The first stage of gum disease is gingivitis, which can typically be reversed with proper oral hygiene; however, if not addressed gingivitis can progress to periodontitis. The pathologic process of periodontitis attacks the supporting tissue and bone around the teeth forming “pockets.” If left untreated, this can result in tooth loss and consequently can affect the rest of the body. Once gum disease has reached periodontitis it is not curable, but with proper maintenance the process can typically be controlled.

Bacteria, toxins, and subsequent systemic inflammation from periodontitis can increase the chance of heart attack and stroke. Diabetics are more prone to periodontal breakdown, with periodontitis leading to difficulty controlling blood sugar levels as well as the increased possibility of heart attack and stroke.  The presence of periodontitis has also been linked to a higher risk for premature birth and low-birth weight for those who are pregnant.

Periodontal disease usually does not cause pain and therefore is asymptomatic or “silent.” The most common early warning signs of gum disease include persistent red, bleeding, and swollen gums along with receding gums and chronic bad breath.

Due to the complexity of the supportive structures of teeth, a Periodontist is often recommended to restore diseased gums and periodontal tissues to health. In some cases, treatment goes beyond just addressing the infection and may include further repair of the periodontal tissues to save teeth and reestablish oral health. Depending on the progression of gum disease, periodontal treatment can include:

a) Scaling and Root Planing

Regular dental cleanings focus on cleaning the visible portions of teeth. Scaling and root planing involves the cleaning and smoothing of the tooth below the gums (root).  Removing calcified plaque (calculus) and bacteria while smoothing the root’s surface reduces one’s risk of periodontal disease. This deeper cleaning often takes longer than a regular cleaning and may take more than one visit.

b) Osseous Surgery (Pocket Reduction Surgery)

As periodontal disease develops and progresses, the bacteria responsible for the tissue inflammation can also cause destruction of the bone around the roots of teeth. While scaling and root planing can remove the bacteria, in more severe cases of disease the significant changes in both bone and gum tissue will not resolve just with the removal of bacteria.  With severe disease the bone has developed indentations and osseous surgery allows for the reshaping of bone to promote successful healing and tissue attachment.

Gum tissue and bone should fit tightly around the teeth and cover each tooth’s entire root. In the presence of periodontal disease, the gum tissue and bone gets destroyed and pockets develop around teeth. If the disease isn’t halted, too much bone can be lost and teeth need to be extracted. Periodontal Regeneration is often recommended to reverse some of the damage by redeveloping lost bone and tissue. During this procedure, the gums are folded back around the site of regeneration and all disease-causing bacteria and plaque deposits are removed. Membranes, bone grafts, or tissue- stimulating proteins can be used to encourage bone and tissue regeneration around the affected teeth to restore a healthier bone level and help teeth last longer.

Soft Tissue Grafting is available to stop further gum recession and/or improve the esthetics of your smile.  Gum recession often develops from periodontal disease, orthodontic issues, aggressive brushing habits, age, and other associated factors. Exposed tooth roots and the appearance of longer teeth are often the result of gum recession. It is common for the exposed roots to be very sensitive to hot or cold foods and liquids. It is also common for patients to be bothered by the appearance of any recession they may have. Soft tissue grafts can be used to cover roots or develop gum tissue where it is absent due to excessive gingival recession. During this procedure, gum tissue may be taken from your palate or another donor source and is placed to cover the exposed root. Soft tissue grafting can be done for one tooth or several teeth to even the gum line and reduce sensitivity. This procedure can reduce further recession and bone loss, cover exposed roots to protect them from decay, and improve esthetics of one’s smile.

Although the goal is always to save teeth, the reality is that not all teeth can be saved. Once all options have been exhausted and a tooth has received a hopeless prognosis, the next step is to surgically remove the tooth. Great care is provided to not damage surrounding teeth, tissues, and alveolar bone upon extraction of a tooth.

The bony ridge that houses the teeth can lose bone mass over time as a result of trauma, periodontal disease, or the prolonged absence of one or more teeth. Preserving or restoring a ridge often calls for the use of bone graft for augmentation. Some of the common surgical procedures to protect an area of bone or create more bone in preparation for dental implants can include:

a) Ridge Preservation

Bone graft material is added to an extraction site to maintain the ridge dimensions of the jaw. The Ridge Preservation procedure is typically done to ensure there will be adequate bone in place for subsequent dental implant placement in the site or to maintain quantity of bone under a bridge to maintain esthetics.

b) Guided Bone Regeneration

It is common for dimensions of the jaw to change significantly if one or more teeth are missing, especially if they have been missing for a significant amount of time. Guided Bone Regeneration describes the process of increasing the dimensions of bone in your jaw with the use of a biocompatible graft that aids the growth of new bone where desired.

c) Sinus Augmentation

There are two maxillary sinuses, which sit above the upper posterior teeth. If an upper posterior tooth is lost, that loss will commonly leave a residual amount of bone between the gums and the sinus floor that is inadequate for dental implant placement. As a result, Sinus Augmentation, a procedure that elevates the floor of the sinus and fills the area with a biocompatible graft, may be necessary. A sinus lift ensures there is enough bone for the stability and success of an implant.

A dental implant is a replacement for a lost tooth root that ultimately will offer support for a replacement dental crown. Dental implants are small, biocompatible, and predominately made of titanium. They are designed to look, feel, and function like natural teeth. They are placed in either of the two jaws and will “osseointegrate” or fuse with the surrounding bone typically in 3-6 months. This fusion of bone to the implant creates a strong foundation for artificial teeth. Once the healing has completed, a general dentist or restorative dentist will design the final crown, bridgework, or denture.

For anyone who has lost a tooth, a dental implant and crown can offer the most lifelike and similar result to having a natural tooth.

Sometimes a tooth will fracture or develop decay that comes in close proximity to the bone that supports the tooth. To successfully restore the tooth, the surrounding bone levels need to be adjusted to promote the health of the soft tissue leading up the edge of the crown or filling. A minimum of 3 millimeters between the bone and edge of the crown is necessary to prevent the gingiva from becoming irritated and swollen since there is not enough space for the gums to heal properly. The crown lengthening procedure serves to slightly reduce and shape the level of bone near the fracture or decay of the tooth and create adequate space for optimal gingival health.