Prevention of Gum Disease
A vast majority of new patients present to our office with some form of gum disease. That's a staggering statement, and, it seems to stem from a general lack of knowing what to be on the lookout for and how to best manage their own personal dental hygiene to ensure prevention. The first thing we want to know when a patient presents for care? What do you do, day in and day out to tend to your dental wellness? That is, mechanically in the ways of brushing and perhaps doing something where the brush can't reach; chemically - toothpaste and mouthrinses; and diet, especially the amount of sugars and refined carbohydrates.
The next question? What do you notice as you accomplish the reported methods? Most importantly, do you notice bleeding?
Bleeding is the "smoke alarm" for gum disease. If our patients are making a comprehensive and effective tour of their mouth through personal dental hygiene, and they notice no bleeding; well, we ought to be able to make our own comprehensive tour and confirm that same profile. If however, bleeding on periodontal probing is discovered, these are areas that may require a bit of technique adjustment or change for effective access and improved profile.
Aaahhhh, Bacterial Plaque. This is the build up of the normal microscopic population of bacteria inhabiting the mouth. When allowed to build on the teeth, the plaque, or smear layer becomes a community unto themselves. The goal of preventive dental hygiene is not to eliminate the population of bacteria entirely, but to simply keep them from having a place to set up camp on the teeth, and minimize the amount of favorite foods they get to eat. When plaque accumulation has happened, the stage is set for their acid waste products to infect, inflame and destroy healthy teeth and gums.
So, just how often should one brush and floss? We get many answers to this question and there is no one right answer that fits everyone. This is because some folks build up plaque slowly or quickly and react to the build up mildly or dramatically. There are differences among us from an immune system response and some are affected due to other systemic conditions, medications, etc. The best answer really comes down to brush and floss often enough so that when you do it thoroughly and effectively you do not bleed!
Ideally, our patients present for a Prophylaxis (their 'cleaning' or 'check up' appointment) with little if any bacterial plaque build up or incidence of bleeding on probing. This is what makes it a Preventive appointment; any other profile becomes a Therapeutic service - the treatment for gum disease.
The Treatment of Gum Disease
Once a diagnosis of Periodontal Disease has been made, The following body of information summarizes our periodontal services, some but perhaps not all of which apply to your care.
Active periodontal therapy or the treatment of active periodontal disease includes scaling and root planing and medications (D9630, included in D4341 fee). During scaling and root planing, the use of
Sometimes treatment from a periodontist for advanced therapies is required. You may wish to consider the use of antibiotic, anti-inflammatory, and antibacterial therapeutic agents as helpful adjuncts during initial therapy. When systemic antibiotics are advised, it is to support treatment by reaching bacteria that have spread into the surrounding tissue. A regimen is prescribed for the first 10 days to 3 months, at the start of initial therapy, and again as soon as 6 months later when necessary.
Following completion of active periodontal therapy, you will be scheduled for periodic perio maintenance visits (D4910, $150.00), until your periodontal health has been established and is maintainable by appropriate personal hygiene and frequency of professional visits. A perio maintenance visit or perio prophy (D4910) is a continuation of periodontal therapy and may include scaling and root planing in isolated areas. These maintenance visits may be alternated between a periodontist and our practice. Our treatment goal is to assist you in attaining a satisfactory level of periodontal health maintenance. You are ultimately accountable for your health maintenance at this stage of care. When an effective home care regimen has allowed you to reach an accountable, disease free level of maintenance, we can then provide for routine dental prophylaxis and oral exam (D1110 prophylaxis, $120.00; D0120 oral exam, $50.00). The time between prophylaxis appointments should be mutually agreeable and shown to be effective in preventing further destruction or flare-up of active periodontal disease.
If you request additional support for reducing anxiety and increasing comfort and tolerance during your treatment in our office, nitrous oxide conscious sedation (D9230, $85.00 per appointment) is available. As long as your medical history and clear breathing capacity allow, nitrous oxide may provide a safe and easily reversible means of relaxation and reduce anxiety during your appointment. If you would like nitrous oxide for any treatment, please alert us at the time of scheduling.
Sometimes, a patient who has been seen for preventive prophylaxis care may experience a renewed incidence of periodontal disease. This can happen for many reasons such as: ineffective personal hygiene, the interval between maintenance visits may have been overextended, or a change in a patient's physical health occurs (for example: medications, general health, physical ability), just to name a few. If you are experiencing the need for therapeutic periodontal treatment rather than preventive measures, we will inform you as to the degree of involvement and the indicated treatment.