The best treatment depends on the determination of what damage has occurred to the supporting structures of the teeth (bone, periodontal ligament, gingiva, oral musculature; saliva glands, etc.). The problem is to find out what has to be fixed to return your mouth to normal health?
What Is Periodontal Disease?
We all know that gingivitis is ‘puffiness’ in the gums that make the gums bleed more easily. This is reversible and is usually known as ‘plaque induced’ gingivitis that is the result of improper brushing and flossing. Fix the way you brush and floss so that you effectively remove the sticky build-up (plaque) and the waste materials from the living organisms in the plaque. This will reduce the irritants that get below your skin to a level where your body does not react to them. Get lazy or careless with your brushing and gingivitis will start all over again in everybody within 21 days. Why?
Think back to when you had your first teeth came in- you were miserable (okay, mom and dad will have to tell you that!). As the enamel of the tooth slipped through the gums, the germs were able to pass below your gums and your immune system reacted ‘big time’. This kept up until your skin cells in the gum stopped making a keratin (callous) like material that skin cells make to protect the skin from rubbing and started to produce a glycoprotein (aka ‘stickum’) to allow your gum skin cells to adhere to the enamel with a weak but effective suction known as a Vander Waal’s force that stopped the germs in your mouth from slipping below the skin of your gum.
From here on in as long as you had teeth sticking through the gum, the potential to develop ‘plaque induced’ gingivitis is a fact of nature. You now develop a sulcus around every tooth. Your sulcus is like a gutter on a house, it can catch lots of things and protect them from the natural cleansing of cheek and tongue rubbing against your teeth and saliva washing it away. That skin lining the gutter(sulcus) has epithelial cells with no keratin. The skin(epithelial) cells keep germs out from under your skin, but the waste products from these germs growing in your sulcus can still more readily seep between the skin cells that don’t have keratin. Your body recognizes that you did not make those chemicals Your body will react to those irritants by bringing in fluid to dilute them(puffiness) and cells from your immune systems to carry off the waste. It is just like when you rub a chemical that you are allergic too on your skin, if it penetrates you will have a red ‘puffy’ reaction.
The best treatment for your periodontal disease is the one that gets your gums back to a healthy state that you can readily clean the plaque away daily to keep your immune system from fighting the germs and waste products from those germs that naturally inhabit your mouth. The way to determine that best treatment is to evaluate what has happened in your mouth. What needs to be reversed? revised, or replaced.
First principle: the longer that you wait to start to take care of your mouth the right way, the more damage will happen that will need to be reversed, revised, or replaced. That leads us to the
Second principle of staging;
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- Assess what damage has been done.
- Establish what stage the damage has progressed to.
- Establish a level of therapy that needs to happen to reverse, revise or
Replace
The American Academy of Periodontology recently released a new set of Guidelines to help determine how to stage treatment and assess its outcome. Three Steps to Staging and Grading a Patient.
Simply stated, this staging and grading is a technique to determine how well your gum disease treatment is going and how likely it will be maintainable with each stage of treatment. As you can see in the chart below, if you smoke, have diabetes or have other medical problems, you may have to have more intervention more frequently.