Scali Dental Associates
425 Trapelo Road
Belmont, MA 02478
Phone: 617-489-7900
Hours:
Monday & Tuesday:
9 a.m. to 6 p.m.
Wednesday:
7:30 a.m. to 3:30 p.m.
Thursday: 12 p.m. - 8 p.m.
Friday: 7:30 to 2 p.m.
Saturday: By Appointment Only
What is periodontal disease?
Periodontal disease is an infection of the tissues that support your teeth.
Your gum tissue is not attached to the teeth as high as it may seem - there is a very shallow v-shaped crevice called a sulcus between the tooth and gums.
Periodontal diseases attack just below the gum line in the sulcus, where they cause the attachment of the tooth and its supporting tissues to break down. As the tissues are damaged, the sulcus develops into a pocket. Generally, the more severe the disease, the greater the depth of the pocket.
What causes periodontal diseases?
The sticky film that constantly forms on your teeth is called plaque, and is made mostly of bacteria. Some of these bacteria produce by-products (called toxins or enzymes) that can irritate the tissues that support your teeth. These by-products can damage the attachment of the gums, periodontal ligament and bone to your teeth.
You can remove plaque with good oral hygiene, brushing your teeth twice a day and cleaning between them once a day with floss or another interdental cleaner. When plaque is not removed through good oral hygiene, it builds up along the gum line and increases your risk of developing periodontal disease.
Plaque that is not removed regularly can harden into a rough, porous deposit called calculus, or tartar. Tartar itself does not seem to cause disease, but it may make it more difficult for you to remove plaque so it should be removed regularly. Tartar can only be removed when your teeth are professionally cleaned in the dental office.
Do some factors increase the risk of developing periodontal diseases?
Yes, some factors can increase the risk of developing periodontal diseases. If one or more of the following apply to you, it is especially important that you practice good oral hygiene and follow your dentist's advice to maintain healthy teeth and gums.
- People who smoke or chew tobacco are more likely to have periodontal disease. And it's more likely to be more severe than in those who do not use any tobacco products.
- Some systemic diseases, such as diabetes, can lower your body's resistance to infection, making periodontal diseases more severe.
- Many medications, such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers, and oral contraceptives can affect the gums. In addition, medications that reduce your salivary flow can result in a chronically dry mouth, which can irritate your oral soft tissues. Let your dentist know about your medications and update your medical history files at the dental office when any changes occur.
- Bridges that no longer fit properly, crooked teeth or fillings that have become defective can contribute to plaque retention and increase your risk of developing periodontal disease.
- Pregnancy or use of oral contraceptives increases hormone levels that can cause gum tissue to be more sensitive to the toxins and enzymes produced by plaque and can accelerate growth of some bacteria. The gums are more likely to become red, tender and swollen, and bleed easily.
How would I know if I had periodontal disease? It is possible to have periodontal disease and have no warning signs. That is one reason why regular dental check-ups and periodontal examinations are very important.
However, several warning signs can signal that you have a problem with periodontal disease. If you notice any of the following, see your dentist:
- Gums that bleed easily;
- Red, swollen or tender gums;
- Gums that have pulled away from the teeth;
- Puss between the teeth when the gums are pressed;
- Persistent bad breath or bad taste;
- Permanent teeth that are loose or separating;
- Any change in the way your teeth fit together when you bite;
- Any change in the fit of partial dentures.
Types of Periodontal Diseases
Periodontal diseases are classified according to the severity of the disease. The two major stages of the disease are gingivitis and periodontitis.
Gingivitis
Gingivitis is a milder and reversible form of periodontal disease that only affects the gums. It develops as toxins in plaque irritate gums, making them red, tender, swollen and likely to bleed easily. It can usually be eliminated by daily brushing, cleaning between your teeth, and regular dental cleanings.
Periodontitis
Gingivitis may lead to more serious, destructive forms of periodontal disease, called periodontitis. There are several forms of periodontitis, with the most common being chronic adult periodontitis.
Periodontitis occurs when toxins, enzymes and other plaque by-products destroy the tissues that anchor teeth into the bone. The gum line recedes, which can expose the tooth's root. Exposed roots can become susceptible to decay and sensitive to cold and touch.
