Periodontal Disease Dr. Rohinton J. Patel, DMD Director, Hawaii Pacific

Dr. Rohinton J. Patel, DMD Director, Hawaii Pacific Dental Group, Inc. Adjunct Clinical Professor, Boston University, School of Dental Medicine [email protected] 6700 Kalanianaole Highway, Suite 216, Honolulu, HI 96825; (808) 955-0008

Disclaimer

• I have no vested nor monetary interests regarding this presentation

1 What is Periodontal Disease

• Periodontitis, or inflammation of the periodontium, is a serious infectious disease that inflicts the gums, jawbones and teeth, resulting in tooth loss, infection and degradation of bone, and bleeding gums.

• It is strongly shown to be a significant risk factor for heart and lung diseases.

How Common is Periodontal Disease?

• Periodontal Disease inflicts over 3 Million Americans each year. • The disease can be halted in a few moths after treatment is initiated and judiciously maintained by the patient, if not, likely relapse will occur. • Periodontal Disease is usually painless in its initial stages.

• A recent CDC report provides the following data related to prevalence of periodontitis in the U.S.: 47.2% of adults aged 30 years and older have some form of periodontal disease. Periodontal disease increases with age, 70.1% of adults 65 years and older have periodontal disease.

2 What are the risk factors for developing periodontal disease? ● Gingivitis. ● Poor oral health habits. ● Smoking or chewing tobacco. ● Hormonal changes, such as those related to pregnancy or menopause. ● Recreational drug use, such as smoking marijuana or vaping. ● Obesity. ● Inadequate nutrition, including vitamin C deficiency. ● Genetics.

Prevention of Periodontal Disease

Professional dental cleanings, electric toothbrush, waterpik and floss

3 Symptoms of Periodontal Disease (mayoclinic.com) Signs and symptoms of periodontitis can include: ● Swollen or puffy gums. ● Bright red, dusky red or purplish gums. ● Gums that feel tender when touched. ● Gums that bleed easily. ● Pink-tinged toothbrush after brushing. ● Spitting out blood when brushing or flossing your teeth. ● Bad breath. ● Pus between your teeth and gums.

Preventive Steps to avoid and maintain a disease free oral environment

● Brush your teeth twice a day or, better yet, after every meal or snack. ● Use a soft toothbrush and replace it at least every three months. ● Consider using an electric toothbrush and a waterpik, which may be more effective at removing plaque and tartar. ● Floss daily.

4 Preventive Steps to avoid and maintain a disease free oral environment (Cont’d.)

● Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist. ● Supplement brushing and flossing with an interdental cleaner, such as a dental pick, interdental brush or dental stick specially designed to clean between your teeth. ● Get regular professional dental cleanings, on a schedule recommended by your dentist. ● Don't smoke or chew tobacco.

Anatomy of Periodontium

5 Anatomy and Physiology of the Periodontium

The periodontium is a complex structure composed of the gingiva, periodontal ligament (PDL), cementum, and alveolar bone.

The primary functions of the periodontium are to allow the tooth to be attached to the bone and to provide a barrier for the underlying structures from the oral microflora.

(Sciencedirect.com)

Healthy Periodontium

6 Signs of Periodontal Disease

Stages of Periodontal Disease

(hydrofloss.com)

7 What do the stages of Periodontal Disease look like?

Diseased Periodontium

8 Juvenile Periodontitis

Adult Periodontitis

9 Treatments for Periodontal Disease (Non- surgical Approach)

Nonsurgical treatments

If periodontitis isn't advanced, treatment may involve less invasive procedures, including:

● Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments, a laser or an ultrasonic device.

Treatments for Periodontal Disease (Non- surgical Approach Continued)

● Root planing. Root planing smooths the root surfaces, discouraging further buildup of tartar and bacteria, and removes bacterial byproducts that contribute to inflammation and delay healing or reattachment of the gum to the tooth surfaces. Laser Therapy to remove plaques and reduce pocketing depths may be utilized in certain cases. ● Antibiotics. Topical or oral antibiotics can help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.

10 Treatments for Periodontal Disease (Surgical Approach) Surgical treatments: If you have advanced periodontitis, treatment may require dental surgery, such as: ● Flap surgery (pocket reduction surgery). Your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone

Treatments for Periodontal Disease (Surgical Approach) (Continued)

● may be recontoured before the gum tissue is sutured back in place. After you heal, it's easier to clean these areas and maintain healthy gum tissue. ● Soft tissue grafts. When you lose gum tissue, your gumline recedes. You may need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or

11 Treatments for Periodontal Disease (Surgical Approach) (Continued) ● using tissue from another donor source and attaching it to the affected site that helps reduce further gum recession. ● Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own or synthetic bone and serves as a platform for the regrowth of natural bone. ● Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your

Treatments for Periodontal Disease (Surgical Approach) (Continued)

● Dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead. ● Tissue-stimulating proteins. Involves applying a special gel to a diseased tooth root that stimulates the growth of healthy bone and tissue.

12 What do I do after I have lost a tooth due to Periodontal Disease? Dental Implants and/or removable dentures, to replace missing teeth lost due to disease, infection, decay, or trauma

Dental Implants

13 Dental Implantology

-Pre-surgery workup: 3D CBCT (3-dimensional Cone-beam Computed Tomograph), Diagnostic digital models pre-operatively, design and 3D printed Surgical Guide Stent to place implant with a minimally invasive guided approach -Surgical Placement: Using surgical stent, implant placement is predictable and minimally invasive, thus minimal pain and discomfort is experienced -Restorative Phase: Load the titanium implant screw, that is integrated into the jawbone, with an abutment and crown

Dental Implantology (Con’t.)

14 Closing Remarks, Questions, and Answers