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Periodontal Care Honolulu Hawaii

For Americans in their 30s and beyond, the threat of gum disease (periodontal disease) is a very real and potentially dangerous condition. Gum disease is particularly dangerous because the progression of the disease is often painless, going undetected until it creates serious problems. Although genetics may play a small role in its development, doctors agree that gum disease is most often directly related to how well people care for their teeth and gums.

The Stages of Gum Disease

Periodontal disease is a gradual infection of the gums and the supporting bone. It is caused when the build up of plaque on and around the teeth calcifies into tartar. This tartar is covered with the plaque that contains micro- organisms which release toxins causing the first stage of gum disease known as gingivitis. Gingivitis is characterized by swelling, inflammation, and bleeding of the gums. In the advanced stage of gum disease (referred to as periodontitis), the toxins cause the bone to resorb or dissolve. The teeth having lost a part of their bone support begin to move & eventually with more bone loss there is tooth loss.

The Surgery

Treatments to alleviate the effects of gum care include deep cleaning, localized delivery of antibiotics, home care & regular follow-up care. The periodontist / Dentist begin by removing the diseased tissue, tartar, and plaque from the tooth’s surface and below the gum line. The root of the tooth may need to be planed and smoothed in order to allow gum tissue to heal properly. The periodontist may also advise bone grafts depending on the amount of bone that is lost due to gum disease.

Prevention
Arestin Therapy

This is a non-surgical treatment of periodontal disease. As the name suggests it arrests the progression of periodontal disease when used in conjunction with scaling and root planing (deep cleaning).

ArestinTM is a locally delivered antimicrobial agent which consists of minocycline HCL microspheres. ArestinTM is intended to be used in pockets with a depth of 5 millimeters or greater. It can be used in one or any number of pockets in one or several visits. It is dispensed as a 1 mg powder and is placed directly into a cleaned periodontal pocket using a specialized delivery system. Following placement over the next several hours or days it will harden and stay within the pocket releasing Minocycline over a prescribed period of time (usually about 18 – 20 days), thereby providing the appropriate dose of antibiotic to the site and reducing the bacterial count in the pocket.

Advantages of Arestin Therapy

Studies have shown that there is a 2 mm reduction in the depth of the pockets when Arestin is used along with scaling and root planing

Arestin therapy is effective in treating resistant sites which do not respond to cleaning alone such as in patients who are smokers, diabetics and have cardiovascular disease

Arestin is very easy to use, it is a safe and effective procedure

Frequently asked questions would you use an antibiotic to treat periodontal disease?

Even though scaling and root planing (SRP) removes a great deal of the bacteria that cause periodontal infection, the instruments used during this mechanical procedure can’t always reach the bacteria that hide in the bottom of pockets or in difficult-to-reach areas. That’s why your dental professional may decide to add a locally administered antibiotic (LAA) such as ARESTIN®. ARESTIN® helps to kill the bacteria left behind by SRP.

What are the contra-indications to the use of Arestin?

Arestin should not be used if you are allergic to tetracycline or if you are pregnant or nursing as it might cause discoloration of the developing teeth in the fetus.

Can I resume normal brushing and flossing following Arestin Therapy?

Delay brushing the treated area for 12 hours after treatment with ARESTIN® and abstain from using interproximal cleaning devices around the treated area for 10 days. Patients should also avoid hard, crunchy, or sticky foods such as popcorn or caramel that could traumatize the gingiva.

Scaling

Scaling is one of the most important processes in periodontal care which helps in curing gum diseases. The procedure involves removal of tarter from the tooth surface and roots. Periodontists use special instruments to clean the surface of the teeth. The instruments clean the gum pockets and reach the teeth roots to remove hardened tarter. Local anaesthesia may be used during the process to relieve patients from pain. The periodontist guides patients about routine maintenance and they may have to visit the dental practice frequently in order to keep the periodontal disease in control.

Periodontal Surgery

Periodontal surgery is performed to improve the life of gum tissues and teeth and to control the factors that give rise to periodontal infection. The surgery involves bringing back the contact between gum tissues and teeth surface. Gum pockets are eliminated during the procedure. Certain medical conditions like uncontrolled diabetes and cardiovascular disease may not be suitable for performing the periodontal surgery. Alcohol consumption should be avoided after the surgery is complete.

