Non-Surgical Gum Disease Treatment

According to several studies nearly 85% of the American population has some stage of gum disease,( medically called Periodontal Disease). It is a painless disease, often unnoticed by patients until their teeth get loose or start shifting. In addition, gum disease is the number one reason we lose our teeth today and it is a risk factor in several diseases including, heart attack and stroke, Alzhimers and Dimentia, Erectile Disfunction, Pancreatic cancer and many more. The list of diseases grows yearly. Surprisingly, many people know very little about it. This is going to change. As the body of evidence regarding the gum disease- systemic disease connection grows and physocains become more aware of the connections, we will see more and more reports about this in the media.

At State of the Art Comfort Dentistry located in Smithtown Long Island, we have made a strong commitment to our patient's health. The purpose of our Hygiene Department is to help our patients maintain healthy gums, and therefore live longer and healthier lives. We follow the current standard of care by performing a six point gum measuring around every tooth on an annual basis as part of our periodic examinations. Accordingly, we treat every patient on an individual basis depending on their own specific needs.

Shockingly, the American Academy of Periodontology has stated that 73% of dental offices do not evaluate their patients for periodontal disease.  In addition, according to the American Dental Association, 50% of the offices diagnosing gum disease do not measure the gums for severity of periodontal disease.  This means that, at best, 13.5% of offices across the country are meeting the gum disease measuring standard of care.

Many advances have been made in the recent years to treat gum disease without surgery. In our Long Island dentaloffice we combine all the possible treatment methods for gum disease in order to help our patients avoid painful gum surgery and maintain healthy gums for a life time.

The four stages of gum disease are described below

Healthy gums: What is important to know is that gums are actually attached to our teeth forming a seal around the tooth. This seal keeps the bacteria inside our mouths from entering out bodies. When gums are pink, firmly attached to your teeth, never bleed they are healthy. In addition to a visual inspection of the gums, dentists evaluate the health of your gums by measuring the space between the gum and the tooth with a round ended ruler. Healthy gums measure between 1 -3 millimeters and do not bleed or hurt during the measuring process. It is also important to evaluate your x-rays to make sure there is no tartar under the gums and no bone destruction around the roots.

Stage I gum disease: When Plaque and Tartar build up around the teeth and are not removed in a timely fashion, gum disease begins. Plaque and Tartar are full of billions of disease causing bacteria that infect the gums causing gum inflammation or Gingivitis. Inflamed gums are red, swollen and bled easily. The good news is that Stage I Gum Disease is fully reversible.

Stage II Gum Disease: If not removed, the plaque and tartar deposits on the roots continue to creep deeper under the gums. This causes the gums to separate from the tooth, breaking the biologic seal. When the space between the gum and the tooth is measured, we get a reading of 4-5 millimeters.

Stage III Gum Disease: As the plaque and tartar buildup progresses further down the root, the bacteria begin to infect and destroy the jaw bone supporting the tooth. When the space between the gum and the tooth is measured, we get a reading of 6-7 millimeters. Bad breath or Halitosis, may become noticeable at this time. Bone destruction and tartar can be seen on x-rays.

Stage IV Gum Disease: Bone destruction continues to progress in between the roots, the teeth begin to get loose or shift, Bad breath is common and it may be difficult to chew. When the space between the gum and the tooth is measured, we get a reading of 8 millimeters or higher.

Left untreated, Gum Disease will lead to eventual loosening and loss of the tooth.  This is the the #1 cause of tooth loss in the United States today.

For moderate and advanced stage gum disease Surgery is traditionally used to cut away diseased gum and bone leaving exposed roots that can be unsightly, sensitive and more prone to decay. In our office we use the Nd:Yag Laser to perform a minimally invasive microsurgery technique.

Treatment Factors

As with any disease, gum disease treatment success depends on several factors:

Aggressiveness of the disease: Some bacteria are more aggressive than others. Some patients present with more advanced stages of disease than others. We are seeing people developing gum disease at an earlier age and the progression of disease is more advanced.

Your immune system: Nutrition, health and stress are all contributing factors in and how fast disease progresses how your body responds to treatment.  For example, Diabetics are at a higher risk for Gum Disease.

Genetics: Your family history plays a significant role. If your parents and grandparents had gum disease chances are that you may be at a greater risk for it as well.

Your home care: is critical for the success of the treatment. Removing Plaque daily is a fundamental requirement for success.

Your commitment to Treatment: Coming in on time and keeping your scheduled appointments is important allow us proper time perform the necessary treatment. We need your commitment to us so that we can help you.

Your commitment Maintenance: Unfortunately at this time, there is no cure for gum disease. Therefore follow care is critical. Studies show that it takes 2-3 months for the bacteria to reestablish themselves under the gums to a disease causing state. We have to constantly disrupt the biofilm that is plaque and not allow tartar to build up on your teeth. This means that missing your maintenance appointments can result in break down all over again. This can be very frustrating for you and us.