As we mentioned earlier, the sulcus deepens into a pocket in the early stage of periodontal disease. Plaque that collects in these pockets can be difficult to remove during regular brushing and interdental cleaning. By-products from the plaque that collect in these pockets can continue to damage the gums, periodontal ligament and bone. In some cases, so much ligament and bone are destroyed that the tooth becomes loose. Usually, your dentist can still treat the disease at this point. In the worst of cases, a loose tooth may need to be extracted or may fall out on its own.
How can I prevent periodontal diseases?
Daily good oral hygiene can help reduce your risk of developing periodontal diseases.
Brush your teeth twice a day. With proper brushing, you can remove plaque from the inner, outer and chewing surfaces of each tooth. Your dentist or dental hygienist can show you a proper brushing technique.
Using a fluoride-containing toothpaste also will help protect your teeth against cavities.
Carefully clean between your teeth once a day with dental floss or another interdental cleaner to remove plaque from areas your toothbrush can't reach. It only takes a few minutes each day and is just as important in maintaining oral health as brushing your teeth.
If you need extra help controlling gingivitis and plaque that forms above the gum line, your dentist may recommend using an ADA-accepted antimicrobial mouthrinse or other oral hygiene aids as an effective addition to your daily hygiene routine.
When choosing dental care products, look for thos that display the American Dental Association's Seal of Acceptance. This is your assurance that they have met ADA standards of safety and effectiveness.
Checking for Periodontal Diseases
During your checkup, the dentist will examine your gums. This is called a periodontal examination. He or she will use an instrument called a periodontal probe to gently measure the depth of the sulcus surrounding each tooth. The healthy sulcus depth is usually three millimeters or less.
Periodontal diseases cause the suclus (the shallow v-shaped crevice between your teeth and gums) to deepen into a pocket. A periodontal probe can determine whether you have developed any pockets and the depth of those pockets. Generally, the more severe the disease, the deeper the pocket.
Dental X-rays, or radiographs, also may be taken to evaluate the amount of bone supporting the teeth and to detect other problems not visible during the clinical examination. If periodontal disease is diagnosed, the dentist may provide treatment or may refer you to a periodontist, a dentist who specializes in the treatment of periodontal disease.
How are periodontal diseases treated?
Treatment methods depend upon the type of disease and how far the condition has progressed.
The first step usually is a thorough cleaning that includes scaling to remove plaque and tartar deposits. The tooth roots also may be planed to smooth the root surface, allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion, or bite, may require adjustment.
Your dentist also may recommend medications to help control infection, pain or to encourage healing. These medications can be given in various forms: a pill that you would swallow, a liquid mouthrinse or in a form that the dentist could place directly in the periodontal pocket after scaling and root planing.
Is surgery sometimes needed?
When deep pockets between teeth and gums (4 to 6 millimeters or deeper) are present, it is difficult for the dentist to thoroughly remove the plaque and tartar. Likewise, you may have trouble keeping these pockets clean and free of plaque. If the pockets do not heal after scaling and root planing, periodontal surgery may be needed. One of the goals of periodontal surgery is to reduce the depth of the periodontal pockets to make them easier to keep clean.
With surgery, the dentist can access hard-to-reach areas that require the removal of tartar and plaque. The tooth root is cleaned and smoothed. Sometimes the bone around the tooth also is smoothed to help remove these pockets. The gums then are sutured back into place or into a new position that will be easier to keep clean at home.
Bone surgery may be used to rebuild or reshape bone that has been destroyed. Grafts of the patient's bone or artificial bone may be used, as well as special membranes. The dentist may use splints, bite guards or other appliances to stabilize loose teeth and to aid the regeneration of tissue during healing.
If excessive gum tissue has been lost from the tooth root (gum recession), a gum graft may be performed.
After surgery, the dentist may apply a protective dressing over teeth and gums. An antibiotic and mild pain reliever may be prescribed.
How do I prevent periodontal disease from recurring?
Good oral hygiene at home is essential to help keep periodontal disease from becoming more serious or recurring. Your dentist also will want to see you at regular intervals. You may need to schedule more frequent visits than you have in the past.
You don't have to lose teeth to periodontal disease. Brush, clean between your teeth, eat a balanced diet and schedule regular dental visits for a lifetime of healthy smiles.
What Is Periodontal (gum) Disease?
