The CDC says periodontal disease, also called gum disease, is one of two biggest threats to dental health. In the US, 47.2% (almost half the population) of adults aged 30 and above have some form of periodontal disease. In Texas, the prevalence of gum disease is 48.25% (the fifth highest by states).
The stats give a clear picture. Periodontal disease is common, even in Carrollton, Texas, and this article explores one of the increasingly popular way to treat it—the use of lasers.
What is gum disease?
Put simply, gum disease is the result of infections and inflammation of the tissues and bone that surround, support, and hold your teeth in place.
Technically, there are seven categories of periodontal diseases to describe the stages of progression. For simplicity, these could be classified in two:
- Gingivitis; where damage is reversible with proper oral hygiene
- Destructive periodontal disease, or often just called periodontitis; where damage is irreversible and treatment is necessary
How it starts
The mouth is always teeming with bacteria. At any time, these bacteria grow, and together with mucus and other particles, form a biofilm or mass called dental plaque. It also goes by different names—oral (or dental) biofilm, microbial plaque, and bacterial (or dental) plaque biofilm.
It is sticky and colorless. And it forms on your teeth (at the front, behind, or between adjacent teeth), on chewing surfaces, and along or below the gumline.
The major reason why you have to brush and floss regularly is to disrupt, control, and remove the mass of bacteria. Failure to practice proper oral hygiene would expectedly allow the dental biofilm to continue to grow. It may take either of two routes:
- become acidic and cause tooth decay (also called cavities or dental caries)—the other biggest threat to dental health aside gum disease
- harden to form tartar (also called dental calculus)
Tartar is often pale yellow or brown. And brushing cannot remove it.
As the buildup and progression of plaque and tartar continues, they’d stay longer on teeth, and the bacteria would cause inflammation of the gum (gingiva). Initially, this inflammation is confined to the soft tissues above the bone level. And the gums become red, swollen, and can bleed easily.
It is this first, mild, initial stage of periodontal disease that is called gingivitis—a portmanteau of gingiva and –itis (a suffix to denote inflammation). It would not lead to any loss of bone or core tissues (the periodontal ligaments) that hold the teeth in place.
The trio of regular brushing, flossing, and regular cleaning by a dentist or dental hygienist; will usually be enough to reverse gingivitis.
However, if gingivitis is not halted, it would almost always advance to periodontitis (pyorrhea). Since periodontitis is the form of gum disease that necessitates treatment, many use both terms interchangeably.
Periodontitis, much like gingivitis, is a portmanteau of periodontium and –itis. The periodontium comprises the specialized tissues that both surround and support the teeth; and affix them to the jawbones. It consists of four primary components—gingiva, cementum, alveolar bone, and periodontal ligament (PDL).
In pyorrhea, the gingivae (gums) pull away from the teeth and form spaces (deepened sulcus) called [periodontal] pockets. These pockets become infected. Eventually the spread of the plaque below the gum line, bacteria toxins, and your body’s immune response to infection cause progressive breakdown of the periodontium.
There’d be loss (destruction) of cementum, periodontal ligament fibers, alveolar bone, which is left unchecked will lead to loosening of the teeth. And the teeth may eventually fall off or have to be removed.
Dental plaque and calculus may be the primary cause of periodontal disease. However, a few factors and conditions—risk factors—may increase the risk and speed up the progress of (and damage caused by) the disease. They include:
- Poor oral hygiene
- Female hormonal changes
- Some medications
- Other illnesses, syndromes, and treatments
- Poor nutrition
- Crooked teeth and bridges that do not fit properly
Gum Disease Treatment Options
The foundation of effective, successful gum disease treatment is establishing and maintaining excellent oral hygiene—brushing twice a day, flossing once a day, and rinsing with antimicrobial mouthwash at least once a day.
Individuals who have dexterity problems, such as those with arthritis, may require frequent professional care and/or have to use a powered toothbrush.
Keeping the growth of plaque and buildup of tartar in check is not a one-time thing. It is a continuous process. And it is essential to restoring and maintaining good oral health (as well as prevent the progress of gum disease at other sites) during and after gum treatment.
- Scaling and Root Planing
The initial therapy to establish gum health involves mechanical removal of the microbial plaque and tartar using specialized curettes. This procedure is nonsurgical, may require multiple visits, and usually only requires local anesthesia.
It is called scaling and root planing (SRP) or deep cleaning. Scaling refers to the process of scraping off tartar from above and below the gum line. While root planing refers to the process of removing rough spots on the tooth root where pathogens gather.
In addition to deep cleaning, it may be necessary to perform other dental procedures, such as:
- adjusting the bite (occlusion) to prevent excessive force on teeth that have diminished bone support
- replacing plaque-retentive, rough restorations
- closing open contacts between teeth
SRP is typically sufficient if the depths of periodontal pockets are less than 4-5 mm (0.16-0.20 in). And monthly reevaluation may be necessary to monitor improvement.
- Flap Surgery
However, if SRP is unsuccessful in managing gum disease and/or you have moderate to advanced periodontitis, you’d need periodontal flap surgery. Flap or scalpel surgery is done to:
- remove dental calculus deposits in deep periodontal pockets, or
- reduce the depth of the periodontal pocket for easier cleaning
It involves lifting the gums (making an incision flap and lifting the flap for access) to remove tartar and then stitching the flap back in place.
