Posts for: April, 2018
Undergoing regular dental cleanings is an essential part of periodontal (gum) disease prevention. While a daily habit of brushing and flossing cleans bacterial plaque from most tooth surfaces, it’s difficult to remove from places your brush or floss can’t access well. That, as well as hardened plaque deposits known as calculus, must be removed by a hygienist or dentist with a technique known as scaling.
Scaling is traditionally performed manually using specialized hand instruments known as scalers. Although hand scalers are quite effective, they must be used carefully to avoid damage to gum tissue or, during deeper cleaning known as root planing, the tooth roots. A different method for plaque removal known as ultrasonic scaling has grown in popularity as an alternative to manual scaling.
Ultrasonic scaling uses equipment emitting vibrational energy that crushes and loosens plaque and calculus, and disrupts growing bacterial colonies in biofilm. Plaque particles are then washed away using water irrigation. The most recent models of ultrasonic scalers have matched the effectiveness of hand scaling in removing plaque and calculus in shallow gum pockets, and surpassed the manual technique in cleaning out pockets greater than 4 mm. In experienced hands, they’re kinder to tooth structure and other tissues. Water irrigation also improves healing by removing bacteria and scaling by-products, which also makes the area easier to view by the hygienist.
On the other hand, any type of power scaler must be used with caution with patients who have pacemakers, and are not recommended for those with hypersensitive teeth or teeth that are in the early stages of de-mineralization. The technique may also produce an aerosol of finely misted particles (with possible contamination) that requires added measures to contain them.
For most patients, though, ultrasonic scalers are an effective tool for plaque and calculus removal. As ultrasonic devices continue to evolve, patients will ultimately benefit from greater comfort and reduced treatment times.
If you would like more information on plaque removal with ultrasonic scalers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Cleanings Using Ultrasonic Scalers.”
Periodontal Disease and Diabetes
Diabetes is one of the leading causees of death in the U.S., affecting nearly 26 million Americans. Diabetes causes the body to not produce or properly supply insulin, a hormone needed to convert sugar (or glucose) into energy. People with diabetes may experience a host of other systemic complications, including periodontal disease.
Periodontal disease is an inflammatory response to a bacterial infection in the gums. If left untreated, the disease may cause damage to the tissues and bone surrounding the teeth, possibly leading to tooth loss. People with diabetes are two to four times more likely to develop periodontal disease than those without diabetes. Additionally, people with diabetes tend to experience more severe levels of bone loss and more aggressive disease activity.
Links and Increased Risks
The tooth loss seen as a result of severe untreated periodontal disease can make chewing and digesting food difficult, having a negative impact on a diabetic;s ability to maintain proper nutrition and control his or her blood sugar levels. Periodontal disease also raises a person's systemic inflammatory signals, which increase blood sugar. It is important for people with diabetes to treat periodontal disease to eliminate the infection for optimal metabolic control.
A series of 2012 consensus reports from the American Academy of Periodontology and the European Federation of Periodontology indicate "an independent association between moderate periodontitis and an increased risk for the development or progressionof diabetes." The shared culprit in periodontitis and diabetes is inflammation, which can aggravate both conditions.
Diagnosis and Treatment
Although a regular oral hygiene routine is important for everyone to follow, people with diabetes should be particularly diligent about how they care for their gums and teeth. In addition to brushing twice a day and flossing regularly, people with diabetes should undergo a yearly comprehensive periodontal evaluation. If periodontal disease is detected, a periodontist can provide treatment that can stop the disease and bring the gums back to a state of health, preventing additional bone or tooth loss. In fact, periodontal treatment has been shown to improve blood sugar levels in people with diabetes.
Keeping Diabetes and Periodontal Disease Under Control
Depending on the patient's unique case, the periodontist will advise on next steps for treatment and care. Patients are advised to develop an informed care team - comprised of a periodontist, physician, and other necessary health professionals - that work together in monitoring and addressing changes in their diabetes or periodontal health statuses.
People with diabetes may want to schedule their dental appointments early in the morning after they have eaten a normal breakfast in order to stabilize blood sugar and prevent a severe or sudden drop in blood sugar levels.
Your smile isn’t the same without healthy gums—neither are your teeth, for that matter. So, maintaining your gums by protecting them from periodontal (gum) disease is a top priority.
Gum disease is caused by bacterial plaque, a thin biofilm that collects on teeth and is not removed due to poor oral hygiene practices. Infected gums become chronically inflamed and begin to weaken, ultimately losing their firm attachment to the teeth. This can result in increasing voids called periodontal pockets that fill with infection. The gums can also shrink back (recede), exposing the tooth roots to further infection.
Although gum disease treatment techniques vary, the overall goal is the same: remove the bacterial plaque fueling the infection. This most often involves a procedure called scaling with special hand instruments to manually remove plaque and calculus (tartar). If the infection has spread below the gum line we may need to use a procedure called root planing in which we scrape or “plane” plaque and calculus from the root surfaces.
As we remove plaque, the gums become less inflamed. As the inflammation subsides we often discover more plaque and calculus, requiring more treatment sessions. Hopefully, our efforts bring the disease under control and restorative healing to the gums.
But while gum tissue can regenerate on its own, it may need some assistance if the recession was severe. This assistance can be provided through surgical procedures that graft donor tissues to the recession site. There are a number of microsurgical approaches that are all quite intricate to perform, and will usually require a periodontist (a specialist in gum structures) to achieve the most functional and attractive result.
While we have the advanced techniques and equipment to treat and repair gum disease damage, the best approach is to try to prevent the disease from occurring at all. Prevention begins with daily brushing and flossing, and continues with regular dental cleanings and checkups.
And if you do notice potential signs of gum disease like swollen, reddened or bleeding gums, call us promptly for an examination. The sooner we diagnose and begin treatment the less damage this progressive disease can do to your gums—and your smile.
If you would like more information on protecting your gums, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Periodontal Plastic Surgery.”