Gummy Smile

An attractive smile exposes minimal gum tissues. In a gummy smile more amount of gum is visible which makes the smile less attractive. This problem can be treated in many ways. A periodontist chooses a particular process based on the complexity of the condition. Laser treatment is one of the commonly performed procedures. However, in more complex cases a surgical contouring or lip repositioning may be necessary. The treatment for gummy smile can also be called crown lengthening. A periodontist or a dentist who has specialized experience in curing gum problems can treat a gummy smile.

Gum Graft

Gum grafting is the process of surgically reconstructing the gum tissues which have receded from gum infection. Gum recession occurs because of plaque accumulation over teeth surface which gradually hardens and turns into tarter. As a result of gum infection the soft tissues are detached from the teeth and further plaque accumulation results in formation of gum pockets. Gum grafting is done to reconstruct the soft tissues so as to cover the teeth root. Soft tissues are removed from the palate region of the mouth and are used in reconstruction. Gum grafting has both esthetic and medical advantages. Patients can get a more attractive smile from the process and the teeth become less prone to decay.

Non Surgical Periodontal Treatment

Anatomy of the tooth supporting structures

To better understand periodontal diseases and treatment you need to know the anatomy of the tooth supporting structures. They include the periodontal ligament which attaches the tooth roots to the interdental bone (socket) and the gum tissue which attaches to the bone and surround the tooth neck like a collar. The word periodontal literally means “around the tooth”. Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) releases toxins causing gum inflammation.

This causes the gums to swell, appear puffy and bleed easily. This early stage of gum inflammation is called gingivitis. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with regular professional Non Surgical Periodontal Treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. With time, plaque hardens to form tartar and begins to grow below the gum line detaching the gums from tooth. Toxins produced by the bacteria in plaque stimulate a chronic inflammatory response causing bone resorption. Gums separate from teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Symptoms include bleeding gums, bad taste in the mouth, halitosis (bad mouth odor) and in severe cases abcesses. Eventually, teeth can become loose and may have to be removed.

The first step towards gum health is regular professional cleaning and good home care. Gingivitis and early periodontitis can be easily be treated by scaling and root planing. Scaling and root planing is careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets using hand instruments and ultrasonics and simultaneously smooth the root surfaces. This may be accompanied with local delivery of anti-microbial agents to aid healing. After scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, majority of the patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal health.

Surgical Periodontal Treatment

When routine scaling and root planing does not help to restore periodontal health periodontal surgery may be advised. Most common surgical procedures are:

  • Pocket reduction procedures
  • Regenerative Procedures
Pocket Reduction Procedures

When with routine scaling and root planing deep periodontal pockets cannot be cleaned your periodontist may recommend pocket reduction procedures. During this procedure, your periodontist folds back the gum tissue and removes the disease-causing plaque and tartar. In some cases, irregular surfaces of the damaged bone are smoothened. This allows the gum tissue to better reattach to healthy bone. The gum tissue is then secured at its new position with sutures.

Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it’s important to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth – and decrease the chance of serious health problems associated with periodontal disease.

Regenerative Procedures

Bone Graft and Guided tissue Regeneration

If there is a defect in the bone, often times a bone graft can be placed to stimulate new bone formation. A combination of natural or synthetic bone can be used for regeneration. Sometimes specialised membranes may be used during this procedure to prevent the gum tissue from creeping in between the tooth and the bone. This helps allow a regeneration of new bone and periodontal ligament.

Cosmetic Surgical Procedures Crown Lengthening

Cosmetic Surgical Periodontal Treatment procedure involves the removal of gum tissue (gingiva), bone or both to expose more of a tooth’s structure.

What it’s Used for

Crown lengthening is done when a tooth needs to be restored, but not enough tooth is present to support a crown or a filling

This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. If your dentist wants to repair the tooth using a crown or a large filling, he or she may need to expose more of the tooth by removing some soft tissue and/or bone.

In some cases, a condition called gummy smile —in which an unusually large amount of gum tissue shows around the upper teeth —can be treated using crown lengthening.

