Gingival (Gum) Health
As a general rule, once the exam has been completed and a treatment plan has been agreed to, the first step is going to be establishing gingival (gum) and periodontal (bone and tooth support) health. There are a couple of good reasons to start here. Perhaps the best reason being that periodontal disease leads to more tooth loss than caries (tooth decay). Tooth decay can advance rapidly in a tooth and cause a toothache in just a year or two. Periodontal problems on the other hand take years in most cases, hence, most tooth loss comes in older patients and often times can involve all teeth. It is not uncommon to extract multiple teeth at a time due to periodontal problems. So what treatment is available to keep gums and bone healthy? If your gums are in pretty good shape, your treatment is going to be a prophylaxis – a cleaning. Part of the exam included measuring how deep the collar is that gums form around each and every tooth. Normal is considered up to 3 mm deep. Pockets deeper than that indicate a gum/bone problem; the higher the number, the deeper the pocket and the bigger the problem. It can be from inflammation of the gums (swelling) due to irritation from plaque and calculus (tartar) or from attachment loss (gums not fastening to the tooth root where they should. As pockets get deeper, they collect more plaque, calculus and bacteria and you have started a vicious circle. A prophylaxis is supposed to be done with healthy gums to keep them healthy. Okay, your gums are not healthy, what gets done. It depends on just how much damage is present. Maybe your teeth have so much tartar on them that you can’t even see the edge of the gums against the tooth. In that case a gross debridement will have to be done to remove enough of the calculus that a periodontal evaluation can be done later. Maybe you have a lot of calculus on your teeth, under the gumline creating inflammation to your gingiva but it hasn’t progressed to losing the normal attachment of your gums, nor is there bone loss yet. Scaling will be done, much as it is during a prophylaxis, it is just going to be more involved, taking more time, having more bleeding and likely is going to be more uncomfortable. If you have deeper pockets and your x-rays show bone loss, scale and root planning, sometimes referred to as deep cleaning, needs to be done and will likely involve being numbed to allow getting all the way to the bottom of the gingival collar.
Back at the beginning it was mentioned that there are a couple of good reasons to get gums healthy first. Besides preventing future loss, the big reason is for better restorations. Unhealthy gums bleed more. If you are having restorations placed that are near the gums, and the gums are bleeding, the restoration may be adversely affected. Tooth colored fillings don’t bond, they then leak and fail. If you are having impressions for crowns, the impression may not be as accurate if gums are bleeding. The better a crown fits, the longer it will last.