Nothing in dentistry works if there is not a solid foundation, just like a house! In dentistry the foundation is the bone, gums and surrounding tissues. When the bone and gums have infection teeth can become loose, more prone to cavities and at times painful. These periodontal diseases are typically silent killers of teeth just like heart disease is a silent killer of the heart. There is very little pain until it is too late.
Once a year during a cleaning appointment (and at your first appointment) your hygienist will "probe" around your teeth. These probings are measurements of gum depth and are measured in millimeters. Healthy gums and bone have probing depths of 0-3mm. Above that we find the beginnings of periodontal disease. Probings of 4-6mm indicate early to moderate periodontal disease and anything greater than 6mm is considered severe periodontal disease. These greater depths indicate bone loss caused by infection of the gums and bone.
When bone around teeth gets infected it resorbs. This shrinkage of bone means that the tooth socket becomes shallow and the ability of the bone and tooth to withstand biting forces becomes weakened. The teeth will start wiggling in their sockets and eventually become non functional and need to be removed. Once bone loss occurs it cannot be fixed. We can stop the disease from progressing but to date we cannot regrow the bone around the tooth once it is lost. This is why it is so important to keep regular cleaning appointments. At regular cleaning appointments your bone can be monitored and if this bone loss occurs it can be treated before it gets worse. Regular cleanings also allow the dentist or hygienist to clean areas that may be difficult for you to clean adequately at home and ensure that periodontal disease won’t sneak up on you.
When periodontal pockets are diagnosed we may recommend scaling and root planing or “deep cleaning.” This type of cleaning addresses bone loss and pocketing around the teeth. Typically you are numb during this procedure because the root surface of the tooth is much more sensitive than the crown of the tooth. Deep cleanings go below the gum line to remove calculus and plaque from the root surface of the tooth. Plaque and calculus on the root surface act as a place for bacteria to colonize and slowly infect the bone around the tooth. Once the bacteria are removed bone disease will stop and the gums can heal. When the gums are no longer inflamed by this plaque and calculus you will be better able to clean the surface of your teeth.
After scaling and root planing is completed you will be encouraged to maintain more frequent cleaning appointments. Once bone is lost it is easier to have these “pockets” get reinfected by bacteria, plaque and calculus. Failure to maintain these more frequent cleaning appointments will cause the deep cleaning to fail. When these treatments fail bone loss will occur more rapidly and another round of scaling and root planing will be advised.
If these pockets get too deep or in the rare case that the scaling and root planing is ineffective, you may be referred to a periodontist for further treatment. Your hygienist will be able to discuss your options from regular 6 month cleanings to periodontal therapy and give you tips on how to prevent or stop the progression of periodontal disease.