Periodontal Evaluation & Screening
Evaluation of your gums and their surrounding structures is periodontal evaluation and screening. Thorough evaluation involves understanding your medical and dental history, taking all the necessary x-rays and a complete examination of teeth and gums and the surrounding tissues. During this examination, your dentist will look at your missing teeth, health of remaining teeth including the fillings, cavities, badly positioned teeth, mobile teeth, infections of teeth and gums and the status of nerve tissue in each of your teeth as these are major contributing factors for gum disease.
The overall hygiene or presence of plaque and tartar or calculus (hard or calcified plaque) will also be examined. Another important part of periodontal examination involves measuring the bone levels around your teeth or measuring periodontal pockets. What are periodontal pocket measurements? Well, as you can see the teeth are surrounded by gums and at this junction of gums and teeth there’s a crevice or sulcus.
The depth of this sulcus is the pocket. It is in these pockets where there is constant mix of food debris and bacteria and if not controlled with optimum oral hygiene and regular dental check ups, can lead to swollen gums, bad breath, bleeding during brushing etc. This is measured by a periodontal probe which is like a millimeter ruler that is inserted into the sulcus along the long axis of each tooth to get the measurements. A reading of 1 to 3 millimeters is considered healthy. Anything over 3 mm is considered inflammation, gingivitis, or mild gum disease.Readings higher like 6 mm or more is periodontitis or advanced gum disease.
Advanced gum disease indicates an ongoing infection which, if left untreated, can cause tooth loss and damage to neighboring teeth and gums. Status of periodontal health is closely linked with your general health. Untreated gum disease is believed to cause increased bacterial growth which can get inside your blood stream affecting your health. You should also know that your general dentist can only accurately treat early stages of gum disease. Based on your clinical situation your dentist may refer you to “Periodontist,” a specialist who has had advanced training in the field of gums and their surrounding structures. It is absolutely essential to follow your general dentist and periodontist’s recommendation to keep your gums and teeth healthy.
Whenever a tooth has lost significant coronal tooth structure (the part of the tooth above your gum) due to tooth decay, fractures and root canal treatment, it becomes weak and if not properly strengthened can be lost. This is when the dentist will decide, based on the specific situation, whether a core build-up or a post and core is appropriate. Core build-ups are done more frequently than posts and cores. As a general rule, if more than half the coronal tooth structure is lost, then we need to posts and cores. If less than half the coronal tooth structure is lost, we do core build-ups. Core build-ups are therefore an addition to the remaining coronal tooth structure. They can be made with composite resins or silver amalgams. However, more and more dentists today are choosing to do the core build-ups with composites as there is better bonding ability with the composite resins. Once the core build-up (composite resin filling material) is bonded to the tooth, it becomes a part of the tooth, and then the tooth is prepared to receive a crown.
Core build-ups accomplish three goals. They give strength, retention, and protect the pulp (nerve of tooth) underneath the crown. Posts and cores are done after the tooth has had a root canal treatment. Root canal treatment takes away the nerve and the blood supply from the tooth, causing the tooth to lose its vitality, making the tooth more prone for fracture. As mentioned before, when more than half the coronal tooth structure is lost, there is not enough tooth left to bond to a filling material (or to do a core build-up). During those situations, we do posts and cores. To do posts and cores we need to remove some of the root canal filling material to make room for the post. Posts are made of metal or carbon fiber, which are inserted into the root of the tooth and extend into the coronal tooth structure. The purpose of the post is to anchor the remaining tooth to the filling material, which is bonded to the tooth. The post maintains the integrity of the tooth by connecting the tooth to the filling material. Not all root canal treated teeth need posts, although most do. Once the post and core is done, the tooth should have a crown. Read about crowns for more information. If you still have questions, you are welcome to call the office.
