Perioscopy (Periodontal Endoscopy) Recent advances in dental technology have enabled us to utilize a very small camera at the end of a periodontal probe, much like the technology used in arthroscopic procedures. This probe can comfortably access the base of periodontal pockets to allow for complete visualization of the infected root surface at as much as a 40 times magnification. Periodontal debridement can then be performed allowing more complete root cleaning. In addition, we can visualize many other problems, i.e. root fractures, root decay, root resorption, etc., which otherwise can only be visualized through surgical procedures. In addition to the previously mentioned uses, we utilize this technology in the treatment of sites with recurrent gum disease during maintenance/supportive periodontal care. Our hygienists have utilized this technology for over 10 years (or longer in Sacramento).
Video: Courtesy of Dr. John Kwan, Oakland, CA
Scaling and Root Planing Scaling and Root Planing is a treatment that goes deeper below the gum-line to remove contaminated debris and bacteria, most often performed on patients with active periodontitis..
Scaling meticulously removes contaminated biofilm, plaque, calculus, microorganisms and toxins from around the gum line down to the bottom of each periodontal pocket (with a measurement of greater than 3mm and with evidence of bleeding and tissue loss), in order to obtain a healing response.
Root planing involves smoothing the root surfaces of your teeth with thin instruments so gum tissue can more firmly reattach to roots that are clean and smooth, to prevent tooth loss and sensitivity problems. This procedure makes it more difficult for plaque, calculus and bacteria to accumulate along these root surfaces.
Scaling and Root Planing Therapy
Some Reasons Why Root Planing May Be Necessary
To control the growth of harmful bacteria
Help the pocket wall reattach firmly to the clean root surface
Prevent further bleeding of the gums from disease
Prevent bone loss
Prevent gum disease related tooth loss
Reduce systemic disease
Supportive Periodontal Therapy After Dr. Zablotsky has completed the active phase of periodontal treatment, your periodontal disease will be under control. He will provide you with a personalized maintenance program of care to keep your gums healthy.
Maintenance therapy is an ongoing program designed to prevent disease in the gum tissues and bone supporting your teeth. Adherence to a program of conscientious home oral care and regularly scheduled maintenance therapy visits with your dentist and Dr. Zablotsky will give you an excellent chance of keeping your teeth for your lifetime.
Why Is Supportive Periodontal Care Important? As you have learned, you are susceptible to gum disease. And, you have probably learned, too, that the main cause of gum disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. The bacteria in this plaque produce toxins, or poisons, which constantly attack your gums and teeth. Unless plaque is removed, it hardens into a rough, porous deposit called calculus, or tartar.
Daily brushing and flossing will help to minimize the formation of calculus, but it won't completely prevent it. No matter how careful you are in cleaning your teeth and gums, bacterial plaque can cause a recurrence of gum disease from two to four months after your last professional cleaning.
Therefore, a dental professional must check for hidden problems and remove the hardened plaque at time intervals appropriate for you so that your teeth and gums stay healthy.
Who Should Perform Supportive Periodontal Therapy? The answer depends on you and the severity of your gum disease before treatment. Generally, the more severe your periodontal disease is initially, the more often Dr. Zablotsky needs to oversee your periodontal care. Most of our patients treated for periodontal disease will alternate perio care between their general doctor and our office. Together, you, your general dentist and Dr. Zablotsky will work out the most effective schedule for your supportive periodontal care.
Your Maintenance/Supportive Periodontal Care Visit May Include:
Discussion of any changes in your health history
Examination of your mouth tissues for abnormal changes
Measurement of the depth of pockets around your teeth
Assessment of your oral hygiene habits and provision of instruction
Removal of bacterial plaque and tartar
X-ray film studies to evaluate your teeth and the bone supporting your teeth
Examination of your teeth for decay and other dental problems
Check on the way your teeth fit together when you bite
Application or prescription of medications to reduce tooth sensitivity or other problems you may have
How Often Should You Have Supportive Periodontal Care Visits? Your periodontal condition is the deciding factor. The interval between your supportive periodontal care (spc) visits might be as often as every few weeks or as infrequent as every six months. Everyone's situation is different.
The Frequency of Your Supportive Care Visits Will Be Influenced by:
The type of periodontal disease you have
The type of periodontal treatment you had
Your response to treatment
Your rate of plaque growth
Your personal commitment to good oral care at home
What Is the Relationship Between Your Dentist and Dr. Zablotsky? Your dentist and Dr. Zablotsky work together as a team to provide you with the best possible care. They combine their experience to formulate the best maintenance plan for you. They keep each other informed about your progress. Although Dr. Zablotsky may see you periodically for maintenance therapy, you will need to see your general dentist as well.
