SCREENING OF THE GUMS
The gum detailed screening is conducted on the entire mouth. Carefully examining the gums by taking six measures per tooth. These measures, in millimeters, expresses the depth of the periodontal pocket. In the case of a patient with teeth 32 , 192 measurements were recorded. This step takes about thirty minutes and is crucial in determining the teeth to target during the gums treatment (SCALING).
CLEANING - SCALING - ROOT PLANING
The scaling is done with an ultrasonic device. The aim of scaling is to remove all deposits, calcified or not, and bacteria from the tooth surface. It removes the tartar above the gum and if there is access, under the gum line. This reduces the inflammation and restores a healthy balance to the the gums.
When periodontal pockets are deep and tartar accumulated in the depth of the pockets, we no longer talk of scaling, but rather root planing. It is made with an ultrasonic device and manual instruments with or without the use of local anesthesia. The goal of root planing is to remove all deposits, calcified or not, and bacteria from the surface of the root. The root planing also removes the granulation tissues (bad scars that block the way for a good cure). This act is called root planing and is predominantly made with the help of laser.
During root planing , irrigating the periodontal pockets with an antibacterial solution calls chlorhexidine is often the course of action taken by most dentists. The solution acts on the bacteria causing a loss of theirs internal components, in other words, kills the bacteria. By its antibacterial effect, the chlorhexidine reduces the inflammation, redness and bleeding gums since it drastically reduce the bacteria concentration.
Chlorhexidine can also be prescribed as a mouthwash if needed in severe cases.
For good results following the root planing, the gum must heal. It has been proven that laser therapy provides:
- faster healing
- removal of infected and scared tissues
- less discomfort following treatment
- reduction of the inflammation
- disinfection pockets
At low power, the laser has a biostimulation effect that increases the blood circulation, the formation of collagen fibers and bone cells activity. The laser stimulates the cells of the body for fast healing. This healing is ideal, because the depth of the pocket is actually reduced and not distorted by tissue contractions. Laser therapy is needed to remove the infected tissue, leaving only healthy tissue in the periodontal pocket.
A study by the Buffalo School of Dental Medicine reports: the laser reduces discomfort following the gum treatment. With the flexibility of the laser power can be adjusted to maximize its positive effects without affecting bone and dental structures. Studies show that the laser significantly decreases the amount of bacteria in the periodontal pocket and particularly invasive bacteria often associated with the progression of gum disease, Actinobacillus actinomycetemcomitans. This bacterial reduction is observed even up to 6 months after therapy.
Laser treatment is done in conjunction with the deep scaling (root planing). For best results, several laser sessions are required within a few months. This allows a quick and perfect healing from a clean and healthy environment.
Prophylaxis is another term for polishing teeth . It is done after completion of scaling and is used to remove plaque on tooth surfaces . Prophylaxis is achieved by means of a rotary rubber cup with a fluorinated paste.
ANTIBIOTHERAPY - PERIOSTAT
In severe cases of periodontitis, an antibiotic, Periostat (doxycycline hyclate), is prescribed in addition to the scaling and root planing treatments. Given low dose, 20 mg, Periostat act as a regulator of the body's response. It prevents the production of destructive factors of the gum, collagenase, thus allowing the gum to heal. In other words, it's reduce the inflamatory respond of the body.
You are the primary doctor in this therapy. In clinic, the therapy consists of debridement and disinfection of your gums and pockets. At home, is your responsability to keep them clean to allow your body to heal and regenerate. Your cares included:
- Teeth brushing after every meal
- Flossing at least once a day
- The use of an antibacterial mouthwash twice a day for 30 seconds
FOLLOW UP AND DENTAL CLEANING
A follow-up every 3 months is prescribed in order to control the healing process and the advance (or regression) of periodontitis. Gum screening, scaling, root planing , laser therapy and chlorhexidine irrigation are repeated again if necessary. The results of the screening are than compare with the previous records at track the revolution/regression of the disease. Once the disease under control, mandatory periodic cleaning are scheduled every 6 months.