Dr. Linda Leon, Board-Certified
Periodontal Care of Monroe, NY

PiPeriodontal Cari. Linda LeonDr. DDr. Linda Leon,
r. Linda Leon, Board-Certified
138 Stage Rd., Monroe, NY  10950
Phone: (845) 783-4490
Tell me about treatment of Periodontal Disease.
 
How is Periodontal Disease Treated?   
     First of all, let us assure you that periodontal treatment is not as scary as some people might imagine.   If you know what to expect, treatment is much easier.  We use local anesthesia to be sure you are comfortable during treatment.  If needed, we have nitrous oxide (laughing gas) to make you more relaxed.  
     Dr. Leon has been in practice for 20 years, and many of her initial patients still come to the office - with a smile!

    *Examination:  The first step in treating periodontal disease is a thorough examination.  Dr. Leon will start by reviewing your medical and dental history.  She'll see how you clean your teeth, how inflamed the gums are, and whether any teeth are loose or have shifted.  We also use a special instrument called a periodontal probe, which is basically a ruler, to see how much the gums hare separated from the teeth.  This distance is called the periodontal pocket.  Normal pocket depths are 1-3 mm.  Studies have show that pockets deeper than 4 mm cannot be thoroughly cleaned by the patient and require special professional help.   
    *Discussion:  Immediately after Dr. Leon has assessed your periodontal problems, she'll have a discussion with you (and your spouse or a friend, if you like) about the extent of the disease, and what is needed to treat it.  The better you understand the problem, the better you can work with us.  Treating periodontal disease is a team effort - you need to help us help you.  
    *Medical Consultation:  If there is a relevant medical issue, Dr. Leon will confer with your physician.  For example, certain blood pressure medications (such as Procardia, Norvasc, or Plendil) can cause your gums to become swollen.  In this situation, Dr. Leon will see if your physician can change the blood pressure medication to one without this side effect.  
    *Home care instruction:  The first step is to learn how to clean your teeth correctly!  It is amazing how many people don't brush and floss properly.  You can also do harm by brushing or flossing too hard.  This can result in gingival recession (shrinking of the gums from the roots of the teeth).  As a result, your teeth look longer.  This is where the expression "longer in the tooth" originated.  
    *Scaling and root planing:  This is how we begin treatment for most patients.  Usually, we get your teeth numb to make you more comfortable.  Then, we carefully and thoroughly clean inside the pockets using a special vibrator (called a Cavitron or ultrasonic) and hand instruments to remove the plaque, tartar, and poisons from the teeth.  The result is a smooth, clean tooth surface.  Now, that the poisons and germs have been removed, the gums will start to heal.  Some of our patients may take tylenol or motrin for a day or two, then stop because they don't need it any more.
    *Loose teeth:   If you have loose teeth, we may do a bite adjustment.  We use a special piece of carbon paper to see which teeth are being traumatized when you bite.  Then, we smooth them slightly.  The basic idea to "even out the bite".   You do not need to be numb for this.  In some cases, the loose tooth will become tighter as a result.  Sometimes, we recommend a bite guard for patients who grind or clench their teeth.   With some patients, we splint the teeth together invisably, by connecting a few fillings so the stronger teeth help stabilize the looser teeth.  
    *Re-evaluation:  Next, we just wait for a month or so.  The body needs time to respond to all of the deep cleaning and your improved brushing and flossing.  As the tissue becomes healthier, the pockets may shrink.  After the month, we re-measure the pockets and see if any areas still need help.  This is mostly a discussion visit, so feel free to bring your spouse or a friend and ask lots of questions.  If additional procedures are needed, she'll use mouth models so you understand completely.
    *Localized antibiotics:  If a few teeth (especially front teeth) still have isolated deep pockets after the scaling, we may place an antibiotic gel under the gums.  This is known as localized delivery.  The advantage of using a localized antibiotic is that the antibiotic stays in the gum area - and does not affect the rest of your body.  By avoiding antibiotic pills, the rest of your body is not exposed to unneccesary antibiotics.  We prefer to save antibiotic pills for when they are truly needed, as overuse will eventually decrease their effectiveness.
    *Surgery:  In some cases, despite our best efforts to be conservative, periodontal surgery is required.   Basically, the gum tissue is gently lifted back so Dr. Leon can see inside the deep pockets more thoroughly.  Most of the surgery involves additional scaling and root planing, just with better visibility.  We may need to recontour some of the underlying support for a better long-term result.  When we ask our patients how they did after the procedure, most of them tell us that they stopped using the pain medication (usually Motrin) after the first few days because they no longer needed it.  

       There are several different surgical procedures, which we will discuss in more detail if you need them.  This is not a complete list of all the surgical procedures we do.  
           -Sometimes we use bone graft and a membrane to try to encourage some of the lost bone to grow back.  This is
                 known as guided tissue regeneration.
           -In other cases, patients may have broken a tooth which is now too short to be fixed.  Or, the cavity is so far under the
                 gums that your dentist can't completely clean it out or seal the new restoration.  Dr. Leon can do a procedure called
                 crown lengthening
, in which the tooth is made longer.  Now, your dentist will be able to save the tooth with a new
                 restoration.  They will be confident that they have removed all of the decay and sealed the filling completely.
           - Another situation is when the gum tissue overgrows the teeth, so you can't clean properly.  The name for this problem
                 is gingival hyperplasia.  This may happen with children who wear braces or people who are mouthbreathers.  Or, 
                 certain medications (such as Procardia, Dilantin, or Cyclosporine-A) can give you "puffy gums".  Surgery will trim the
                 excess gum tissue away,  resulting in a better appearance and easier home cleansing. 

Does Periodontal Treatment work?
    For the vast majority of patients, periodontal treatment will result in saving your teeth.   Of course, the earlier the gum disease is diagnosed, the simpler the treatment and the better the prognosis.  As a chronic disease (like high blood pressure), there is no "cure".  But, just like high blood pressure, if you take care of your teeth properly and see the Periodontist regularly, we can definitely keep the periodontal disease well-controlled  There are a few important factors to help you save your teeth: 
  1.Please quit smoking.  The chemicals in the smoke affect the gums, undoing the benefits of periodontal treatment. 
  2.It is very important that you clean your teeth thoroughly at home with proper brushing and flossing.  You are the first defense in preventing new bacteria from attacking the gums.
  3.Periodontal maintenance.  For most patients, getting a thorough dental cleaning every 3 months is the most important way to prevent new problems.  No matter how well you clean your teeth at home, you will always leave some plaque and germs behind.  Studies have shown that it takes about 3 months for any germs left behind to start causing problems again. 
It has been proven that getting your teeth cleaned every 3 months is the best defense against new gum problems.  We have found that the best method is to alternate the cleanings between our office and your general dentist's office four times a year.  Twice a year, your dentist's office cleans your teeth and checks for cavities,  makes sure your bridges are still fitting well, checks the caps and root canals, etc.   And, twice a year, we check the gums, pockets, tooth mobility, etc., as well as thoroughly clean your teeth and review proper brushing and flossing techniques.

Please feel free to ask questions when we see you.  To paraphrase - an educated dental patient is our best dental patient. 
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