Procedure

This procedure is usually done under local anesthesia. Incisions are made to reflect the gums away from the teeth. This provides access to the roots of the teeth and the bone that surrounds them. In some cases, by simply removing a little gum tissue when the incisions are made enough tooth structure will be exposed for your dentist to place a crown of filling. However, in most situations it will also be necessary for the periodontist to remove some bone from around the roots of the teeth. The bone is removed using a combination of hand instruments (resembling chisels) and rotary instruments (similar to the drill and burs used to treat cavities).

Then the gum tissue is secured with sutures. At this point, your teeth will look longer because the gums are now sitting at a lower level then before the surgery. Sometimes a periodontal dressing may be used —an intraoral bandage —to cover the surgical site. It helps protect the surgical site and aids in healing.

Any temporary crowns will be removed before the procedure begins and replaced afterward.

Soft tissue Grafts

Soft tissue grafts are used for treating gum recession, and/or to improve the esthetics of your gum line.

Gum Recession could be due to a variety of reasons including aggressive tooth brushing, periodontal disease or clenching of teeth.

Exposed tooth roots are the result of gum recession. Gum recession makes your teeth longer giving an older look. Also since the roots are exposed your teeth will be sensitive to cold liquids and foods. Soft tissue grafts can easily eliminate this problem.

Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During this procedure, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth. A soft tissue graft can reduce further recession and bone loss. It also protects the root from decay and reduces sensitivity.

Cosmetic Surgical Procedures

Crown Lengthening

This procedure involves the removal of gum tissue (gingiva), bone or both to expose more of a tooth’s structure.

What it’s Used for

Crown lengthening is done when a tooth needs to be restored, but not enough tooth is present to support a crown or a filling

This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. If your dentist wants to repair the tooth using a crown or a large filling, he or she may need to expose more of the tooth by removing some soft tissue and/or bone.

In some cases, a condition called gummy smile, in which an unusually large amount of gum tissue shows around the upper teeth can be treated using crown lengthening.

Procedure

Cosmetic Dental Surgery procedure is usually done under local anesthesia. Incisions are made to reflect the gums away from the teeth. This provides access to the roots of the teeth and the bone that surrounds them. In some cases, by simply removing a little gum tissue when the incisions are made enough tooth structure will be exposed for your dentist to place a crown of filling. However, in most situations it will also be necessary for the periodontist to remove some bone from around the roots of the teeth. The bone is removed using a combination of hand instruments (resembling chisels) and rotary instruments (similar to the drill and burs used to treat cavities).

Then the gum tissue is secured with sutures. At this point, your teeth will look longer because the gums are now sitting at a lower level then before the surgery. Sometimes a periodontal dressing may be used —an intraoral bandage —to cover the surgical site. It helps protect the surgical site and aids in healing.

Any temporary crowns will be removed before the procedure begins and replaced afterward.

Soft tissue Grafts

Soft tissue grafts are used for treating gum recession, and/or to improve the esthetics of your gum line.

Gum Recession could be due to a variety of reasons including aggressive tooth brushing, periodontal disease or clenching of teeth.

Exposed tooth roots are the result of gum recession. Gum recession makes your teeth longer giving an older look. Also since the roots are exposed your teeth will be sensitive to cold liquids and foods. Soft tissue grafts can easily eliminate this problem.

Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During this procedure, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth. A soft tissue graft can reduce further recession and bone loss. It also protects the root from decay and reduces sensitivity.

Maintenance

Procedure

Periodontal maintenance (PM) is essential to the ongoing periodontal stability of patients. Optimal periodontal health requires regular follow up care. Your periodontist may advise the frequency of your follow up care based on the severity of your gum problem. Periodontal maintenance care helps eliminate the bacterial plaque on a regular basis and facilitate healing and prevent further destruction of bone.

Office Hours

Monday 8:00 AM5:00 PM
Tuesday 8:00 AM5:00 PM
Wednesday 8:00 AM5:00 PM
Thursday Closed
Friday 8:00 AM5:00 PM
Saturday 7:30 AM2:00 PM
Sunday Closed

Our Address

Advanced Restorative Dentistry
1401 South Beretania Street
Suite #470, Honolulu, Hawaii 96814

808-732-0291

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