Appointments for periodontal maintenance do not replace regular dental checkups. If Dr. Zablotsky detects tooth decay during a maintenance visit, he will refer you to your general dentist for treatment.
Your general dentist is primarily responsible for your overall dental health, including such dental needs as filling new or recurrent cavities or making changes in fillings, crowns or bridges.
Are Supportive Periodontal Care Visits Worth the Cost? Without question! By treating disease in the early stages, you save dollars — and discomfort — in the long run. Maintenance visits help to protect your periodontal health and prevent future dental problems. They are a wise investment in your dental health. If you have dental insurance, it may pay for just one dental examination every six months. Because you are susceptible to periodontal disease, you may need to be seen more often. So, you may need to personally pay for some of your maintenance visits.
Will I Be Protected From Unnecessary X-rays? Dr. Zablotsky takes x-ray films, or radiographs, only when essential to diagnose your periodontal problems. Generally, Dr. Zablotsky or your general dentist takes a full set of x-ray films every two to four years unless a patient's disease requires more frequent x-ray studies. X-ray studies are important to disease diagnosis because they allow Dr. Zablotsky and your dentist to see conditions that are not evident on a visual examination, thereby helping him detect periodontal disease in its early stages. When films are taken at our office, Dr. Zablotsky shares these x-ray series with your general dentist to minimize your exposure to x-rays. Additionally, we only utilize digital radiography, which gives diagnostic films at a radiation exposure 1/10th that of normal x-rays.
To prevent periodontal disease, the major cause of tooth loss in adults — and keep your natural teeth for your lifetime — carefully and conscientiously follow the guidelines of the maintenance program that Dr. Zablotsky recommends. Protecting your periodontal health through preventive maintenance has great benefits for you. You will be able to chew with more comfort, and you will be able to smile and speak with greater confidence. You will be able to keep dental costs down by preventing future problems. Your commitment to maintenance therapy is your commitment to your better oral health.
Microultrasonics Ultrasonic Scalers use ultrasonic vibrations to help break down the plaque and calculus on the teeth that cause gingivitis and periodontal disease. The ultrasonic cleaners create microscopic bubbles that implode on the surface of the tooth, killing microbes and removing plaque and tartar in the process. Our instruments use a thin tip to better navigate in the periodontal pockets to help maintain optimal gingival health.
The procedure uses water and/or an antimicrobial liquid called chlorhexadine. It can remove tartar buildup in hard-to-reach areas, with no damage to the tooth enamel. Manual scaling often uses pressure for cleaning, while the vibration produced by the scaling tip of an ultrasonic scaler is barely perceptible. This makes ultrasonic cleaning suitable to those with sensitive teeth. The cleaning process is faster than manual scaling making your visit more comfortable.
After your teeth have been cleaned with the ultrasonic cleaner, your teeth will be hand scaled to check for any residual deposits and then polished.
The Role of Your Bite (Occlusion) in the Progression of Gum Disease In some cases, the bite may play a significant role in exacerbating the progression of periodontal disease. Parafunction happens when there are tooth contacts occurring outside normal function (i.e. chewing and swallowing). This is often a manifestation of stress, and clenching or grinding forces can be many times that of normal function (and can happen at night for hours at a time).
Severe Wear on the Inner Aspects of This Patient’s Upper Front Teeth and Notching Lesions (Abfractions) On the Outer Aspects of Teeth at the Gum-line
Treatment of Biting Problems
Night guard/bite appliances which separate the teeth, reduce muscle forces, and splint the teeth to give them strength to resist overloading forces
Bite adjustment which reduces overloading forces by reducing heavy contacts through gentle recontouring of tooth structure
Restorative treatment. It may be necessary to build up the bite in some areas to facilitate a more normal occlusion/bite
Orthodontic treatment, if tooth positions are significantly out of alignment such that restorative treatment or bite adjustment cannot overcome the bite discrepancies
Biofeedback, if clenching occurs during the day, can be used to deprogram the musculature. This will allow the jaws to stay apart
Referral to Oral and Maxillofacial Pain Specialist is sometimes considered, if bite problems and pain cannot be conservatively dealt with
Restorative Treatment's Influence on Gum Health Without Surgery
Note the red, swollen inflamed gumline associated with old crowns. This patient was referred for crown lengthening surgery. It was my opinion that once the poor fitting crown margins were addressed that crown lengthening surgery would possibly not be indicated.
The left photo was of tissue two months after just smoothing the margins of the existing crowns. The right picture is 6 months later after well fitting provisional (temporary) crowns were placed.
The photograph was after final crowns were fabricated with NO Surgery performed.
1 Scripps Drive, Suite 305 Sacramento, CA 95825 Map