Periodontal (gum) disease is a condition in which bacteria attack the tissues that surround and support teeth. Simply put, it is an infection that can result in tooth loss if not treated. Because it is often painless, you may not be aware that you have a problem until your gums and bone are seriously affected. The good news is that periodontal diseases often can be treated in the early stages with a treatment called scaling and root planing.
What Causes Periodontal (Gum) Diseases?
Plaque is a sticky film of bacteria that clings to teeth and gums. Even if you brush and clean between your teeth every day, you may not completely remove plaque, especially around the gumline. The bacteria in plaque create toxins that injure the gums and underlying bone. Over time, these toxins can destroy gum and bone tissue.
Plaque that is not removed completely every 24 to 48 hours hardens into a rough, porous deposit called tartar, or calculus. Once tartar develops, the only way to remove it is by having your teeth cleaned at the dental office.
Tartar that builds up below (under) the gumline makes it more difficult to remove the film of plaque. This can lead to chronic inflammation and infection.
If you schedule regular dental checkups, your dentist can detect developing periodontal disease before the gums and the bone supporting your teeth are irreversibly damaged. Periodontal diseases are progressive and, if left untreated, the condition will worsen.
Come see us if you notice any of the following signs:
- Gums that bleed easily.
- Red, swollen or tender gums.
- Gums that have pulled away from the teeth.
- Puss between the teeth and gums when the gums are pressed.
- Persistent bad breath or bad taste.
- Permanent teeth that are loose or separating.
- Any change in the way your teeth fit together when you bite.
Diagnosing Periodontal Disease
During a checkup, the dentist examines your gums for periodontal problems. An instrument called a periodontal probe is used to gently detect "pockets" between your gums and teeth.
At the very edge of the gumline, gum tissue is not attached to each tooth. Instead, there is a very shallow, v-shaped groove called the sulcus between the tooth and gums. The normal space between teeth and healthy gums should be three millimeters or less. With periodontal diseases, this tiny space develops into a pocket that collects more plaque bacteria and is difficult to keep clean.
If gum disease is diagnosed, your dentist may provide treatment, or you may be referred to a periodontist, a dentist who specializes in the diagnosis, prevention and treatment of periodontal diseases. Treating the disease depends on how far the condition has progressed.
Gingivitis is the earliest stage of the disease. The gums become red, swollen and they may bleed easily. At this stage, the disease is still reversible. If not treated, it may lead to a more severe condition, called periodontitis.
Periodontitis is the more advanced stage of periodontal disease. At this stage, the disease may require more complex treatment to prevent tooth loss. The gums, bone and other structures that support teeth are damaged. Teeth can become loose and fall out or they may have to be removed.
Prevention and Treatment
The first line of defense is prevention. This includes a good oral hygiene routine at home. Brushing twice a day and cleaning between teeth once a day with floss or an interdental cleaner helps prevent plaque from accumulating. The dental office staff may provide instructions on additional cleaning methods or oral hygiene products to use at home.
Regular dental checkups and cleanings are important in preventing periodontal diseases. If these measures are not taken, the likelihood of disease increases. In some cases, even with these measures, a certain percentage of patients experience some form of periodontal disease that must be treated.
When your dentist diagnoses periodontal disease, one of the treatments is scaling and root planing. Depending on the extent of the disease, your dentist may recommend that one or more sections (quadrants) of the mouth be treated. Treatment may require one or more visits.
Scaling is used to remove plaque and tartar beneath the gumline. A local anesthetic may be given to reduce any discomfort. Using a small scaler or ultrasonic cleaner, plaque and tartar are carefully removed down to the bottom of each periodontal pocket. The tooth's root surfaces are then smoothed or planed to allow the gum tissue to heal and reattach to the tooth.
Once the scaling and root planing treatment is complete, another appointment will be made so the dentist can check how your gums have healed and how the periodontal pockets have decreased. When pockets greater than 3 mm persist after root planing and scaling, additional treatment may be needed.
You'll be given instructions on how to care for your healing teeth and gums. Caring for your teeth and gums after treatment is critical. Practicing good oral hygiene every day will reduce the risk of recurring periodontal disease.
Periodontal disease will not go away by itself. Left untreated, surgery may be needed to save affected teeth. Preventing and treating the disease in the early stages are the best ways to keep your smile healthy.
