The Tooth about Gum Disease Part II

Treating gum disease! Amongst dentistry, there is no more difficult disease to treat than periodontitis (which is the technical term for gum disease). I always tell my patients that the closest disease to gum disease, is Cancer.

Why cancer? Because it is a silent painless and usually slow progressing disease. By the time you notice there is a problem, the disease has become very far along and usually has destroyed a lot of your mouth. So just like cancer the key to success is early detection! As soon as we see signs of the disease we must treat and maintain.

The key word there is MAINTAIN. Just like cancer, gum disease has the tendency to relapse. So often do patients come in for treatment and then disappear for a several months or even years! When the come back for another visit, surprise surprise..... disease is BACK! So the key thing to remember is maintenance is the key to keeping gum disease away. How do we do that? Lets start by talking about treatment.

The first step of treatment is what is common called a "deep cleaning." I'm not sure how this term came to be because the technical term is called "scaling and root planing." But I believe people derived this term because it feels like the dentist (or hygienist) is doing the same thing except deeper.
However, although we use the same instruments, we have a very different mentality during this procedure. Going back to the cancer analogy, this is the "surgery" portion of the treatment. We have things we need to remove for the disease to resolve and we need to do it very aggressively.



Looking at this picture, it illustrates how far underneath the gums we need to go in order to remove the plaque and tartar(technically termed Calculus). Most of the time we are cleaning in between your teeth. There is very little room to operate and scraping these hardened plaques can be very taxing. Ultimately depending on the shape of the tooth and how much access we have, we may or not be able to get 100% of it off, but of course we all do our best.

Now here comes the key......

Once we get this stuff off, its very easy for it to grow back. Why? Because even though we have removed whats there, you still have a "deep pocket" that was formed when you originally got the disease. Food and debris easily gets lodged back into those areas and can quickly reform the tarter.

So once you have a deep cleaning done, standard brushing and flossing rules DO NOT APPLY!

You have to be even more diligent, brushing and flossing more thoroughly and often. I suggest patients to use extra aids to automate the process such as electric tooth brush and waterpik.



Keeping this stuff off isn't easy, and so you have to return to have your teeth cleaned every 3 months for what we call Periodontal Maintenance. And while its very similar to a cleaning as well, its more involved because we still have to retreat the pockets until the gums start to shrink back to health.

Sometimes no matter how hard we try, they still won't shrink won't back to health. Thats when we need to go to the next step. More on that next time.