Deep cleaning or Scaling and root planning is the most common, conservative and non-surgical therapy used to treat gum disease. Scaling is the process of removing plaque and calculus around teeth especially below the gum line along the root surface. Root planning smoothes the irregular surfaces along the roots after scaling. Deep cleaning is done during the early stages of gum disease and quite often this may be all that is needed to get the progression of gum disease under control. In advanced or severe gum disease, scaling and root planning is done as a first step before gum surgery. Depending on the depth of periodontal pockets, your hygienist may suggest you be given local anesthetic to numb the area to be scaled and root planned. This will make the treatment go smoothly causing very little to no discomfort.
This may be done in two to four visits depending on each patient’s clinical situation. Scaling and root planning is done with a combination of ultrasonic or hand instruments. After deep cleaning, for the first few days you may experience gum soreness and temperature sensitivity which can be relieved by over the counter pain meds. Your hygienist may suggest the use of antiseptic mouth rinse as well to speed the healing of your gums. You may also notice minor bleeding from your gums after deep cleaning during brushing and flossing which should resolve in a few days. You will need a follow-up visit with your hygienist to reevaluate your gums and remeasure your pockets to see if you responded well to deep cleaning. It is important that you follow all the instructions given to you by your hygienist or dentist. If your hygienist feels that the condition of your gums is less than adequate despite deep cleaning, your dentist may suggest other options including seeing a Periodontist.
The maintenance of optimum oral health includes regular dental visits and cleanings and great home care. Another key factor towards excellent oral health is the use of fluoride. Fluoride is a mineral that slows down the progression of dental caries or tooth decay. The correct and timely use of fluoride can prevent dental cavities or tooth decay and can reverse the very initial stages of dental carries. There are two ways that teeth can benefit from fluoride: topical and systemic. Topical fluoride is available over the counter in drug stores in fluoride-containing tooth pastes and mouth rinses. The other way to do topical fluoride is in your dentist’s office at your regular visits, where the hygienist will apply fluoride at the end of your cleaning. This can be done in a tray containing fluoride gel, foam, or fluoride varnish. The ADA recommends fluoride for everyone every six months starting from the first dental visit up to age fourteen, even though you use fluoride-containing tooth pastes and mouth rinses and have fluoridated water in your area. This is because there is not as much fluoride in tooth paste and mouth rinses, and you may not drink enough water to get the full benefit of fluoride.
After the application of fluoride, your hygienist will tell you not to brush, floss, eat, or drink for thirty minutes to get the maximum benefit. Some older children and adults can also benefit from fluoride if they are heavily prone to cavities. Systemic fluoride is available through fluoridated water in your home, or in grocery or drug stores. If you live in a town where water is not fluoridated, you should let your dentist or hygienist know so that you can get fluoride prescriptions, which can be filled in your pharmacy. The fluoride prescriptions are given based on your age and your town fluoridation and are typically taken once daily orally. Flouride prescriptions are recommended for babies as young as six months old, and can be taken up to age twelve or thirteen if there is no town fluoridation. If you have any questions or concerns about fluoride, please do not hesitate to ask your dentist or hygienist.
- Root canal appointments are typically single appointment procedures, but may occasionally need a second appointment. In either case, you will have a temporary filling in the tooth. There is some compromise to chewing while you have the temporary filling. Please avoid chewing directly on the temporary filling if possible till your next appointment.
- Moderate pain, sometimes severe pain, for one or two days following root canal procedures is normal. You may experience some pressure sensitivity also. Please take all of the medications as prescribed.
- If you have been advised to make an appointment following the completion of the root canal treatment, please do so. At this appointment, the temporary filling will be removed and a more permanent restoration will be placed. The permanent restoration may be just a permanent filling or a post and core or a crown. This would be determined based on the clinical presentation of the tooth.
- As you are aware, during a root canal treatment, the nerve and the blood supply from the tooth is removed and replaced with a filling. This removes the vitality of the tooth or the tooth functions as a “dead” tooth. As a result, the tooth can get dehydrated, brittle, and will be prone to fractures. Therefore it is extremely important that you follow the treatment recommendations made by your dentist after the root canal treatment.
