Periodontics is the dental specialty focusing exclusively in the inflammatory disease that destroys the gums and other supporting structures around the teeth. Dental Aesthetics specializes in the prevention, diagnosis, treatment of periodontal, and in the placement of dental implants. Our periodontists received extensive training in these areas, including three additional years of education beyond the dental school. As dental specialists in Lahore, we are experts in the latest techniques for diagnosing and treating periodontal disease. We are also trained in cosmetic periodontal procedures. Dental Aesthetics offers a wide range of treatments, such as scaling and root planning (the cleaning of infected root surfaces), root surface debridement (the removal of damaged tissue), and regenerative procedures (the reversal of lost bone and tissue). When required, we also perform surgical procedures for patients with severe gum disease at our dental facility in DHA Lahore. Additionally, our dentists are trained in the placement, maintenance and repair of dental implants.Periodontology is an emerging specialty in the field of dentistry which deals with the diseases of the tooth supporting structures. At our clinic in Lahore, we advocate proper tooth brushing technique and flossing to avoid periodontal problems. We communicate with the patient and teach them the correct way of brushing and flossing.
What causes gum disease ?
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can form tartar. And only a dental hygienist can remove tartar.
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria causes inflammation of the gums which is called gingivitis. During gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.
When gingivitis is not treated, it can advance to “periodontitis” (which means inflammation around the tooth). In periodontitis, gums pull away from the teeth and form spaces (called pockets) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If ignored, the bones, gums, and tissue that support the teeth are destroyed.
Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment. Hormonal changes in girls/women are also a factor. These changes can make gums more sensitive and make it easier for gingivitis to develop. People with diabetes are at higher risk for developing infections, including gum disease. Diseases such as AIDS and its treatments can also negatively affect the health of gums. Moreover, there are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections. And some medicines can cause abnormal overgrowth of the gum tissue. Also, some people are more prone to severe gum disease than others.
Treatment of periodontitis may include several steps, the first of which often requires the removal of the local causative factors in order to create a biologically compatible environment between the tooth and the surrounding periodontal tissues, the gums and underlying bone. Left untreated, chronic inflammation of the gums and supporting tissue can raise a person’s risk of heart disease.
Prior to beginning these procedures, the patient is generally numbed in the area intended for instrumentation. Because of the deeper nature of periodontal scaling and root planing, either one half or one quarter of the mouth is generally cleaned during one appointment. This allows the patient to be entirely numbed in the necessary area during treatment at Dental Aesthetics. It is typically not recommended to have the entire mouth scaled at one appointment because of the potential inconveniences and complications of numbing the entire mouth.
Generally, the first step is the removal of dental plaque, microbial biofilm, from the tooth, a procedure called scaling. Root planing involves scaling the tooth’s root. These procedures may be referred to as scaling and root planing, periodontal cleaning, or deep cleaning. These names all refer to the same procedure. The term “deep cleaning” originates from the fact that pockets in patients with periodontal disease are literally deeper than those found in individuals with healthy periodontia. Such scaling and root planing may be performed using a number of dental tools, including ultrasonic instruments and hand instruments, such as periodontal scalers and curettes. The objective for periodontal scaling and root planing is to remove dental plaque and calculus (tartar), which house bacteria that release toxins which cause inflammation to the gum tissue and surrounding bone.
Removal of adherent plaque and calculus with hand instruments can also be performed prophylactically on patients without periodontal disease. A prophylaxis refers to scaling and polishing of the teeth in order to prevent oral diseases. Polishing does not remove calculus, but only some plaque and stains, and should therefore be done only in conjunction with scaling.
Often, an electric device, known as an ultrasonic, sonic scaler, or power scaler may be used during scaling and root planing. Ultrasonic scalers vibrate at a frequency to help with removing stain, plaque and calculus. In addition, ultrasonic scalers create tiny air bubbles through a process known as cavitation. These bubbles serve an important function for periodontal cleanings.
Sonic and ultrasonic scalers are powered by a system that causes the tip to vibrate. Sonic scalers are typically powered by an air-driven turbine. Ultrasonic scalers typically use either magnetostrictive or piezoelectric systems to create vibration. Magnetostrictive scalers use a stack of metal plates bonded to the tool tip. The stack is induced to vibrate by an external coil connected to an AC source. Ultrasonic scalers also include a liquid output or lavage, which aids in cooling the tool during use, as well as rinsing all the unwanted materials from the teeth and gum line. The lavage can also be used to deliver antimicrobial agents.