Are there special instructions I should follow after getting a filling or crown or after having a root canal?
For fillings and crowns: Avoid drinking hot liquids or eating chewy foods until the numbness from your anesthesia wears off (it may last as long as four hours). This will prevent you from accidentally burning your mouth with a hot drink or biting your cheek or tongue. Afterward you may drink or eat anything you want. You might also experience a mild sensitivity to heat and cold in the repaired tooth, but this usually disappears within a day.
For root canals: The tissue surrounding your tooth may become inflamed, and your tooth may be tender. Over-the-counter pain treatment can help ease discomfort. Teeth that undergo root canal treatment can also become discolored and may require bleaching, bonding, or a crown.
Do I need to clean any differently around my crown?
Be particularly vigilant about brushing and flossing along the edges of your crown. Trapped food and plaque can build up around the gumline and adjacent teeth and lead to gum disease or decay.
Is the mercury in amalgam fillings hazardous to my health?
A very small number of people are allergic to mercury, and minute amounts of mercury vapor may be released when you chew and grind your teeth. But worldwide studies conducted for more than a century have failed to link the mercury in amalgam fillings to medical problems. Amalgam is still a safe, cost-effective and durable restorative material.
Why should I have a root canal? Can't my dentist just remove my damaged tooth?
It's much better to keep as many of your natural teeth as possible. When teeth are extracted and not replaced, teeth near the empty spaces begin to shift. This can affect your chewing ability, cause your mouth to sink in and your face to change appearance, and allow plaque to build up more easily. Also, if teeth are replaced, bridges may be more expensive than root canals.
What should I do If I lose a crown or a filling?
Call and schedule an appointment with your dentist immediately. Don't put the filling or crown back on the tooth (it could cause damage or you may swallow it). Just bring it with you to the dentist. In the meantime keep the area clean by performing your normal dental hygiene routine of brushing and flossing.
What can I expect after I get a bridge, implant or denture?
For bridges: There is usually no recovery period, and you can eat whatever you like right away. Your dentist or hygientist may suggest using such dental aids as a floss threader to help you clean around your new bridge.
For implants: Recovery from implant surgery usually takes one to two weeks. You may experience some pain, bruising or swelling, and your dentist will probably prescribe antibiotics and pain medication. Many dentists suggest consuming only liquids or soft foods for one to two weeks after surgery.
For dentures: When you first wear dentures you may notice an increased saliva flow. Dentures also may feel loose or bulky or may cause the tongue to feel crowded. Try eating soft food or small pieces of food that you chew in the back. This helps your gums get used to holding dentures and keeps dentures from tipping side to side. After several weeks, your cheek and lip muscles should adjust. If you still feel soreness, consult your dentist.
How do I clean and store my dentures?
After meals, rinse your mouth and dentures with water. At night, rinse the dentures again, and gently brush all the surfaces with a denture cleanser and either a denture brush or a soft-bristled toothbrush. Be sure to rinse the cleanser off thoroughly (it can irritate your gums). Your mouth tissues need a rest, so store dentures overnight in a denture box filled with cool water or a cleaning solution. Before you put them in again, brush your gums, tongue, and palate. If you wear partials, be sure to brush and floss supporting teeth.
How should I clean my bridges or implants?
Although you can't get cavities in your tooth replacements, they are potential food and plaque traps. To keep supporting teeth and gums healthy, brush and floss diligently or use interdental cleaners (ask your dentist or hygienist about these devices that clean between teeth). Use a toothbrush with a small, tapered head to reach hard-to-clean areas, and rinse with water after meals.
Will I be able to keep the same dentures forever?
Probably not. The artificial teeth in your dentures will wear down with time and eventually will need to be replaced. Also, as you age, the bone and gums supporting your dentures can shrink, causing dentures to loosen and chewing to be impaired. See your dentist if you notice any problems.
How do bridges and dentures secured with implants differ from conventional bridges and dentures?
Dentists may suggest implant-supported bridges to prevent filing adjoining teeth to hold a regular bridge. They suggest implant-supported dentures to people who can't wear regular dentures or to those whose dentures are loose, causing discomfort. Implant-supported dentures provide more stability and allow you to eat a larger variety of food than the traditional denture wearer can.
