Table of Contents

FREQUENTLY ASKED QUESTIONS

What are periodontal diseases?
The word periodontal literally means "around the tooth." Periodontal diseases are serious bacterial infections that destroy the attachment fibers and supporting bone that hold your teeth in your mouth. Left untreated, these diseases can lead to tooth loss. There are many forms of periodontal disease:

Who is a periodontist?
A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire. Often, dentists refer their patients to Dr. Raschkovsky when their periodontal disease is advanced. However, you don't need a referral to see Dr. Raschkovsky. In fact, there are occasions when you may choose to go directly to Dr. Raschkovsky or to refer family member or friend to him.

Is there a relationship between tobacco use and periodontal disease?
Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smokers are much more likely than non-smokers to have calculus form on their teeth, have deeper pockets between the teeth and gums and lose more of the bone and tissue that support the teeth.

Is it normal for my gums to bleed when I brush my teeth?
Bleeding gums are one of the signs of gum disease. Think of gum tissue as the skin on your hand. If your hands bled every time you washed them, you would know something was wrong. There are a number of other warning signs of gum disease.

What are pockets?
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space in which bacteria can live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

Could my periodontal disease be genetic?
Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interventive treatment may help them keep their teeth for a lifetime.

Can I pass my periodontal disease to others?
Periodontal disease may be passed from parents to children and between couples, according to an article in the September 1997 issue of the Journal of the American Dental Association. Researchers suggest that bacteria causing periodontal disease are passed though saliva. This means that when a family or couple come into contact with each other's saliva, they're at risk for contracting the periodontal disease of another family member. Based on this research, the American Academy of Periodontology recognizes that treatment of gum disease may involve entire families. If one family member has periodontal disease, the AAP recommends that all family members see a dental professional for a periodontal disease screening.


Prevention:

What can I do to avoid periodontal disease?
To keep your teeth for a lifetime, you must remove the plaque from your teeth and gums every day with proper brushing and flossing. Regular dental visits are also important. Daily cleaning will help keep calculus formation to a minimum, but it won't completely prevent it. A professional cleaning at least four times a year is necessary to remove calculus from places your toothbrush and floss may have missed.

What is the relationship between the general dentist and Dr. Raschkovsky?
Your dentist and Dr. Raschkovsky work together as a team to provide you with the best possible care. They will combine their experience to formulate the best treatment plan for you while keeping teach other informed about your progress.

After active periodontal treatment is completed Dr. Raschkovsky will refer you back to your general dentist, but may also see you periodically for follow-up care and periodontal treatment.

I'm over 55. Does this mean I'm more likely to get periodontal disease?
Your chances of developing periodontal disease increase considerably as you get older. More than half of people aged 55 and older have periodontitis. The good news is that research suggests that these higher rates may be related to risk factors other than age. So, periodontal disease is not an inevitable part of aging. Risk factors that may make older people more susceptible include general health status, diminished immune status, medications, depression, worsening memory, diminished salivary flow, functional impairments and change in financial status.

When should I see a periodontist?
If you value your oral as well as overall health, anytime is a good time to see Dr. Raschkovsky for a periodontal evaluation. Sometimes the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation may be especially important if you:

Notice any symptoms of periodontal disease, including:
- Gums that bleed easily, such as during brushing or flossing
- Red, swollen or tender gums
- Gums that have pulled away from the teeth
- Persistent bad breath
- Pus between the teeth and gums
- Loose or separating teeth
- A change in the way your teeth fit together when you bite

Are thinking of becoming pregnant?
Pregnant women who have periodontal disease may be seven times more likely to have a baby born too early and too small. In addition, about half of women experience "pregnancy gingivitis." However, women who have good oral hygiene and have no gingivitis before pregnancy are very unlikely to experience this condition.

Have a family member with periodontal disease?
Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.

Have heart disease, diabetes, respiratory disease or osteoporosis?
Ongoing research is showing that periodontal disease may be linked to these conditions. The bacteria associated with periodontal disease can travel into the blood stream and pose a threat to other parts of the body. Healthy gums may lead to a healthier body.

Feel that your teeth are too short or that your smile is too "gummy." Or, if you are missing one or more of your teeth and are interested in a long-lasting replacement option.

