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Periodontal (Gum) Care

Scaling and root planing

During this process the plaque and tartar concentrated deep in the gum pocket the is removed. This is done using a metal dental tools  and/or ultrasonics. The plaque and tartar is broken up before being scraped out. If the roots have plaque buildup as well, the root planing procedure will scale them to remove the plaque and then smooth out any rough areas so the tooth can be both healthy and fully functional with connective tissue fibers reattaching to it, thus decreasing pocket depths.  

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Will the dentist use anesthesia?

Your gums will be numbed with local anesthetic.  We often will do two quadrants of the mouth at a time.  Some patients do not feel the need to use local anesthesia and are comfortable with a topical numbing cream. 

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What to expect after the visit?

After your visit your gums may feel tender or look inflammed.  This is because the buildup has been removed.  You can help control this with ibuprofen and ice packs if necessary. Typically, the worst part is over within four hours, so you may just want to go home and sleep. In the rare case your jaw feels sore and stiff, you can place a warm compress on it.

For a few days after you may experience some sensitivity when eating, especially if you are eating anything sweet. One way to address this is to use something soft to clean the area and then place a desensitizing toothpaste on a Q-tip so it can be gently applied to the area around your gums.

There will be some bleeding when you brush your teeth, but this should only last for a day or two. Just remember to be gentle when brushing around your gums. You should be able to resume your normal activities the same day.

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Arestin®
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Gum disease can be treated with an antibiotic. Unlike antibiotics that are swallowed, ARESTIN® is a powder that we place directly into infected areas or pockets in your gums when you receive scaling and root planning (deep cleaning). Arestin has been shown to significantly decrease the size of pockets when combined with scaling/root planing and to destroy the bacteria commonly affiliated with periodontal disease.

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INDICATIONS:
ARESTIN® is indicated as an adjunct to scaling and root planning ( deep cleaning) procedures for reduction of pocket depth in patients with adult periodontitis. ARESTIN may be used as a part of a periodontal maintenance program, which includes good oral hygiene and scaling and root planning.

ARESTIN® powder contains 100,000 tiny microspheres, invisible to the eye. These microsphores contain the antibiotic drug minocycline, which is released over time into the infected pocket. This means ARESTIN® keeps fighting disease – causing bacteria after you’ve left the dentist’s chair.

IMPORTANT SAFETY INFORMATION:

  • ARESTIN® should not be used in any patient who has known sensitivity to minocycline or tetracycline.

  • ARESTIN® should not e used in children and in pregnant or nursing women.

GINGIVAL FLAP PROCEDURE (also called Pocket Reduction)

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For this procedure the gums are separated from the teeth. Then, they get pushed back temporarily to give the dentist access to the root and bone.

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Gingival flap surgery is to treat patients with moderate to advanced gum disease.  This is generally done after non-surgical treatments like scaling and root planing.  It can be used during osseous (bone) reshaping surgery.

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All tartar and plaque will be removed from the teeth.  Then, the area will be numbed and the dentist will use the scalpel to separate the gums from the teeth. They will get folded and lifted back into a flap. This allows complete access and visibility to the root surfaces of the teeth.

Diseased and inflamed tissue will be removed from between the teeth. Curetage and direct access Scaling and root planning is performed. If there are bone defects, they will be treated with osseous recontouring.

 

After the procedure, the gums are put back against the teeth and anchored with stitches. These will be removed a week to 10 days after surgery. You may notice some mild discomfort after the procedure is over.  An over-the-counter pain reliever will help with the pain.

 

GINGIVECTOMY

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This is where excess gummy tissue is surgically removed.   This procedure is often necessary when the gingiva have loosened and overgrown from the teeth creating deep pockets. The pockets make it hard to clean away plaque and tartar.

A favorable environment is made for gingival healing to occur.  Gingivectomy is also indicated in instances where gum tissue may overgrow as a reaction to certain medications or even when gingival tissue overgrows over ill fitting restorations or broken teeth.

Although gingivectomy was first developed for treating periodontal disease, it is now a common procedure to employ to cosmetically shape the gums.  This is sometimes called a "gum lift" and is used to help reduce the appearance of a gummy smile.  Gingivectomy alone is ideally used to remove overgrown gum tissue.  

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CROWN LENGTHENING PROCEDURE

This procedure is used to uncover tooth structure that becomes fractured or a cavity that extends below the gum line.  
When there is not enough supporting tooth structure it becomes difficult or impossible to restore the tooth.  There is not enough tooth exposed that the crown or restoration can connect to.

A crown lengthening procedure, which shapes the gum and supporting tissues to expose more tooth will solve this issue.  This will allow a restoration to be placed in a healthy environment.

Like gingivectomy, crown lengthening can also be done for cosmetic purposes.  The difference would be crown lengthening needs to have hard tissue removed to expose more clinical crown and shortening the gum proportions.

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Prophylaxis and Periodontal Maintenance
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Your maintenance/supportive periodontal care visit may include:

  • discussion of any changes in your health history

  • examination of your mouth tissues for abnormal changes

  • measurement of the depth of pockets around your teeth

  • assessment of your oral hygiene habits and provision of instruction

  • removal of bacterial plaque and tartar

  • x-ray film studies to evaluate your teeth and the bone supporting your teeth

  • examination of your teeth for decay and other dental problems

  • checkup on the way your teeth fit together when you bite

  • application or prescription of medications to reduce tooth sensitivity or other problems you may have.                

How often should you have supportive periodontal care visits?

This is based on your specific periodontal condition. The time between your periodontal visits may be every few weeks or every six months.  The frequency of your periodontal visits will be determined by:

   • What type of periodontal disease you have

   • Which periodontal treatment you had

   • Your response to treatment

   • Your rate of plaque growth

   •  Good oral care at home.

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© 2019 Gail Fernando DMD PC

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