Although the final result of ultrasonic scalers can be produced by using hand scalers, ultrasonic scalers are sometimes faster and less irritating to the client. Ultrasonic scalers do create aerosols which can spread pathogens when a client carries an infectious disease. Research shows no difference in effectiveness between ultrasonic scalers and hand instruments. Of particular importance to dentists themselves is that the use of an ultrasonic scaler may reduce the risk of repetitive stress injury, because ultrasonic scalers require less pressure and repetition compared to hand scalers.
A new addition to the tools used to treat periodontal disease is the dental laser. Lasers of differing strengths are used for many procedures in modern dentistry, including fillings. In a periodontal setting, a laser may be used following scaling and root planing in order to promote healing of the tissues.
Following scaling, additional other steps may be taken in order to ensure disinfection of the periodontal tissues. Oral irrigation of the periodontal tissues may be done using chlorhexidine gluconate solution, which has high sustantivity in the oral tissues. This means that unlike other mouthwashes, whose benefit end upon expectorating, the active antibacterial ingredients in chlorhexidine gluconate infiltrate the tissue and remain active for a period of time. However effective, chlorhexidine gluconate is not meant for long term use.
Site specific antibiotics may also be placed in the periodontal pocket following scaling and root planing in order to provide additional healing of infected tissues. Unlike antibiotics which are taken orally to achieve a systemic effect, site specific antibiotics are placed specifically in the area of infection. These antibiotics are placed directly into the periodontal pockets and release slowly over a period of time. This allows the medication to seep into the tissues and destroy bacteria that may be living within the gingiva, providing even further disinfection and facilitation of healing. Certain site specific antibiotics provide not only this benefit, but also boast an added benefit of reduction in pocket depth. Arestin, a popular doxycycline site specific antibiotic claims the ability to regain at least 1 mm of gingival reattachment height.
In cases of severe periodontitis, scaling and root planing may be considered the initial therapy prior to future surgical needs. Additional procedures such as bone grafting, tissue grafting, and/or gingival flap surgery done by our periodontist.
Patients who present with severe or necrotizing periodontal disease may have further steps to address during their treatment. These patients often have genetic or systemic factors that contribute to the development and severity of their periodontitis. Common examples include diabetes type I and type II, a family history of periodontal disease. Intervention may also include discontinuation of medication that contributes to the patient’s vulnerability or referral to a physician to address an existing but previously untreated condition if it plays a role in the periodontal disease process.
A scaling and root planing procedure is to be considered effective if the patient is subsequently able to maintain his/her periodontal health without further bone or attachment loss. The long-term effectiveness of scaling and root planing depends upon a number of factors. These factors include patient compliance, disease progress at the time of intervention, probing depth, and anatomical factors like grooves in the roots of teeth, concavities, and furcation involvement which may limit visibility of underlying deep calculus and debris.
First and foremost, periodontal scaling and root planing is a procedure that must be done thoroughly and with attention to detail in order to ensure complete removal of all calculus and plaque from involved sites. If these causative agents are not removed, the disease will continue to progress and further damage will result. In cases of mild to moderate periodontitis, scaling and root planing can achieve excellent results if the procedure is thorough. As periodontitis increases in severity, a greater amount of supporting bone is destroyed by the infection. This is illustrated clinically by the deepening of the periodontal pockets targeted for cleaning and disinfection during the procedure. Once the periodontal pockets exceed 6 mm in depth, the effectiveness of deposit removal begins to decrease, and the likelihood of complete healing after one procedure begins to decline as well. The more severe the infection is prior to intervention, the greater the effort required to arrest its progress and return the patient to health. Diseased pockets over 6 mm can be resolved through periodontal flap surgery, performed by periodontists at Dental Aesthetics.
Although healing of the soft tissues will begin immediately following removal of the microbial biofilm and calculus that cause the disease, scaling and root planing is only the first step in arresting the disease process. Following initial cleaning and disinfection of all affected sites, it is necessary to prevent the infection from recurring. Therefore, patient compliance is, by far, the most important factor that has the greatest influence on the success or failure of periodontal intervention. Immediately following treatment, the patient will need to maintain excellent oral care at home. Coupled with proper homecare, which includes but is by no means limited to brushing twice daily for 2-3 minutes, flossing daily, the potential for effective healing following scaling and root planing increases. If the patient fails to change the factors that allowed the disease to set in, the infection will likely recur.
Since the patient may still have pockets that surpass the effective cleaning ability of a brush or floss, it is vital to the long term success of their treatment that they return every 90 days in order to ensure that those pockets remain free of deposit. This will let us determine whether the intervention was successful. Furthermore, this appointment allows for the review of homecare or some necessary additions.