Are not satisfied with your current tooth replacement option, such as a bridge or dentures, and may be interested in dental implants.

What can I expect the first time I visit a periodontist?
During your first visit, Dr. Raschkovsky will review your complete medical and dental history with you. It's extremely important for Dr. Raschkovsky to know if you are taking any medications or being treated for any condition that can affect your periodontal care. You will be given a complete oral and periodontal exam. Dr. Raschkovsky will examine your gums, check to see if there is any gum line recession, assess how your teeth fit together when you bite and check your teeth to see if any are loose. Dr. Raschkovsky will also take a small measuring instrument and place it between your teeth and gums to determine the depth of those spaces, known as periodontal pockets. This helps your periodontist assess the health of your gums. Radiographs (x-rays) may be used to show the bone levels between your teeth to check for possible bone loss.



Oral Care Products:

What kinds of oral care products should I use?
Here are some guidelines for choosing dental care products – what works for most patients most of the time. To find out what is best for your particular needs, talk to Dr. Raschkovsky.

Begin with the right equipment – a soft bristled toothbrush that allows you to reach every surface of each tooth. If the bristles on your toothbrush are bent or frayed, buy a new one. A worn-out brush will not clean your teeth properly.

In addition to manual toothbrushes, your choices include automatic toothbrushes and "high tech" electronic toothbrushes. These are safe and effective for the majority of patients.

Oral irrigators (water spraying devices) will not remove plaque from your teeth unless used in conjunction with brushing and flossing.

Another aid is the rubber tip, often found on the handle end of a toothbrush used to massage the gums after brushing and flossing.

Other options include interproximal toothbrushes (tiny brushes that clean plaque between teeth) and interdental cleaners (small sticks or picks that remove plaque between teeth). If used improperly, these dental aids can injure the gums, so it is important to discuss proper use with your periodontist.

o How should I choose toothpaste and mouth rinses?
Fluoride toothpaste and mouth rinse used in conjunction with brushing and flossing can reduce tooth decay as much as 40 percent. So, using products with fluoride is a good idea.

However, mouth rinses are not recommended for children under six. Children should use only a pea-size dab of fluoride toothpaste on the brush to avoid fluoride overdosing. Tartar control toothpaste will reduce tartar (a buildup of hardened plaque) above the gum line.

Anti-plaque rinses approved by the American Dental Association contain chemical agents that may help bring early gum disease under control. These rinses can be a helpful addition to brushing and flossing.



Periodontal Procedures

Dental Implants

What are the advantages of dental implants?
Dental implants look and feel like your own teeth. They can help prevent the bone loss and gum recession that often accompany bridgework or dentures. In addition, they don't sacrifice the quality of your adjacent teeth like a bridge because neighboring teeth are not altered to support the implant. Implants are secure and offer freedom from the clicks and wobbles of dentures. The success rate of implants is highly predictable. The advantages of implants are:
- Advanced tooth replacement system.
- Works and functions like natural teeth.
- More than 9-10 implants last more than 15 years.
- Never develop tooth decay.
- Never requires root canal.
- Help reserve jawbone, which can prevent premature aging.
- Provide stability for lower denture, enhancing chewing ability.
- Age is not a disqualification if patient is healthy.
- Single or multiple teeth replacement.


More about dental implants


How do I care for my dental implants?
Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply.


What is a crown?
There is 2 parts to the tooth. The part located above the gumline (crown - visible) and the part below the gumline (root - not visible). The crown is the replacement for the part of the tooth that you use for chewing.



How can I avoid surgery for my periodontal disease?
Depending on how far your periodontal disease has progressed, treatment can vary widely. If the disease is caught early, simple procedures can be done that will remove the plaque and calculus from below the gum line and eliminate the infection-causing bacteria. If the disease has advanced to the point where the periodontal pockets are deep and the supporting bone is lost, surgery might be necessary. You may have heard about new products on the market that claim to cure periodontal disease. However, they do not replace traditional periodontal therapy. Rather, the intent of these products is to improve the effectiveness of traditional therapies.

