
- Hereditary conditions can not be changed
Daily cleaning helps keeping plaque and calculus build-up to a minimum, but it will not completely prevent it, especially if the build-up is under the gum-line or in areas difficult to access. Therefore you need to have your teeth cleaned professionally.
A regular periodontal evaluation is very important. This is done using a small measuring instrument (probe) gently placed between your tooth and gum to measure the depth of the pocket. Several other measurements may be necessary as well.
Dr. Hoffmeyer will be very gentle when performing this evaluation. Please feel free to ask questions at your visits.
Dr. Hoffmeyer finds great professional satisfaction in helping you, but keep in mind that the results depend on your optimal participation and corporation.
Is Periodontal Disease Treatable?
Yes! Periodontal disease is treatable. Periodontal disease will not go away by itself. Periodontal health should be achieved in the least invasive and most cost-effective manner.
- The mild stage is often treated through non-surgical treatments (“deep cleaning”).
- The advanced stage is often treated with a combination of non-surgical and surgical treatment. The purpose of surgery is to gain visible access to deep pockets, remove calculus, shrink the pockets and repair tooth and bone defects if possible. This makes future maintenance and prognosis better.
- The extremely advanced stage with severely loose teeth is treated with extraction and placement of implants or other restorative solutions.
A periodontist is trained to deal with many varieties of gum disease. The goal is to help you achieve a good oral health and help you maintain it.
Dr. Hoffmeyer will discuss your chief complaint, review your medical and dental history, perform a comprehensive clinical examination, a digital x-ray evaluation and propose treatment options. In some cases additional diagnostic tests may be performed.
It is very important that you fill out your medical history form as accurately as possible, prior to your consultation.
Prophylaxis – Professional cleaning
A prophylaxis is a scaling and polishing procedure performed to remove plaque, calculus and stains by various foods, beverages and tobacco.
- The cleaning is done with an ultrasound, with hand instrumenst and polishing
- This removes tartar, plaque and decolorization
- Healthy teeth needs to be cleaned 1-2 times per year
- Teeth with periodontitis needs it 3-4 times per year
Scaling and Root Planing (Deep-Cleaning)
This is a cleaning of the root surfaces to remove plaque and calculus from deep pockets and to smooth the tooth root to remove bacterial toxins. It is done with ultrasonics and hand-scalers. It is a “deeper cleaning” than the routine prophylaxis cleaning.
The procedure requires more time and often more than one visit. A local anesthetic will be offered to reduce any discomfort.
This treatment reduces gingival inflammation. Patients with mild disease most often do not require a following surgical therapy. After this therapy Dr. Hoffmeyer will perform a re-evaluation exam and discuss the outcome, prognosis and possible need for further treatment. When pockets are greater than 5 mm additional treatment may be needed.
- Perio flow is a kind of “sand fan”, that mixes water with powder.
- It can be used over and under the gum.
- It is effective to use difficult places for e.g between roots.
- It can be used as af supplement by periodontitis treatment.
It has been difficult to reach high enough levels of antibiotic by pill or injection to kill all periodontal microbes without undesirable side effects. In very few cases, antibiotic pills are prescribed at the time of scaling and root planning.
This is never given routinely since you increase your chance of developing drug resistant bacteria.
Local delivery antimicrobials (host modulators)
In general these drugs do not lead to antibiotic resistance.
Local delivery antimicrobials are antibiotic agents (Tetracycline, Minocycline or Metronidazole) that are released into the pocket over time. This produces a very high level of medicine for the affected area but an extremely low dose for the rest of the body, clearly eliminating the risk of side effects.
Host modulators are pills containing anti-inflammatory drugs (NSAID) or sub-antimicrobial antibiotics (do not contain a high-enough concentration to kill the bacteria, but helps offset the body’s response to the bacteria). They can fight the breakdown of gum and bone caused by periodontal microbes before reaching the dosage level required to kill the same microbes. Enzymes causing the bone breakdown are controlled. This allows long term use of the pills without the side effects seen at the higher dosages
Checking your occlusion (jaw relationsship and bite)
When upper and lower teeth are not in harmony, this may participate in causing damage to your teeth and supporting bone. A slight adjustment of your teeth or an occlusal night guard may be recommended and performed by Dr. Hoffmeyer.
Periodontal Mainteance Procedure (Supportive Periodontal Therapy)
When re-evaluation exam reveals non-pathological or non-treatable pockets you will enter into a maintenance phase.
This is a thorough cleaning about every 3 months (varies from 1-6 months) in order to help you protect your teeth and gums from relapse of periodontal disease. Depending on the prognosis of your periodontal condition, this maintenance phase may be performed alternating between Dr. Hoffmeyer and your referring dentist or hygienist (a licensed professional who performs professional cleaning in the dental office and provides education in proper care of the teeth and gums).
This treatment with Dr. Hoffmeyer is different from traditional six-month dental exams with you general dentist, who helps you check and maintain your teeth.
Please notify Dr. Hoffmeyer of any medical and dental changes since your last visit.
At this visit you will receive a comprehensive assessment of your pocket depths, attachment of your teeth, bone and gums, oral cancer screening and possible x-rays to evaluate the bone. Bacterial plaque and calculus are removed and if necessary non-surgical root planning is performed to smooth infected root surfaces. Your oral hygiene routine is reviewed and possibly modified to fit your current periodontal condition. Any new or recurring periodontal disease will be treated or treatment planned with you.
Remember periodontal disease is a chronic disease and early diagnosis and immediate treatment is preferable for a god prognosis.