Dental Office Care

Your dentist has excellent ways to fight gum disease. In addition, if your general dentist does not specifically treat gum problems, he will refer you to a periodontist. A periodontist has had three years of advanced training in the treatment of PI and other oral health problems.

The most common treatment in either office is the prophylaxis, or cleaning. The dental hygienist, an integral member of either dental team, normally cleans teeth. Even if you are an ardent tooth brusher and flosser, there may be places you routinely miss. The hygienist will clean these areas, show you how to improve your home care, and coach you through any learning process. This is a good opportunity to bring in devices, such as your electric toothbrush or irrigator, for hands-on instruction.
Deep pocket cleanings are procedures called curettage, scaling and root planing. These steps are performed when a regular cleaning is no longer effective. These non-surgical techniques are done well below the gum line.

Curettage is the thorough cleaning of the soft tissue lining the pocket. Scaling removes deposits of bacterial plaque, calculus, food debris and pus that have accumulated in the infected pocket. Root planing smoothes and cleans the root of the tooth, so that the gum tissue may heal next to the tooth.

Together, they are designed to remove calculus, which is attached to cementum, the protective shield of the root. It is important to remove as little cementum as possible because taking away cementum can expose the porous dentin of the root to microbial invasion.155,156 Removing just the right amount of hardened calculus and plaque under the gums will allow the gum area to heal and reattach.

Deep cleaning requires an instrument called an ultrasonic or piezo scaler that dislodges calculus and flushes away debris with a stream of antimicrobial solution. This action simultaneously cleans and disinfects the pocket.
Deep cleaning is a beneficial step in controlling PI. Although it sounds complicated, it is a non-traumatic course of action, with little post-op discomfort. In most cases, deep cleaning requires anesthesia.

Sometimes a deep cleaning cannot reach an infected root area that is hidden beneath the curtain of the gum. These cases may require surgery, which allows the dentist to visibly see and correct the areas that are not responding to more conservative treatments. Surgery removes hidden calculus and inflamed tissue from deep pockets. In a procedure referred to as a gingivectomy, excessive gum tissue is trimmed to reduce pocket size.

Periodontal surgery also smoothes root surfaces and arranges gum tissue into a shape that will be easier to keep clean. Modern equipment, local anesthesia and new techniques make this treatment more comfortable than it used to be. Today, it is mildly painful for a day or two and requires about eight weeks to fully heal.

Two other procedures that are performed in a periodontist office to help the PI patient are gingival or soft tissue grafts and osseous surgery.

Gingival grafts are designed to replace or enhance the amount of gum supporting a tooth. When there is inadequate gum remaining to support a tooth, or excessive recession exposes the root, PI quite often develops. When this happens, these areas can be covered with a graft of new gum tissue often taken from another part of the mouth. Cosmetically, this can eliminate the "long-in-the-tooth" look which, for some, denotes an aging appearance. A reverse of this procedure is used when infection causes the gums to grow excessively and become puffy, creating a "gummy smile."

Osseous surgery is designed to modify and reshape the bone surrounding the tooth. This is a necessary procedure in the effective treatment of advanced PI because uneven progression of the disease causes an odd configuration of bony support. New materials of either artificial or freeze-dried bone can fill in for lost bone.