- New dentures will be uncomfortable and maybe somewhat painful for a few weeks.
- Sore spots with new dentures are extremely common and therefore, you may need to visit the office several times for denture adjustments.
- You will notice that speaking will be difficult with new dentures. You’re welcome to read books aloud or anything else of your choice to practice your speech with the new dentures.
- Despite the discomfort with the new dentures, you are advised to wear your new dentures as much as possible to get used to them. If you feel you cannot eat with them right away, it’s normal. Please start with a soft diet initially, and then work your way to a more normal diet as you get more and more comfortable with your new dentures.
- Please take your dentures out every night and place them in a container with water and a denture cleansing solution. It’s extremely important to not wear your dentures day and night because your gums and jaw muscles need some rest time.
- Use your toothbrush and toothpaste to clean your dentures twice daily.
- Please call the office if you have any other concerns.
- Crown and bridge appointments are usually 2 to 3 visits. Some bridge appointments may need a fourth visit.
- The first visit is always the longest, taking up to 2 ½ hours. At the end of this visit, your mouth will be very numb in the area where the work was done. In addition, you will have a temporary crown or a temporary bridge in place.
- To avoid injuring your mouth while you’re numb, do not eat or drink anything hot. You may drink something cold. The temporary crown or bridge is made of a soft acrylic material, and cannot withstand heavy loads of chewing. As a result, please do not eat anything hard (nuts or ice), sticky (caramel or candy) or chewy (tootsie rolls, chewing gum).
- Cold and pressure sensitivity for a period of two to three weeks after the placement of the temporary crown or bridge is normal. You are welcome to take over the counter pain medications for relief. If this concerns you, please call the office.
- After about two or three weeks of temporary crown or bridge, it will be time for the placement of the permanent crown or bridge. It is important that you make this appointment within three or four weeks of the first appointment. This is because the temporary crown or bridge may get loose and come off. If this happens, please save your temporary crown or bridge and call the office for the re-cement. It is important for you to have the temporary crown or bridge the entire time till the permanent crown or bridge is cemented. This avoids drifting and movement of neighboring teeth, and makes the permanent crown or bridge appointment easier.
- When you receive the temporary or permanent crown or bridge, your bite may feel different for a few days. Please call the office if it lasts beyond a few days.
- The feel of the temporary crown or bridge may not be as smooth as your natural teeth. The feel of the permanent crown or bridge will be very close to or feel exactly like your natural teeth.
- If you have any questions or concerns, please call the office.
- After your surgery is over, you may rest a while and go home as soon as you feel you’re able to.
- Certain amount of bleeding and swelling is normal. To speed your recovery, be sure to follow your surgeon’s instructions.
a. You may be asked to drink only clear liquids the rest of the day.
b. Take all medications as desired.
c. Do not put any pressure on your jaw.
d. Eat a soft diet for the first several days till your mouth or surgical site starts to get better and heal.
e. If you have been given a temporary denture, you may not be able to wear it continuously as you will be sore.
- Much of the healing depends on your keeping your mouth clean. Use a soft tooth brush after every meal initially and you may be prescribed an antiseptic rinse to prevent chances of infection. Follow all directions and instructions.
- Depending on your needs, a healing abutment will be used after surgery that helps heal gum tissues around the implant site. Once fully healed, you will need to follow up with your general dentist for the crown or final prosthesis.
- It often takes 3-4 months for jaw bone to firmly adhere to implants. During this time, please keep all your follow-up visits with the surgeon. If you have a denture you can visit your general dentist for a follow-up so we can reline your denture for more comfort.
- Call your surgeon if you notice excessive swelling, bleeding, pain (if not relieved by medications), or fever or numbness that does not go away after anesthetic.
