Drs. L.A. Christopher & M. Favagehi
Periodontists
PATIENT INFORMATION GUIDE
Frequently asked questions and issues : Home
Periodontists are dentists who have additional specialty training in diagnosis and treatment of the diseases and conditions of tissues around teeth ( gums, bone, etc.). Periodontists also receive training in treatment planning, surgical placement and maintenance of dental implants to substitute missing teeth.
Periodontists complete a 3 year specialty training in an American Dental Association accredited post-doctoral residency. A typical periodontist receives 11 years of higher education training.
About 80% of dentists are general dentists and they are trained to diagnose and treat most dental and oral conditions. About 20% of dentists are specialists. The American Dental Association recognized specialties are:
1. Endodontics 2. Oral Pathology 3. Oral and Maxillofacial Surgery 4. Orthodontics
5. Pediatric Dentistry 6. Periodontics 7. Prosthodontics
8. Oral & Maxillofacial Radiology 9. Public Health Dentistry
Answer: plaque ( bacteria in dental plaque )
Bacteria found in dental plaque are the primary agents causing periodontal disease. Dental plaque is a colorless film that forms on teeth and their roots. There are about 300 bacteria normally found in the oral cavity. Most of these bacteria are harmless. The pathogenic ( harmful) bacteria that cause periodontal disease are a group of about 30 microbes which cause gingival and periodontal inflammation. This inflammation leads to bone loss around teeth.
Tartar or calculus are calcified structures that harbor bacterial plaque under the gum line. Deep pockets under the gum line and calculus formation promote the growth of the harmful bacteria under the gum line. Periodontal therapy focuses on eliminating harmful bacteria under the gum line. This is achieved by tartar and plaque removal, pocket reduction procedures and antibiotic therapy.
The main risk factor for periodontal disease is: poor plaque control ( not brushing & flossing regularly ).
Other risk factors involved with periodontal disease may be:
1. smoking. 2. diabetes 3. genetics 4. hormones 5. stress 6. defective dental restorations
7. crowding of teeth 8. AIDS 9. malnutrition 10. wisdom teeth 11. bone pathology
12. endodontic (root canal) problems 13. medications
Dental implants are an excellent way to replace missing teeth. They can also be used to stabilize dentures. The first step in implant therapy involves the placement of implant(s) in the area of missing teeth. A few months later, custom made crowns are placed over the implants. The overall success rate with implant treatment is more than 90%. Since dental implants are made of titanium, they are resistant to tooth decay, or root canal problems.
Implant therapy usually involves a team approach. The implant surgeon is usually a periodontist or an oral surgeon with years of advanced surgical training. The dentist who restores the implants with crowns, bridges or dentures is usually a general dentist or a prosthodontist.
During the consultation visit you will be asked about your medical and dental history. You should report to the doctor what medications you are using and what you may be allergic to. Make sure to let the doctor know if you are pregnant or have any medical conditions.
The doctor will evaluate your mouth and the x-rays. He may order new x-rays. A periodontal screening will be done to determine your treatment needs. The doctor will give you an overview of your periodontal diagnosis, prognosis, and treatment options. You are encouraged to ask questions about your dental condition as well as fees, insurance, or other matters. In some cases, a consultation report will be given to you or your dentist. In some cases you will be asked to return for a more comprehensive examination.
In most cases, there are no special restrictions prior to surgery. You should eat a light breakfast or lunch and take your regular medications.
If you are prescribed HALCION prior to surgery: Take one tablet about an hour prior to bed-time the night prior to surgery. This will be a good orientation for you to see how you feel when you take this medication. This would also help you sleep better, as a good night's rest is highly recommended the night before surgery. On the day of the surgery, you should have someone drive you to the office. You can have a light breakfast or lunch. You should take one tablet of Halcion about one hour prior to surgery. Make sure you will have someone drive you home after the surgery.
If oral pre-medication , sedation, nitrous oxide gas or general anesthesia is to be used, you should have someone drive you to and from the office. In case of general anesthesia or sedation you should avoid eating for at least 12 hours prior to the procedure.
Post-operative instructions
__ Motrin 800 mg : Take 1 every 5-6 hrs for the first 3 days after surgery, then use as needed.
__ Advil, Ibuprofen, or Motrin are all trade names for ibuprofen: Each over the counter tablet is 200 mg. Please take 3-4 (Three to four) tablets every 6 hours. This will add up to the maximum recommended dosage.
__ Vicodin , Vicodin ES, Vicoprofen, Lortab, hydrocodone, percocet, oxycodone: Take only if you are already taking Motrin, ibuprofen or advil and you need additional relief. Take 1 every 4-6 hrs. Do not drink alcoholic beverages or drive. Do not take with any sedatives. It is recommended that you take one prior to bed-time.
__ Penicillin 500 mg ; take one, four times daily.
__ Amoxicillin 500 mg ; take one, three times daily.
__ Doxycycline 100 mg; take two the first day, followed by one per day. Don’t take with milk products. Do not use
if pregnant . If taking birth control pills, note that the effectiveness of birth control is reduced.
