What to do when you’ve got bacteria in your pockets?
Wait, did we just switch from dentistry to laundry advice? No… though you can expect some common themes here as we discuss treating periodontal 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 those 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?
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, perio surgery is necessary to gain complete access and successfully remove bacteria from the deep pockets.
Pocket Reduction Surgery: Evicting Bacteria 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 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 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.