What is Periodontitis?
Periodontal disease is the inflammation and infection of the gums. It can affect one tooth or many teeth. It is caused by plaque, a thick and sticky film of bacteria that builds up on the teeth.
Plaque can harden to become calculus, also known as tartar. Plaque and calculus are caused by poor oral hygiene.
The gums are typically classified as:
When gums are healthy, a periodontal probe can be placed in the gum pocket (the tooth – gum junction) without bleeding or inflammation. The periodontal ligament attaches the tooth to the alveolar bone.
Gingivitis is the early stage of gum disease and there is usually little or no discomfort. Gingivitis treatment in Brisbane can be done by our professionals and involves the removal of plaque and calculus, followed by thorough brushing and flossing daily.
Gingivitis can be accelerated by multiple factors including, but not limited to smoking, genetics, pregnancy, puberty, stress, medications, clenching or grinding your teeth, diabetes, poor nutrition and other systemic diseases. If gingivitis treatment in Brisbane is left untreated, it can lead to pain, swelling and permanent damage to your teeth and gums.
Symptoms are usually swollen red gums that bleed easily, gums that have shrunk from the teeth, persistent bad breath, a bad taste in your mouth, abscesses between teeth and gums, and loose teeth.
When plaque is not properly removed from around the tooth, the gum surrounding the tooth becomes red, swollen and inflamed. This is a response to the millions of bacteria in plaque which accumulates around teeth within hours of brushing. This redness, swelling and inflammation is called gingivitis, and causes the gums to appear puffy and to bleed when brushed or flossed. When the plaque is removed with effective brushing and cleaning, the swelling and redness subsides. Gingivitis does not cause the loss of gum support or bone.
Periodontitis (Gum disease)
Periodontitis is the advanced stage of gum disease. As gum inflammation and infection gets worse, gum pockets are formed, and gums may recede from the teeth. As a result, the teeth can become loose, fall out or require extraction by a dentist.
Periodontitis can result in the loss of many teeth in some people.
Periodontitis refers to an inflammatory gum response to plaque which affects around 10-17 percent of the world’s population. Periodontitis is much more destructive than gingivitis, and causes the breakdown and loss of surrounding bone and gum. If the tissue destruction proceeds unchecked, the tooth may become loose and eventually be lost.
Benefits of seeing a Periodontist:
The purpose of seeing a periodontist is to stop or slow down the progression of gum disease and save your teeth.
Benefits include having:
- A mouth that feels, looks and is healthier.
- Teeth that feel smooth and look clean.
- A much better chance of keeping your teeth for life.
Who Can Suffer From Periodontitis
Recent studies suggest that up to 50-75 percent of periodontitis can be attributed to genetic influences. Therefore, periodontitis can be inherited from one’s parents and the condition can run in families. This destructive reaction to plaque is also influenced by the body’s immune response. Anything which suppresses your immune response has the potential to accelerate periodontal disease, such as smoking. Numerous studies have show that gum disease is far more common and more destructive in smokers. Similarly, diabetes will exaggerate the destructive response to plaque. Other conditions that exacerbate the symptoms of periodontal disease include puberty, pregnancy, stress and some medications.
How is Periodontitis Treated?
The aim of periodontal therapy is to remove all plaque and calculus deposits from the tooth and root surface. Once these deposits are removed, we have eliminated the cause of the periodontal inflammation. Providing the tooth surface is kept clean and free of plaque, the gums will return to a healthy, non-inflamed state.
After examining your gums and teeth, your periodontist will develop a treatment plan explaining all treatment procedures and costs involved.
Gingivitis treatment in Brisbane may involve the following:
Treatment may involve the following:
- Removal of build-ups of plaque and calculus.
- Scaling– Cleaning the tooth surface above and below the gum line at a shallow level.
- Root debridement– Removal of calculus and plaque from the tooth roots and deep pockets beneath the gum line This treatment may require several visits to complete.
- Instructions on how to improve your oral hygiene.
- Quit Smoking: Smoking increases the risk of gum disease and reduces the chances of successful treatment
1. Initial Periodontal Treatment:
Oral Hygiene Education
The long term success of periodontal therapy is dependent on you being able to effectively remove plaque on a daily basis. If plaque is not being removed daily, bacteria will accumulate and cause the symptoms of periodontal disease to reoccur.
LANAP or conservative debridement
In the first phase of your treatment, such as lasers, machine driven and special handle instruments , will be used to carefully and thoroughly clean (debride) each tooth and its root surfaces. The aim is to clean deep below the gum line and remove all of the deposits right to the base of the gum pocket. This is usually completed s using a local anaesthetic to minimise discomfort.
Scaling and Root Planing
In the first phase of your treatment, special instruments will be used to carefully and thoroughly clean (debride) and polish each tooth and it’s root surfaces. The aim is clean deep below the gum line and remove all deposits, right to the base of the gum pocket. This is usually completed over several appointments using local anaesthetic to minimize discomfort.
2. Assessing the Response to Treatment
After a healing period of several weeks, you will be required to return for a review appointment to assess your response to the initial treatment. There can be great variation between people reaction’s to periodontal treatment, due to the different inflammatory responses to plaque and calculus within the population. Occasionally (less than 10% of the time), the areas of inflammation do not respond to scaling and root planing. In these instances, gum access surgery may be required to allow visual observation to facilitate the removal of retained plaque and calculus.