__ Medrol dosepack: take as directed .
__ Ultram 50 mg: Take 2 immediately, followed by 1 to 2 every 4 to 6 hours.
__ Metronidazole 500 mg ( Flagyl), take one every 6 hrs. ( NO ALCOHOL)
Mouth rinse:
___ Saline: You may rinse 4-5 times daily with salt water (saline) after surgery. You may use commercially available saline products or make saline by adding 1 tea-spoon of salt in an 8 oz. glass of warm water.
___ Peridex, Periogard, Chlorohexidine : To use following surgery. Rinse with ½ oz twice daily.
9. Post-operative appointment: You may be asked to return for suture removal and post-operative care one or two weeks following surgery. If you have any non-resorbable sutures placed, please make sure to visit your doctor for a brief suture removal appointment. Not visiting your doctor for post-operative appointment may put you at risk for infections or discomfort. If you have simple extractions performed, you may not need to see your doctor for a post-op appointment. Please call your doctor if you are not sure you need a post-op appointment.Please note the surgical dressing neither enhances nor delays wound healing, it is used under special circumstances to protect the surgical site. The periodontal dressing may become dislodged before your post-operative appointment. You do not have to replace the periodontal dressing if it is dislodged.
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The goals of periodontal therapy are to arrest the progression of periodontal disease and to create a healthy periodontium to provide adequate foundation for teeth in the jaw bone. The bacteria that cause periodontal disease are commonly harbored in calculus deep under the gum line.
The decision to have surgery depends on the diagnosis of the stages of periodontal disease. Usually in the cases of initial and moderate periodontitis calculus can be removed and pocket depths can be reduced with more conservative non-surgical therapy. In more advanced cases, surgery is the preferred mode of therapy. You should consult with your periodontist to see what treatment is best for you.
You may have read or heard about the above in the media. Perio chip, Atridox, or Actisite are disinfectant or antibiotics that are used as an adjunct to scaling & root planing ( non-surgical periodontal therapy ). These products are placed under the gum line in deep periodontal pockets to control periodontal inflammation. These products can enhance the positive results obtained from non-surgical therapy and may delay or eliminate the need for periodontal surgery. The decision to use these products depends on the diagnosis of the stages of periodontal disease. You should consult your doctor to see if you can benefit from the above adjunct treatment modalities.
Periodontal surgery is performed in more advanced cases of periodontal disease. There are many procedures and techniques used to surgically reduce periodontal pocket depth and to remove subgingival calculus (tartar) deposits. Some periodontal surgeries involve the regeneration of lost bone and periodontal tissues by using bone grafts or guided tissue regeneration.
Periodontal surgery is usually performed with local anesthesia. It takes about 1-2 hours to perform periodontal surgery in a segment of the mouth. Patients are usually prescribed a mild-moderate pain medication such as ibuprofen. Good oral hygiene and frequent maintenance recall appointments with your hygienist, dentist or periodontist is essential after periodontal surgery to ensure long term success.
Gum (gingival) recession can be caused by factors such as poor anatomy, periodontal disease, tooth movement, trauma or aggressive brushing. Gum ( gingival ) grafting is a routine procedure performed by Periodontists to replace missing gingival tissues around teeth. The gingival tissue around teeth or implants plays an important role in establishing a biological seal around the neck of teeth to prevent bacterial invasion and inflammation.
The gingival donor site is usually in the palatal area ( roof of the mouth ). A small piece of tissue is harvested from the palatal area, and is transplanted to the recipient area. In some cases, gum grafting is performed for esthetic reasons to cover exposed roots. However, in many cases gum grafting is necessary to protect teeth from future periodontal problems.
It takes about 1 hour to place a gum graft. The superficial healing will take place after 7-10 days.
Part of the bone anchoring the teeth is lost due to periodontal diseases. In some cases this bone can be regenerated by using bone grafts and G.T.R. ( Guided Tissue Regeneration ). G.T.R. is achieved by placing a barrier (usually a membrane) under the gum tissue to prevent soft tissues to occupy the bone defect. This gives the bone cells ample time to grow and deposit new bone to fill the bony defect. Bone grafting and GTR can be used if the bone defect has certain characteristics. Your periodontist can determine if you are a candidate for bone grafting.
Some patients show too much gum tissue when they smile ( " gummy smile "). This may be due to normal anatomy, genetic factors or excessive growth of gum tissue. Your periodontist can reduce the gum tissue and create a more beautiful smile. Not everyone is a candidate for cosmetic procedures, please consult with your periodontist.
Yes. There are different periodontal diseases. In some cases, periodontal disease is associated with a systemic disorder such as diabetes. In other cases, periodontal disease has a more genetic component. Some examples of different periodontal diseases are: Adult Onset Periodontitis, Juvenile Periodontitis, Necrotizing Ulcerative Periodontitis, Desquamative gingivitis, Rapidly Progressive Periodontitis, and Refractory Periodontitis.