In addition to flap surgery, it may be necessary to have procedures to help regenerate tissue and/or bone that had been lost. These include:
- bone grafting
- guided tissue regeneration
- soft tissue graft
- use of growth factors
- Laser Surgery
Laser surgery for gum disease, also called LANAP [Protocol], is an alternative to the flap surgery. It has a lot of promise and will be discussed in detail in the sections below.
Laser Gum Surgery Carrollton, Texas
Gum therapy is mainly about removing tartar in periodontal pockets. Laser gum surgery uses laser (an intense and narrow beam of light of a single wavelength) to not only remove tartar but also to vaporize infected or diseased pocket-lining epithelium (debridement) without causing damage to the underlying connective tissue (called selective photoantisepsis).
It also slows or stops loss of attachment, reduce pocket depth (since the laser used has coagulative ability to form fibrin), and stimulate regeneration (regrowth) of the periodontium.
It is an advanced form of therapy and is minimally invasive. It is also called periodontal laser therapy (or surgery) and laser periodontal therapy (or surgery).
The only FDA-cleared laser gum therapy is the Laser-Assisted New Attachment Procedure (LANAP or PerioLase Laser). It uses the PerioLase MVP-7, which is a free-running, variable pulsed Nd:YAG (neodymium:yttrium-aluminum-garnet) type of dental laser at 1064 nm (nanometer) wavelength.
LANAP offers similar results to alternative periodontal therapies, but without the need for major incisions; stitches; and related substantial pain, bleeding, and swelling.
Benefits of LANAP
- General anesthetic is rarely needed
- Since gum laser surgery is less invasive, it is associated with limited post-op pain, bleeding, and swelling
- Recovery and healing takes less time
- It is just as effective as traditional gum surgery in eliminating bacteria
- Its effect on the reduced pathogens, shift of bacterial subgingival flora, and promoting the growth of normal flora is long-lasting
- It reduces the risk of infection
- It reduces exposure and post-op sensitivity
LANAP Laser Gum Surgery Process Carrollton, TX
The LANAP Protocol
- Local anesthetic is used to numb the area to be treated.
- A perio probe is used to ascertain excessive periodontal pocket depth
- A diode laser, also called an injection laser diode, is introduced into the periodontal pocket to direct the laser light that is about as thick as three human hairs for removal the damaged tissues and bacteria.
This diode is an electrically-pumped semiconductor laser that is about the size of the pen.
- An ultrasonic scaler (and sometimes, special handheld instruments) are used to remove accretions (plaque and tartar) on the tooth root surface.
- Bone may be modified.
- The diode laser is reintroduced for use in forming and stabilizing a gel-clot that contains stem cells from bone and periodontal ligament.
- A dental drill may be used to perform bite adjustment to ensure teeth stability.
- A closed system is created by reattaching the rete ridges (pegs) of the gingiva to the clean root surface using a stable fibrin clot at the gingival crest
- Trauma from occlusion is adjusted
- You may experience mild soreness at the treated areas. Soreness or pain experienced is usually mild. And it would not considerably affect your ability to carry out your daily routine, such as speaking, eating, and drinking. Taking pain medication like ibuprofen should be sufficient to alleviate any pain you feel.
- You may notice slight discoloration of the gum tissues around the teeth. This is temporary.
- You may need to have splints placed to stabilize and immobilize the teeth. Endeavor to wear these splints as instructed to promote healing.
- Post-op instructions will mandate you not to brush or floss treated areas for a specific time (usually 7 to 10 days after surgery).
- You’d also be mandated to stay on a soft diet.
- Avoid smoking, as it interferes with the healing process.
- Maintain good oral hygiene after you get the thumbs up and keep your dental appointments
Most individuals would only need TWO 2 to 3 hour sessions to complete LANAP. However, you should show up for any post-op scheduled visits.
Laser Gum Therapy versus Traditional Gum Flap Surgery
Traditional periodontal scalpel surgery and periodontal laser surgery do the same thing differently. And that process makes all the difference as it confers on laser therapy specific advantages that make it appealing.
The main differences between both options include:
Cuts and stitches
Flap therapy requires making an incision and suturing once complete. Laser therapy doesn’t require cuts nor stitches, rather using a light beam. The option you’ll likely be more comfortable with is obvious—light over cuts.
The implications of the minimal invasive nature of laser gum surgery are:
- the use of local anesthesia for most procedures; unlike flap surgery where the use of general anesthesia may be necessary in some cases
- little or no recession of the gum line; unlike flap surgery where immediate gumline reduction after the procedure is inevitable.
This is important as gumline reduction can be as significant as 15mm for flap therapy, which would lead to associated aesthetic issues (longer appearing teeth) and increased tooth sensitivity.
Compared to flap therapy, LANAP protocol involves less discomfort.
While laser surgery requires one or two visits, flap surgery requires two to four visits (not inclusive of the post-op visit to remove stitches).
Because laser gum therapy is less invasive, its healing time is shorter compared to that of scalpel surgery.
- Periodontal laser surgery selectively targets damaged tissue while sparing healthy tissues. Flap surgery is not as precise as healthy tissue will inevitable be scraped away with damaged tissue. This contributes to the longer healing time of flap surgery.
- In addition to removing bacteria, laser promotes the regeneration of soft tissue and bone that had been lost. It also has coagulative properties. Flap surgery does not have either effect.
Cost of Laser Gum Disease Surgery Carrollton, Texas
The cost of laser gum surgery and regular flap surgery of corresponding complexity is comparable.
It is also usually covered by healthcare insurance policies in Carrollton, TX, since reimbursement of periodontal treatment is not contingent on the type of procedure used. You should get confirmation from your insurance company before you proceed to have laser surgery.