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Education
Dr. Rosen has completed training with Dr. Pat Allen in root coverage
with Alloderm
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Training
Dr. Rosen has trained with Dr. Steven Wallace in doing sinus grafts.
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Dr. Rosen gave a talk on Dental Sleep Medicine at Emerson Hospital as
part of a panel of sleep physicians.
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PERIODONTICS
Periodontics involves the diagnosis, treatment and
prevention of gum disease by a general dentist or a periodontist. A periodontist is a
dentist who has had additional years of specialized training in periodontics at a
post-doctoral educational program and is certified as such. |
The word
periodontal means “around the tooth.” Healthy gum tissue fits like a cuff
around each tooth. Where the gum line meets the tooth, it forms a slight
v-shaped crevice called a sulcus. In healthy teeth, this space is usually
three millimeters or less.
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Periodontal
diseases are infections that affect the tissues and bone that support teeth.
As the tissues are damaged, the sulcus develops into a pocket that is
greater than three millimeters. Generally, the more severe the disease, the
greater the pocket depth and bone loss. The enlarged pockets allow harmful
bacteria to grow and make it difficult to practice effective oral hygiene.
Left untreated, periodontal diseases may eventually lead to tooth loss.
It's possible to have periodontal disease
without apparent symptoms. That's why regular dental visits and periodontal
examinations are very important.
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| The most common type of periodontal disease are GINGIVITIS
and PERIODONTITIS |
HEALTHY
GUMS AND BONE
Gums appear light pink and are sharply defined. Bone completely surrounds the roots of
the teeth. Teeth are firmly anchored into the bone.
GINGIVITIS is the mildest form of periodontal
disease. It causes the gums to become red, swollen, and bleed easily. There
is usually little or no discomfort at this stage. Gingivitis is reversible
with professional treatment and good oral care at home.
CHRONIC PERIODONTITIS is a form of periodontal
disease that results in inflammation within the supporting tissues of the
teeth. Patients
experience progressive loss of tissue attachment
and bone. Chronic periodontitis is characterized
by pocket formation and/or recession of gum
tissue and is the most frequently occurring form
of periodontitis. It is prevalent in adults, but can occur at any age.
Progression of attachment
loss usually occurs slowly, but periods of rapid
progression can occur.
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HEALTHY

GINGIVITIS

MODERATE PERIODONTITIS

SEVERE PERIODONTITIS
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| CONTRIBUTING
FACTORS TO PERIODONTAL DISEASE
The response of the gums and bone to dental plaque may be modified by one or more of
the following factors.
- Poorly fitting dental restorations
- Smoking
- Crowded teeth, improper bite alignment
- Clenching or grinding of teeth
- Hormonal changes, including pregnancy, menstruation and menopause
- Diet
- Systemic diseases, including blood disorders and diabetes
- Medications, including calcium channel blockers and anti-convulsants
WARNING SIGNS OF PERIODONTAL
DISEASE
- Gums that bleed easily
- Red, swollen or tender gums
- Gums that have pulled away from your teeth
- Persistent bad breath
- Pus between the teeth and gums
- Loose or separating teeth
- A change in the way your teeth fit together when
you bite
- A change in the fit of partial dentures
DIAGNOSIS OF PERIODONTAL DISEASE
Periodontal disease can be easily detected by a general dentist or periodontist
during regular examinations. A periodontist is a
dentist who specializes in the diagnosis, prevention and treatment of gum disease. A
periodontal charting should be performed for all teeth. A periodontal probe,
with ruled millimeter markings, is used to measure the depth of the space
between the teeth and gums. Ideally, normal measurements range between 1 and 3
millimeters. Depths greater than this may signify the presence of
periodontal pockets and associated gum disease. X-rays should be taken to see if bone
damage has occurred as a result of the disease process.
TREATMENT OF PERIODONTAL DISEASE
The main goal of periodontal treatment is the elimination of the disease process from
the gums, periodontal ligaments and bones that surround the teeth, and the restoration of health that can
be predictably maintained in the future. Shallower pockets, less than 3 mm,
are easier to maintain and keep healthy.
PHASE I
Initial treatment involves educating patients in the proper methods of
effective, daily plaque removal and oral hygiene. This is a critical component of
successful therapy. |
| Scaling and root planing are performed to clean the tooth
surface and remove bacterial plaque and calculus deposits from the gum pockets.
These deposits are the source of the infection. This may be the only treatment necessary in
cases of gingivitis and very mild periodontitis |
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PHASE II
| When deep pockets develop, it is
difficult to completely remove plaque and tartar even with thorough daily
oral hygiene. If the pockets do not heal after scaling and root planing,
periodontal surgery may be needed to reduce the pocket depth and make teeth
easier to keep clean. Surgery allows the dentist to access hard-to-reach
areas that require the removal of tartar and plaque. The gums are sutured
back into place or into a new position to make tissue snug around the tooth.
Bone surgery, including bone grafts, may be used to rebuild or reshape bone
destroyed by periodontal disease. Splints, bite guards or other appliances
may be used to stabilize loose teeth and to aid the regeneration of tissue
during healing. If excessive gum tissue has been lost, a gum graft may be
performed. After surgery, the dentist may apply a protective dressing over
teeth and gums and a special mouth rinse may be recommended or prescribed.
An antibiotic and mild pain reliever also may be prescribed. |
OSSEOUS
SURGERY

| Additional treatment methods may be necessary to treat
periodontal disease and restore health.
These may include:
- Bone grafts for bone regeneration
- Gingival (gum) grafts to treat gum recession and pathological root
exposure
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Cosmetic plastic surgery
of the gums to improve
appearance
- Fabrication of night guards for bruxism (tooth
grinding)
- Splinting or bonding teeth together for increased
strength and stability
- Orthodontics (braces) to straighten and realign
teeth
- Removal of diseased roots on some types of molars
- Use of medications such as antibiotics, fluoride and
antimicrobial rinses
MAINTENANCE
Once the active phase of treatment is complete and health has been restored, it is
extremely important that patients be seen by a hygienist for routine dental and
periodontal cleaning on a regular basis. This regimen,
along with diligent home care and oral hygiene, will give the best chance for preventing
recurrence of disease and maintaining long term periodontal health. |
| This information was adapted from the ADA brochure " Periodontal
Disease: Don't Wait Till it Hurts." |
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