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SEVERE PERIODONTAL DISEASE

Advanced periodontal disease.

30% of the population is affected with chronic periodontitis*

This condition can NOT be reversed with simple brushing,
 it can ONLY be treated by a
periodontist.

Infectious Disease Surgery
Severe Disease Left Untreated
Treatment

At this stage, the infection will be treated surgically!    

  The difference between gingivitis and periodontal disease is that in gingivitis the infectious disease attacks the connective tissue around the tooth. The bacteria release toxins in the pockets or sulcus which trigger the infection but destruction is caused by the body's own immune system.  Cytokines (chemical machetes) cut their way through healthy tissue and release PMNs like collagenase, prostaglandins and interleukin which destroy healthy connective tissue.  In periodontitis the infectious disease has gone PAST the tissues into the supporting bone of the tooth causing tooth motility leading to permanent tooth loss if not professionally treated by your dentist. 

 Calculus, pus, infection...mr gross mouth!

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Signs of Advanced or Severe Periodontal disease :

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gum tissue had receded even further

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amount of attachment loss is defined as the sum of the recession and pocket depth.
a.        Slight- 1-2mm of attachment loss
b.        Moderate- 3-4mm of attachment loss
c.        Severe- 5mm or greater of attachment loss

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very red and swollen  gums  

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gums are sore and painful

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gum tissue bleeds very easily which is a good indicator that you have ACTIVE disease

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periodontal ligament is further destroyed 

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presence of pain

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abscess and pus

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loss of, often healthy, teeth

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six or more bleeding points       

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bad breath

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gingival recession with soft tissue defects or frenum pulls

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pocket depths of 8 mm or deeper

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very mobile teeth

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advanced loss of the supporting bone.

     Here half or more of the original bone holding the tooth has been lost and once the bone has been lost it does not grow back.  This condition causes tooth loss resulting in impaired chewing, speaking, an unpleasing smile and occlusal problems.   

Bacteria loaded calculus and infection

PERIODONTAL DISEASE IS NOW A PAINFUL PROGRESSIVE INFECTIOUS DISEASE THAT HAS AFFECTED YOUR OVERALL WELL-BEING

This disease has now severely attacked and destroyed your gums, bones and supporting structures of your teeth. This stage requires periodontal surgery.

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Treatment:

1.  Professional treatments-to remove this harmful bacterial growth from you teeth and gums. You will be placed in the red program which includes two sessions with us & multiple sessions with a specialist :

A. Session 1:
 1.   Comprehensive/Recare exam
 2.   Perio bag including home care 
       items
 3.   Oral Hygiene Instructions

B. Session 2: 

1.   Root Planing and Scaling and/or

2.   Corrective periodontal surgery with periodontist. 

Surgery

Surgery is indicated when deep pockets remain underneath the gum after extensive cleaning sessions. These pockets must be reduced. The surgery itself allows:
bullet access for further cleaning of the root surface
bullet removal of diseased tissue
bullet repositioning and shaping of the bones, gum, and
   tissues supporting the teeth. 

Surgical procedures vary depending on the individual diagnosis and needs of the patient. In general, the procedure follows five steps:
1. shaping gum tissue
2. lifting, or flapping, the gums away from the tooth and surrounding bone
3. cleaning and removing diseased root surfaces
4. contouring the remaining bone and attempting to regenerate lost bone and gingival attachment through bone grafts and guided tissue regeneration
5. replacing gum tissue so that there is minimal pocket depth.

Bone Grafting.  This involves the surgical placement
of bone graft material into the defect, which stimulates new bone growth. The material used may be commercially prepared bone substance called decalcified freeze-dried bone allografts (DFDBA), which is obtained from donors, or bone from the same patient. 

Guided-Tissue Regeneration. A technique called guided tissue regeneration uses a specialized piece of fabric, which is sewn around a tooth to cover a crater in the bone that has been meticulously cleaned out. The gum is then sewn over the fabric. This fabric prevents the gum tissue from growing down into the bone defect and allows the bone and the attachment to the root to regenerate. After four to six weeks the fabric must be removed using a minor surgical procedure.**

C. Session 3: 

       1.   Remeasuring and updating 
        perio charting
  2.   Cleaning with fluoride
  3.   Oral Hygiene Instructions

2.  Three month perio maintenance visit to remove the tartar, which harbors and nurtures the growth of undesirable bacteria. You need to be seen every 3-4 months because that's about how long it takes for the biofilm to re-establish causing bacteria infection.

3.  Good brushing for a minimum of twice a day and after meals (if possible) using your soft bristled perio instrument (Rota-dent) for at least two minutes.

4.   Daily flossing. Start cleaning BETWEEN your teeth.  Periodontal disease begins between the teeth.  The area between the teeth are more prone to infection than facial or tongue gum tissue surfaces simply by anatomy.  This tissue is not keratinized like tissue found on the facial and tongue surfaces.  Non-keratinized tissue is more susceptible to breakdown.  It is also a very protected area, NOT reached by brushing or rinsing. 

     Since the disease starts between the teeth, it makes sense to start cleaning in between the teeth and than brush.  You can clean this area with interdental brushes, picks, sticks, oral irrigation, and automatic flossers.  remember this disease needs to be treated both in the office and at home.++

5.   Use of Periogard, an antimicrobial medicated mouthrinse.

6.   Daily fluoride treatments.

7.   Do not smoke or use alcoholic beverages while your gums are inflamed.

8.  Good dietary habits.  Cut back on foods and beverages that contain sugar.

9.  On going education about the health of your mouth.

     To insure successful results following periodontal treatments, patient cooperation in maintaining  excellent oral hygiene is essential.

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 Remember: If left untreated, serve periodontitis will lead to:  

Consequences of untreated periodontitis  

bulletInfection that can affect your overall health
bulletPain
bulletBone loss
bulletTooth loss
bulletChanges affecting your appearance
bulletPoor nutrition, weight loss

Delaying treatment is a risky decision because gum disease never goes away on its own. It is an ongoing destructive bacterial infections of gums and bone that can have systemic effects.

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Case Type IV Advanced Periodontitis-Diagnosis Code 4800-Major loss of alveolar bone support usually accompanied by an increase in tooth mobility with possible furcation involvement. Probing depth are generalized 6mm and above.
       
Case Type V Refractory Progressive Periodontitis-Diagnosis Code 4900-Is characterized by rapid attachment and bone loss. There is usually a progression of the periodontal breakdown even after aggressive intervention

Type 2 Diabetes and Gum Disease Increases Risk of Death by Three Times

A recent study suggest people with type 2 diabetes should be be certain they are taking excellent car of their teeth and gums.  According to a study published in the journal Diabetes Care on the effects of periodontal disease on mortality, people with severe periodontal disease had more than THREE TIMES the risk of dying of cardiac or renal disease. Johns Hopkins Medical Letter Vol. 17, Issue 2 pg 1 April 2005

 

* Dentistry Today pg 44 April 2001 from alpha Omega, Vol 93, No.4. Dec 2000
**[email protected]
*AAP Parameters of Care

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