According to the AAP treatment guidelines, periodontal health should be achieved in the least invasive and most cost-effective manner. Often this is accomplished with scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar]), and adjunctive therapy such as local delivery antimicrobials and host modulation. The treatment of cavities, inadequate fillings, broken fillings, crowding of teeth, rotated or tilting teeth are also a component of non-surgical therapy. These patients are then maintained with proper home care and periodic professional maintenance cleanings. Non-surgical therapy does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy and facilitate oral hygiene practices. The following are periodontal surgical options to obtain or improve periodontal health.
- Pocket Reduction Procedures
- Regenerative Procedures
- Crown Lengthening
- Soft Tissue Grafts
- Dental Implants
After a thorough periodontal examination, you will be presented with a tailored periodontal treatment plan created to your specific needs and ability to complete your recommended treatment.
Periodontal disease is considered an acute or chronic inflammatory response to a low-grade infection of the periodontium (gums) with minimal noticeable signs and symptoms. The main cause of periodontal disease is bacterial plaque which is colorless and continuously forms on your teeth. As bacterial plaque accumulates and matures with inadequate hygiene, its toxic effects intensify. Toxins released by these bacteria initiate the inflammatory response which results in gingivitis (inflammation of the gums) and may progress to the more severe periodontitis (bone loss) form of periodontal disease. Only with the progression of bone loss may patient experience noticeable discomfort, tooth mobility and spreading of teeth. Besides bacterial plaque, risk factors such as genetic predisposition, uncontrolled diabetes and smoking may directly influence the disease progression. Eighty percent of American adults have some form of periodontal disease.
Good oral hygiene (brushing and flossing) and periodic professional cleanings (by a dentist or hygienist) are the best prevention of periodontal disease. Cavities, inadequate fillings, broken fillings, crowding of teeth, rotated or tilting teeth, stress, poor nutrition, hormonal changes, have all been associated with periodontal disease. Whether or not treatment is necessary, preventing periodontal disease or progression of the disease is directly influenced by patient compliance.
Periodontal disease may not only decrease your quality of life due to tooth loss and poor nutrition, it may directly increase your risks of cardiovascular disease, diabetes and other systemic diseases.
The use of lasers in surgery has been shown to reduce bleeding, swelling and discomfort during and after surgical procedures. As a method of treatment of periodontal disease, the Americal Academy of Periodontolgy has published a number of statements.
According to the American Academy of Periodontology, at this time, there is insufficient evidence to suggest that any specific laser wavelength is superior to the traditional treatment methods of the common periodontal diseases, such as periodontitis.
The use of lasers for ENAP and gingival curettage should be evaluated in light of the available evidence. The Academy is not aware of any published data that indicates that the ENAP laser procedure is any more effective for these purposes than traditional scaling and planing.
For additional information, please review the American Academy of Periodontology’s Commissioned Review on Lasers in Periodontics.
Frequently Asked Questions about Lasers in Periodontology
Are there potential benefits to using lasers in periodontal therapy?
Limited research suggests that the use of lasers as an adjunct to scaling and root planing (SRP) may improve the effectiveness of this procedure. SRP is a non-surgical therapy used to treat periodontal diseases. In addition, when the lasers are used properly during periodontal therapy there can be less bleeding, swelling and discomfort to the patient during surgery.
Can the use of lasers in periodontal therapy harm patients?
Yes and no. Each laser has different wavelengths and power levels that can be used safely during different periodontal procedures. However, damage to periodontal tissues can result if an inappropriate wavelength and/or power level is used during a periodontal procedure.
Does the research on lasers support their use in periodontics at this time?
At this time, there is insufficient evidence to suggest that any specific laser wavelength is superior to the traditional treatment methods of the common periodontal diseases, such as periodontitis.
Can I trust the claims in an ad for periodontal therapy performed with a laser?
It is important to beware of advertising that sounds too good to be true because it very well may be. A dental professional can help you separate fact from hype.
Will my insurance carrier cover the use of a laser in periodontal therapy?
Insurance carriers reimburse for the procedure being performed rather than the device used to perform it. Therefore, whether your periodontist uses traditional tools for treatment or lasers, your reimbursement will be the same for that specific procedure. Before having surgery, always consult with your insurance carrier to determine what procedures are covered in your plan.
Source: American Academy of Periodontology
Local Delivery Antibiotics (LDAs)
Local delivery antibiotics (LDAs) have been shown to have limited clinical success in the treatment of periodontal disease. It is our philosophy they may be of limited use in isolated sites with mild periodontal disease or in medically compromised patients.
According to the Academy of Periodontolgy, the existing data appear insufficient to conclude that adjunctive sustained or controlled release LDA treatment can either reduce the need for surgery or improve long-term tooth retention, or is cost effective. The clinician’s decision to use LDAs should be based upon a consideration of clinical findings, the patient’s dental and medical history, scientific evidence, patient preferences, and advantages and disadvantages of alternative therapies.
For additional information, please review the Academy Report on Local Antibiotics