Our Office: We are fully committed to your health. We spend many hours per year attending lectures on the latest advances in research and treatment modalities for gum disease treatment. We use the latest techniques, instruments, and medicines to treat gum disease. We are passionate about the care we provide to our patients. We believe in treating disease as early as possible. As soon as we can detect it. We are her for you.

The biggest obstacle to providing proper care for our patients is patient commitment to treatment.

The second biggest obstacle are the insurance companies. We treat people on individual basis depending on their specific needs. Insurance companies take the one size fits all approach which just does not work. This may come as a surprise, but insurance companies do not care about your health, they care about their quarterly profits. We suggest you watch the movie "Sicko" by Michael Moore to understand this better. Many insurance benefits are limiting. Approval for care is often done based on codes and numbers not on the patients needs. The insurance company representative does not actually see the disease going on in the patient's mouth; they do not consider your family history, health, home care, disease virulence, degree of inflammation or tartar and plaque buildup, etc…

Fortunately we do not treat your insurance policy, we treat you. We will try our hardest to play their game and maximize your benefits. One of the biggest problems we see is in the area of limitation frequency of professional cleanings by the insurance companies. Our commitment is to provide you with the right care. The choice to receive treatment is ultimately yours and we will respect your choice to follow our treatment recommendations or to follow what your insurance company "allows". Just do not expect the same results.

The third obstacle is the confusing medical terms and insurance codes.

Below are some translation of common dental insurance codes on gum disease treatment, names that we use and why we do it.

Prophy: This is a name give to a professional dental cleaning. By definition it is the removal of plaque and tartar above the gum line. In our office, we utilize a Piezo ultrasonic instrument, hand instruments and floss to remove plaque and tartsr depostis on your teeth.  Bakingsoda-water microabrasion and polishing paste are used to remove the most stubborn satin. . Most insurance companies only allow a maximum of 2 per year. A prophy is performed during your maintenance visit, it is not considered therapeutic.

Full Mouth Detriment: This is the removal of superficial tartar and plaque and debris from the teeth to facilitate healing of inflamed gums and help expose any tartar under the gums. This is a therapeutic treatment. It is always followed up by either a Prophy or more advanced gum disease treatments such as deep cleanings. Unfortunately most insurance companies downgrade a Gross debriment to a Prophy or not pay for it at all.

Scaling and Root Planning: This is the removal of plaque, tartar and bacterial waste products (toxins) deep below the gum. We use specially designed ultrasonic instruments and hand instruments not only to remove deposits from the roots, but to smooth the roots as well. This facilitates reattachment of the gums to the roots and healing. This procedure is always done with Novocain for your comfort. Even with proper maintenance, deposits may accumulate under the gums and a deep cleaning may need to be done again in a few years.

Periodontal Maintenance: Essentially this is a Prophy. However patients with a history of periodontal disease are allowed by some insurance plans to have more frequent maintenance visits. They call these a Periodontal Maintenance. Many insurance companies do not allow Perio Maintenance indefinitely; perhaps they want you to develop gum disease all over again.

Sub-gingival Irrigation:  Our bodies heal better without the presence bacteria. Following the physical removal of plaque, tartar and bacterial toxins from the roots (scaling and root planning) we irrigate below the gums with a Chlorohexidene rinse This  is a safe and very effective to flush out the gum pockets and rapidly reduce the bacteria numbers deep under the gums. 

Localized Delivery of Chemotherapeutic Agents: In deep pockets you may choose to have an antibiotic gel placed to further kill any remaining bacteria. Studies show that this improves healing and reattachment by as much as 62% when done in conjunction with a deep cleaning. The gel slowly dissolves over a period of 1-3 months. It has virtually no systemic effects (does not enter your body) and acts directly in the pocket itself.

Periostat: Periostat is a pill that helps to stop or slow down the progression of gum and bone break down around teeth. It is taken 2 times per day. It is a very low dose of Tetracycline. In such a low dose it does not behave like an antibiotic as it does not kill bacteria, but it does retain its gum disease fighting properties.

Chlorahexidine Rinse: This is a liquid medicine that is a strong antimicrobial agent. It is one of the best rinses that has been shown to kill gum disease causing bacteria and has been safety used in dentistry for many decades.

Oral-B Triumph Rotary Brush: Is an electric tooth brush that has soft bristles which are very gentle on sensitive roots, but very effective in removing plaque and stain. Research shows that when used properly it is Superior to the Sonicare in treating Gingivitis. The Oral-B Triumph with its pointed head is used during the scaling and root planing phase of your treatment to deliver Chlorahexidine deep under your gums to kill disease causing bacteria. It is also great for patients with bridges and braces.

Refractory Periodontitis: Even with proper treatment and maintenance some patients continue to have gum problems. This is very frustrating for us and even more frustrating for the patients. But just like any chronic disease, relapse is a reality. Sometimes an adjustment to non-surgical therapy is needed, sometimes Gum Surgery is necessary, sometimes disease continues despite everything we do. There are factors beyond our and your control such as genetics, disease virulence; sometimes there are things that are difficult to control: stress, your immune system, your home care, nutrition. We will continue helping you any way we can because we are committed to your health.

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