Will periodontal surgery hurt?
New treatment options using refined techniques can be performed comfortably as office procedures. Improvements in medications, local anesthesia, anxiety and pain control, and, in some cases, conscious sedation are available to make your treatment more pleasant and comfortable.

Will I be able to speak and eat normally after surgery?
You should be able to speak normally after the anesthetic has worn off. It is important to eat a well-balanced, nutritious diet after surgery, You may need to avoid chewing some foods in the surgical area for a few days.

Following some types of periodontal surgery, the teeth may be more sensitive to hot and cold. This will diminish considerably during the first few weeks after surgery.

Will I ever need surgery again?


In most instances, you will not need surgery in the same area again. However, in certain cases retreatment or additional surgery may be needed. As you have learned, you may be prone to periodontal diseases that require constant and careful attention. Like other chronic diseases, such as diabetes, hypertension and asthma, there is no cure. Periodontal surgery helps control disease and prevents further destruction to the gums and bone, thereby minimizing tooth loss.

More about periodontal surgery



Supportive Periodontal Therapy

What is supportive periodontal therapy?
Supportive Periodontal Therapy or Maintenance or is an ongoing program designed to prevent periodontal disease from recurring in patients who have undergone periodontal treatment. This ongoing phase of treatment will allow your periodontist to assess your periodontal health and make sure infection stays under control. During maintenance therapy, your mouth is examined, new calculus and plaque are removed, and, if necessary your teeth are polished and your bite is checked.

o How often do I need supportive periodontal therapy?
The answer varies from person to person. Your dentist or p Dr. Raschkovsky will recommend a schedule that best that is tailored to protect your periodontal health. The intervals between visits may range from every few weeks to four times per year, in addition to checkups by your general dentist.



Non-surgical Treatments

o What are root scaling and planing?
These are non-surgical procedures in which the periodontist removes plaque and tartar from below the gum line. Tooth root surfaces are cleaned and smoothed with specially designed instruments. It is important to remove the plaque and tartar from the pockets, because aside from the bacterial toxins that irritate the gums, plaque and the rough surfaces of tartar make it easier for bacteria to get a foothold.



Cosmetic Periodontal Procedures

What can be done to improve the look of my "gummy" smile?

Crown lengthening is a procedure to remove excess gum tissue to expose more of the "crown" of the tooth. Your gumline can be sculpted to give your new smile just the right look.

More about crown lengthening

What can be done to correct my "long" teeth or receding gums?
Soft tissue grafts and other root coverage procedures are designed to conceal exposed roots, reduce further gum recession, and protect your vulnerable roots from decay. During this procedure, Dr. Raschkovsky takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

More about soft tissue grafts



Payments

Will insurance cover periodontal procedures?

Many insurance plans pay a portion of periodontal services. Your periodontal health is important, so talk to Dr. Raschkovsky about payment options. Often the office staff will work with your insurance company to secure maximum benefits.



Periodontal Disease and General Health

Links to other diseases

What is the relationship between periodontal disease and respiratory disease?
More research is needed to confirm how periodontal disease may put people at increased risk for respiratory disease. What we do know is that mouth infections like periodontal disease are associated with increased risk of respiratory infection. An analysis of research has revealed that periodontal (gum) disease may be a far more serious threat to your health than previously realized.

How does periodontal disease increase my risk for heart disease?
Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the bloodstream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks. Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Can periodontal disease increase my risk for having a premature baby?
Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. More research is needed to confirm how periodontal disease may affect pregnancy outcomes. What we do know is that periodontal disease is an infection and all infections are cause for concern during pregnancy because they pose a risk to the health of the baby. If you are thinking about becoming pregnant, be sure to include an evaluation with a periodontist as part of your prenatal care.


More about pregnancy and periodontal disease
Periodontal disease at other stages of a woman's life

What is the relationship between periodontal disease and diabetes?
For years we've known that people with diabetes are more likely to have periodontal disease than people without diabetes. Recently, research has emerged suggesting that the relationship goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Though more research is needed, what we do know is that severe periodontal disease can increase blood sugar, putting diabetics at increased risk for complications. If you are among the 16 million Americans who live with diabetes or are at risk for diabetes or periodontal disease, see Dr. Raschkovsky for an evaluation.

More about periodontal disease and diabetes


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