In some cases, antibiotics are indicated to fight the bacteria that cause periodontal disease. The bacterial plaque that causes periodontal disease can't be eliminated by antibiotics if there is tartar or caluculus formation under the gum line. Tartar or calculus formations are specialized structures that harbor and protect bacteria on the root surfaces of teeth. In most instances, removal of the calculus or tartar significantly reduces bacterial populations under the gum line and the immune system is capable of fighting the bacteria effectively. Antibiotics can be used as an adjunct treatment modality to help the immune system in fighting periodontitis. Use of antibiotics alone, without other therapy, is not an effective method in treating periodontal disease.
If anesthesia is not used, periodontal therapy can be painful in some cases. However, in cases where periodontal therapy is uncomfortable, local anesthetics are used during the procedure. Post-operative pain medications of choice are non-steroidal anti-inflammatory medications such as aspirin or ibuprofen.
"Deep cleaning" is a term used to describe scaling & root planing. This procedure is a non-surgical treatment. The goals of scaling & root planing are: removal of tartar or calculus formations on teeth and their roots, disruption of the bacterial flora under the gum line, making the gum tissue healthy, and making the root surfaces smooth to discourage calculus or tartar formation. Curettage or removal of infected gum tissue lining of the periodontal pocket is performed at the same time as scaling and root planing. In many cases, scaling & root planing is a definitive periodontal therapy. In other cases, scaling and root planing is performed in preparation for gum surgery. Stable results can only be obtained with good plaque control.
Periodontal osseous surgery involves the correction of gum tissue and bone ( osseous ) defects caused by periodontal disease. Following the administration of local anesthesia, the gum tissue is pulled back for access to clean the roots and correct damaged periodontal tissues. Sutures (stitches) are used following surgery to close the surgical site.
Your bite can affect the periodontal foundation of teeth. The severity of periodontal disease or prognosis and treatment outcome in periodontics can be influenced by your bite. Bite adjustment (Occlusal adjustment) is sometimes necessary as an adjunct treatment in periodontal therapy .
The T.M.J. (Tempramandibular joint) is the joint connecting your lower jaw (mandible) to the skull. Bite problems may damage this joint or associated muscles causing pain, discomfort and headaches.
Cells in the gums are affected by hormones such as estrogen. During puberty, pregnancy, menstrual cycle, and menstruation there are significant changes in hormonal levels. These changes affect gum tissues. Some women experience periodontal and gingival problems during puberty, menstruation cycle, pregnancy or menopause. There is new research that shows women with periodontal disease are more likely to have babies with low birth weight. Your periodontist can work with your physician to adjust hormone levels and provide treatments for hormone related gingival problems.
Recent research has shown that periodontal infections cause changes in blood biochemistry that ultimately place patients at more risk for developing cardiovascular problems such as heart attacks or strokes. Periodontal treatment can reduce the risk of heart attacks or strokes in some individuals. Please consult with your periodontist and physician.
Stress can cause changes in the immune response and wound healing. These changes can affect your response to periodontal infections. There is new research that shows stress can be considered a risk factor for periodontal disease. Dr. Mehrdad Favagehi has published scientific articles and a thesis with respect to this subject. Please refer to publications by Dr. Favagehi in this web page to obtain more information.
Periodontal or implant therapy is less successful if the treatment outcomes are not maintained over the long term. Patients are usually asked to be seen in intervals ranging from 2-6 months for maintenance recall visits. A typical recall regimen after surgical active periodontal therapy involves a 3 month recall program. Recall appointments are usually shared between the general dentist and the periodontist so that patients visits both doctors twice a year. One of the major goals of recall appointments is to intercept and treat problems before they become serious. Regular cleaning and oral hygiene reinforcements are also expected with recall appointments.
As specialists in prevention of periodontal diseases, Periodontists can work with you and your dentist to make recommendations on oral hygiene materials and techniques. Please consult with your periodontist to see what material is recommended for you.
Our office exclusively uses computerized X-rays (digital radiography technology). A major advantage is that patients get up to 10 times less radiation exposure compared to conventional X-rays. Other advantages are providing patients, insurance companies, or referring doctors with an e-mail copy of the x-rays, faster duplication of X-rays, and computer aided analysis of X-rays. Furthermore, our office is not exposed to the chemicals necessary for processing x-rays, since digital radiography is filmless and does not require processing.
Payments are expected at the time of service.
To assist our patients, our office accepts credit cards (VISA & MASTERCARD), and checks. As a complimentary service, our office files insurance claims with your medical and/or dental insurance company. Our office is a provider with most dental plans, and we accept most insurances.
For those patients intersted in payment plans, our office provides various options. There are payment plan options provided by outside companies**. The advantages of some outside financing plans may include all or some of the following : 1. On-The Spot Approval for creditlines up to $ 10,000.00 2. 90 Day No Interest Options 3. No payments for 3, 6, or 12 months (depending on plan) 4. Low monthly payments
** Outside financing is subject to policies of the various outside financing companies.
Our office is set up to coordinate your treatment with your dentist. If you don't have a general dentist, we can help you find a dentist. X-rays and other clinical information are forwarded to referring doctors regularly.
Recall ("cleaning") appointments typically alternate between our office and your dentist.
Procedures such as dentures, crowns, bridges, bonding, fillings, and root canals, etc... will be done by your dentist.