Following routine extractions, some bleeding is to be expected. The dentist will place thick gauze at the extraction site; please keep biting on it for twenty to twenty-five minutes. After the twenty-five minutes, remove the gauze and throw it away. If there is very little bleeding after the gauze is removed from the extraction site, do not worry as it will clot naturally and will eventually stop bleeding. If there is excessive bleeding upon removal of the gauze after twenty-five minutes, put a thick gauze packet again as instructed by your dentist for another twenty-five minutes. If excessive bleeding still continues after the first hour, put the gauze packet again and call the office for an immediate follow up.
Minor swelling around the extraction site is normal. This should subside in three to five days. To help relieve the swelling, please put ice packs on and off for thirty minutes at a time. Please keep your head elevated as much as possible for the first few days after the extraction. This will also help reduce the swelling. However, if the swelling gets worse or does not get better after one week, please call the office.
You will be numb after the extraction for two to three hours and will not notice the pain. As the anesthetic starts to wear off, you will start to feel pain. Please take pain medications or any other medications as prescribed by your dentist. Please refrain from pain medications containing aspirin, as aspirin increases the bleeding. The pain usually lasts the first two to four days.
4. Dry socket
If you feel the pain following the extraction got worse after three to four days, you may have a dry socket. A dry socket is an infection that develops due to the complications during extraction; examples: removal of broken or curved roots or difficult locations or angulations of extracted teeth. Please call the office if you feel you’re developing a dry socket. We will place a dry socket dressing, which will help with the discomfort.
5. Bone and bone fragments
During extractions, there is a lot of instrumentation done around the bone and the gums to remove the roots, so minor bony fragments or sharp edges may remain under the gums. This will naturally heal in about two to four weeks. If this is bothersome, please call the office.
6. Hygiene and other habits
It’s extremely important that you do not smoke or take alcohol for the first five to seven days following extraction. This is because smoking and alcohol containing products can aggravate the healing process and cause unnecessary swelling, redness, pain, and even dry socket. Continue brushing your teeth as always, but please be gentle around the extraction site. Please refrain from alcohol containing mouth washes to rinse your mouth for the first few weeks. You may rinse your mouth with warm salt water forty-eight hours after extraction. Do not drink with a straw or do heavy exercise for the first fort-eight hours, as this may increase the bleeding.
Please eat a soft diet following extraction and do not eat any nuts or hard foods, spicy foods, hot foods or drinks, or popcorn kernels, ect. for the first week. you may slowly resume normal diet after seven to ten days.
If sutures have been placed, please check with your dentist about the appointment for removing the sutures. If absorbable sutures have been placed, you will not need a follow up appointment.
9. If you have any further questions, please do not hesitate to call the office.
Please inform your dentist about your general health. If you are taking any prescriptions or over the counter medications that may impair the healing process, we will let you know. If you have any other medically compromised health factors ex. Diabetes, cancers, heart problems, ect. please let us know as this will affect the normal healing following extraction.
- You will be numb for about 2 hours after the completion of your appointment. Please do not eat or drink anything hot, to avoid burning and biting on the numb part of your mouth. If you have received a silver amalgam filling please do not eat anything hard for twenty-four hours, you can eat a soft diet over the silver amalgam fillings after the numbness has worn off. The white composite fillings are completely hard by the time you leave the office, and you can eat right away on the white fillings after the numbness is gone.
- Once the numbness has worn off, you will be sore for a few days in your gums and your mouth from staying open during the procedure.
- Hot and cold sensitivity from 2 to 7 days is normal, it usually will subside. Please call the office if you have any further questions.
- If after your numbness has worn off, you find it hard to bite down, it means your bite is off, and it needs adjustment. Please call the office right away.
- If you were told your cavity was deep your sensitivity will last longer than a week. you will feel a dull toothache that can last up to 6 weeks. If you feel that your tooth is constantly throbbing and is not getting better, then your nerve in the tooth is damaged from the bacteria penetrating into the nerve from the deep cavity. This will need to be treated and we call this the root canal treatment.