Online Dental Education Library
Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.
Periodontal Disease
When to See a Periodontist
Periodontal treatment may be sought in several ways. Your general dentist or a hygienist may recommend a consultation with a periodontist if they find signs of periodontal disease through the course of a checkup or other dental care appointment. You may also decide to see a periodontist on your own, as a referral is not necessary to be seen at our office.
In fact, if you experience any of these symptoms, we encourage you to schedule an appointment at our office without delay:
- Unexplained bleeding while performing regular cleaning or consuming food is the most common sign of a periodontal infection.
- Ongoing halitosis (bad breath), which continues despite rigorous oral cleaning, can point to periodontitis, gingivitis or the beginnings of a gum infection.
- Longer-looking and loose-feeling teeth can indicate recession of the gums and/or bone loss as a result of periodontal disease.
Patients with heart disease, diabetes, osteopenia or osteoporosis are often diagnosed with correlating periodontal infections. The bacterial infection can spread through the blood stream, affecting other areas of the body.
- Bleeding while brushing or eating normal foods
- Bad breath
- Loose teeth and gum recession
- Related health concerns
What is Periodontal Disease?
Periodontal disease is a chronic infection of the periodontal or gum tissue. This infection is caused by the presence of a bacterial film, which is called dental plaque, that forms on the teeth surfaces. Bacteria that found in dental plaque produce toxins which irritate the gums. They may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. Plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss. With periodontal disease, bleeding, redness and swelling do not have to be present. Further, pain is usually not associated with periodontal disease. This disease damages the teeth, gum and jawbone of more than 80% of Americans by age 45. Each case is looked at individually, because in addition to plaque there are co-factors such as genetics, smoking, and overall health, which contribute to disease severity. Once periodontal disease is detected, our goal as therapists is to provide information and treatment necessary to control/ or arrest the active infection, and help keep the disease in an inactive or controlled state.
However, don’t be fooled!
With periodontal disease, bleeding, redness and swelling do not have to be present. The periodontal disease symptoms of inflammation may only be evident with sub gingival probing. Further, pain is usually not associated with periodontal disease.
In the early 20th Century, not long after X-rays were discovered, medical professionals recognized their value as diagnostic tools: They could clearly reveal structures hidden inside the body without the need for risky surgery. At the dawn of the 21st century, a revolutionary new technology has entered the diagnostic arena. Today, Cone Beam Computed Tomography (CBCT) promises to change the way many dental problems are diagnosed and treated.
Cone Beam CT has some similarities with conventional X-rays, and also with the standard CT scans you would get in a hospital setting. But it's a quantum leap forward in technology and diagnostic precision. For the dentist, it offers the ability to visualize intricate structures inside the mouth, such as root canals, nerves and sinuses (air-filled spaces) in the jaw — in three dimensions — without surgery. For the patient, it can reduce the need for invasive procedures, shorten treatment time and offer the chance for a better outcome.
The detailed diagnostic images that CBCT provides have made it an essential tool in many dental specialties. But, as with any diagnostic tool that uses radiation, the medical benefits offered must be weighed against the (small) potential risks of the procedure.
How Cone Beam CT Works
X-rays, like visible light, are a form of energy on the electromagnetic spectrum. Just as light makes an image on photographic film (or a digital camera sensor), X-rays can also form an image. The difference is that energetic X-rays can penetrate bone and soft tissue, and reveal its hidden structure by their varying degrees of absorption; in other words, they form a grayscale picture of what's underneath the surface. But conventional X-rays are limited: Like a still-life picture, they show only one perspective on the scene.
Now imagine a “flip book” — the kind of small book made up of a series of pictures, each slightly different. When you rapidly page through it, you may see (for example) an animated cartoon or a still subject from different perspectives. If you could put together a flip book made from a series of X-ray “slices” of the same subject, taken at slightly different angles, you would be able to create an “animation” of the X-rays. And from there, it's only one more step to making a 3-D model.
That's exactly what CBCT scanners do. Using a rotating imaging device that moves around the patient's head, the scanner records between 150 and 600 different X-ray views in under a minute. Then, a powerful computer processes the information and creates a virtual model of the area under study. When it's done, the model appears as a three-dimensional image on a computer screen: It can be rotated from side to side or up and down, examined in greater or less detail, and manipulated in any number of ways — all without the patient feeling any discomfort... or even being present.
Where Cone Beam CT Is Used
The ability to see fine anatomical structures in 3-D has proven invaluable in treating conditions in many areas of dentistry.
- Orthodontics: Having accurate information on the position of teeth and jaws helps determine exactly how and where teeth should be moved.
- Dental implants: Detailed CBCT images are used to determine the optimum location for the titanium implants while avoiding nerves, sinuses and areas of low bone density.
- Orthognathic Jaw Surgery and Temporo-mandibular Joint (TMJ) Disease: Patients benefit when the specialists who treat these conditions can evaluate their anatomy with the three-dimensional perspective that cone beam CT provides.
- Oral Surgery: Treatment for tumors or impacted teeth is aided by the level of fine detail shown in these scans.
- Endodontics: Dentists performing intricate procedures (like complex root canals, for example) can benefit from a clearer visualization of the tooth's anatomy.
- Sleep Apnea: Imaging the tissues and structures of the nose, mouth and throat can aid in diagnosis and treatment of this dangerous condition.
Could Cone Beam CT Benefit You?
Each patient's situation is different, and must be carefully considered by a clinical professional before any test or procedure is performed. While CBCT delivers a smaller dose of radiation (X-rays) than many other diagnostic tests, it still carries a small risk — particularly for younger patients, or those with other health problems. As is the case for any medical procedure, all risks, benefits and alternatives are taken into account before the procedure is recommended.
Related Article
Getting The Full Picture With Cone Beam Dental Scans Dental imaging took a major leap forward at the beginning of the new millennium with a three-dimensional technology known as cone beam computed tomography (CBCT). The name comes from the cone-shaped beam of x-rays the CBCT machine projects as it rotates around a person's head, taking multiple images that are compiled into a 3-D picture by a computer. Find out what CBCT can reveal and how it helps a doctor to make a highly informed diagnosis and choice of treatment... Read Article