3. Periodontal Maintenance – ‘Keeping your teeth for life’
Given your susceptibility to gum disease, you will always be at risk of further periodontal destruction. As such you will require gum assessments for the rest of your life. Any treatment we undertake will not change your body’s inflammatory reaction to the presence of plaque, and thus we can never fully ‘cure’ your gum disease. However, if all the plaque or calculus is removed, there can be no inflammatory response, thus it is possible to maintain the health of your teeth and gums for the long term.
Regular reassessment visits are essential for people with periodontal disease. With continual monitoring, we can prevent the recurrence of periodontal disease in areas where plaque is inadvertently left on the teeth. Eventually a regular interval will be established which is best optimised for you to maintain your gums free of plaque and bleeding. This will be shared between your general dentist and our periodontal clinic.
Consequently, healthy teeth and gums can be retained for life.
Side Effects of Treatment may include:
- Pain during scaling & root planing.
- Gum Tenderness
- Tooth Sensitivity
- Gum Shrinkage
These side effects are temporary. However depending on the severity and the person response or oral hygiene, can vary from hrs to days to weeks.
Preventing and Controlling Gum Disease:
To cure periodontal disease, or keep it under control:
Excellent oral hygiene must be maintained daily.
Bleeding from the gums, caused by periodontal disease, must be decreased or stopped.
Plaque and calculus on the teeth roots must be treated.
Gum pockets around the teeth must be treated.
As Periodontal disease tends to recur, Maintenance therapy will follow periodontal treatment and is most important.
The aim is for you and your periodontist to work together to prevent, monitor and control periodontal disease.
Your Periodontal Appointments
The Consultation Appointment
This appointment is about diagnosing your periodontal disease and planning the best treatment for you.
Initially, there will be a conversation about your history and knowledge about periodontal disease. If you have an x-ray already available, this can be reviewed.
There will also be a specific chat about cleaning your teeth, gums and maintaining good oral hygiene. A detailed explanation about the different techniques and aides you can use will also help you to keep your teeth clean.
Your teeth and gums will also be measured and compared to your x-ray to give an indication to assess the periodontitis. This information is critical and will be used in conjunction with discussions with you to help decide the best treatments.
The Cleaning Appointment
In order to make your periodontal appointment as comfortable as possible, it is important to prepare yourself for certain aspects of the treatment.
Local anaesthetic is used to ensure your comfort during the procedure, and to enable thorough cleaning of the root surfaces around your teeth and deep deposits at the base of the gum pocket. A topical anaesthetic gel will be applied to your mouth and gums before the injections to make the experience as painless as possible. You can expect your mouth to be numb for approximately three hours after your treatment. Have something to eat before your appointment and wait until the anaesthetic has thoroughly worn off before you have something to eat afterwards.
During the procedure, potentially Lasers, ultrasonic scalers and hand instruments will be used to clean thoroughly around each root surface. These instruments generate a lot of water and vibration. Due to the local anaesthetic, you should not be able to feel any sensitivity and all water will be removed with suction by the dental nurse. If you have access to a personal music player or iPod, we recommend bringing it and listening to your own selection of music to make your treatment more comfortable.
Your comfort is our priority during the treatment and we will do our best to ensure that the experience is as painless as possible.
After the appointment
Postoperative pain and swelling may occur for a few days after treatment. It is important to follow the post-treatment instructions provided to you at the completion of your appointment, especially if any medications such as pain relief or antibiotics are prescribed.
Root surface sensitivity: is common after periodontal treatment and is best managed with daily fluoride mouth rinses and other applications as outlined by Dr Darby.
Gum recession: Please note that following successful periodontal treatment, the gum usually shrinks back as the swelling of the gum inflammation resolves. In some instances where there has been extensive bone loss around the tooth, noticeable spaces or gaps will appear between the teeth. This gingival recession can create an aesthetic concern if it occurs on the upper front teeth.
Professional Dental Fees & Your Health Insurance
Professional fees for periodontal therapy: Unlike Medicare, dental fees are not subsidized by the Federal Government and there is no recognized Medicare Dental fee schedule.
The Australian Dental Association Inc publishes ‘The Australian Schedule of Dental Services and Glossary’ which has been universally accepted as the definitive coding system of dental treatment and is endorsed by the National Coding Centre. A three-digit code is assigned to each defined dental procedure. Fees will vary between dental practices, as they are set to take into account the individual costs of providing a service. The fees charged in this practice are kept in accordance with the level of care provided, ensuring the highest quality treatment possible.
The most effective way to reduce your dental costs is to follow the preventative dental advice that you have been given, and undertake the regular periodontal maintenance program that has been individually tailored for your dental health.
Dental cover as part of your private health insurance:
Please check with your health insurance provider to determine your eligibility for partial reimbursement for fees quoted if you have dental cover. The rebates available vary between providers, and we recommend you quote the ADA code numbers listed in your treatment plan to determine your ‘out of pocket’ expenses.
When you take out health insurance to cover your dental fees, you should be aware that:
1. Each health fund determines what level of rebates it will pay, based on it’s own commercial requirements. In many cases, the rebates for common dental item numbers are unlikely to cover more than 60% of fees and may cover less than 20% of the cost of complex and expensive procedures.
2. If you have a problem with your private health insurance, you should contact the fund directly. If you are unable to reach a satisfactory agreement with your fund, contact the Private Health Insurance Ombudsman, an independent body formed to help resolve complaints and provide advice.
The Ombudsman can be reached on 1800 640 695 or by writing to Suite 1201, Level 12, St Martins Tower, 31 Market Street, Sydney NSW 200. Fax: 02 9261 5937. Email: firstname.lastname@example.org.
Before paying premiums for dental benefits, or selecting a particular benefit table, you should ensure that the costs represent value for you and your family.