Periodontal Surgery Services
What to do when you’ve got bacteria in your pockets? Read more about our periodontal surgery services.
Wait, did we just switch from dentistry to laundry advice? No… though you can expect some common themes here as we discuss about treating gum disease.
Periodontal disease or gum disease is a bacterial infection under the gums, which includes the spaces between the teeth as well as the jaw bone. Once bacteria take root under the gums, they hollow out little houses or pockets between the teeth, the gums and the bone where they can collect debris from food and live happy little bacteria lives destroying the gum tissue and the bone that hold teeth in place. So when we talk about bacteria in your pockets, we mean that literally… only you might have been thinking we meant different pockets.
So what do we do about that gum disease, pesky bacteria living in our pockets?
The same thing we’d do if we have bacteria in our jeans’ pockets – clean them out! Scrape out the gunk. Powerwash if necessary. Disinfect. Lather on antibacterial anything. Isn’t that what we’d do if we have disgusting bacteria junk living in the pocket of our favorite jeans? That’s what we do in the mouth too, only using much tinier cleaning tools, more precision and no laundry detergent. This first cleaning process is called “root planing and scaling”. Our hygienist uses her instruments to “plane and scale the roots of teeth”, ie clean the bacteria out from under the gums so that the body’s own healing processes can go behind and restore a healthy balance.
If Root Planing and Scaling is so effective, why do you have a page about periodontal surgery services?
So glad you asked! Lets stay with the jeans analogy for a minute. Imagine that the bacteria have eaten through the corner of the pocket and are now working their way down the pant leg. Now, of course, when it comes to jeans, we’d just turn them inside out and keep cleaning. We can’t turn your gums inside out to reach the depths of deep infection pockets. In order to clean pockets extending more than 6mm below the gums, periodontal surgery services is necessary to gain complete access and successfully remove bacteria from the deep pockets.
Pocket Reduction Surgery: Evicting Bacteria Infection One Pocket at a Time
After root planing and scaling, patients frequently see their pocket depths return to a healthy normal range. This means 2-3 mm readings with some 4 mm’s. However, even on a strict maintenance cleaning schedule, it is possible for the bacteria to succeed in deepening pockets here or there in the mouth. When this happens, the teeth nearest the pocket are at high risk for being lost. To save the teeth, it’s necessary to get that pocket back to normal. Since we can’t turn the gums inside out, we have to open them surgically to clean and repair the area and the pocket.
Osseous Surgery: Evicting Bacteria One Neighborhood at a Time
Sometimes, when people have been neglecting their teeth and haven’t kept up the three to four month maintenance schedule, we’ll see pockets pop up throughout the mouth and when we look a CT Scan of the mouth, we see highly uneven bone levels. In these cases, pockets are developing deep and fast because the bone loss creates space for extra bacteria. Removing the bacteria requires leveling the bone so that the gums attach evenly to the teeth. This surgery is similar to pocket reduction, but on a larger scale. The gums have to be opened, everything has to be cleaned and then the bone is recontoured, sometimes with the help of grafting.
Gum Grafting: Replacing Lost Gums
If you read our missing teeth pages or watched our video implant seminar, then you may have already heard us say that “Gums follow bone.” What this means for patients with gum disease (periodontal disease) is that as the disease dissolves bone, the gums “dissolve” away as well, eventually leaving tooth roots visible. Exposed tooth roots are a problem, both because they are more susceptible to infection and cavities, but also because they are painfully temperature sensitive and unattractive. So whether you’re hoping to replace your lost gums because you think it looks bad or because you can’t stand the zinging shock every time you drink a cold coke or a cup of coffee, a gum graft is going to be your go-to solution. Like other periodontal surgery services, (perio surgeries) it’s always necessary to remove and treat infection first and to build up bone as necessary. After laying a firm foundation, a gum graft is completed, typically using a small amount of tissue from the roof of your mouth.
Not Sure If You actually NEED an Dental Extraction?
Hearing you need an dental extraction when you’re not sure why it’s necessary. How can you know if the tooth truly needs to come out or if it could actually be restored? Isn’t it best to keep your own teeth as long as possible?
We meet new patients all the time coming in for a second opinion and feeling frustrated that another dentist wanted to take a tooth out that the patient is pretty sure could be saved. What we’ve discovered is that about 5% of the time, there was a restorative option available that was overlooked. However, about 95% of the time, the tooth needs to be extracted and the diagnosing dentist simply didn’t take the time to adequately explain why.
It’s easy as a dentist who “does teeth” all day long every day, to forget that patients don’t “do teeth” all day long and that they need extra information in order to feel comfortable making decisions, especially about losing teeth. Dentists also have different personal guidelines about what “saving a tooth” means.
Here are my personal guidelines for when teeth should be extracted:
- If the tooth has an untreatable level of infection inside the tooth
- If the tooth has an untreatable level of infection in the surrounding gums
- If the bone around the tooth has dissolved and can’t support the tooth
- If the tooth has broken or decayed to the point that it can’t support a crown
- If the tooth has already been root canaled twice
Why these guidelines? Because I don’t believe that fixing a tooth just to have it break again in a month counts as “saving a tooth.” Every one of these scenarios could be patched, but would explode as a toothache, dangerous infection or deeper trauma within days or weeks, further risking your health. I’m not willing to put my patients’ health at risk for convenience.
If you’re not sure why your tooth “needs an dental extraction” come see me for a second opinion. We’ll take a look and a 3D-CT radiograph give you a clear explanation of what is going on either with that one tooth or in your whole mouth depending on how much you’d like to know.