Comprehensive Periodontal Evaluation
A CPE assesses your risk of periodontal disease and determines the right types of treatment if periodontal disease is diagnosed.
Teeth: Dr. Hong will evaluate each tooth as well as dental fillings, implants, crowns, or other types of restoration. The position of the teeth and their closeness to each other will be noted.
Bite: The evaluation will include a check of the way your teeth come together when your mouth is closed, also known as occlusion or bite. Your dental professional will look for moving or loose teeth, which can be a sign of periodontal disease.
Plaque and Tartar Buildup: The amount and location of bacterial plaque and tartar will be assessed.
Gums: A dental probe will be inserted into the spaces between your teeth and gums to see how well your gums attach to your teeth. Any inflammation or bleeding that occurs during the probing process is documented.
Bone Structure: X-rays may be taken to evaluate the quality of the bone in your upper and lower jaw and to determine if any bone loss has occurred.
Risk Factors: Dr. Hong will ask about a number of periodontal disease risk factors, including age, tobacco use, family history of periodontal disease, or if you have another systemic condition that may be linked to periodontal disease, such as heart disease or diabetes.
Why do I need Comprehensive Periodontal Evaluation?
With periodontal disease affecting nearly 64.7 million people in the United States (almost one in every two adults over the age of 30), the health of your gums should be monitored consistently to minimize your risk.
Many patients don’t see a dental professional until after they’ve noticed pain, bleeding gums, or loosening teeth, all signs that periodontal disease is in its advanced stages. An annual CPE can detect periodontal disease before it becomes severe, and is the first step to creating a suitable treatment and/or maintenance plan for your individual situation.
Scaling and Root Planing (SRP)
The starting point for the treatment of periodontal disease is the “deep cleaning”. The deep cleaning is performed under local anesthetics using ultrasonic and had scalers to remove bacterial plaque, tartar, and toxins that are attached to root surfaces of teeth above and below the gum line. In addition, recommendation for effective oral hygiene technique will be provided in that appointment.
Four to six weeks later, new exam will be performed to re-measure your pocket depths around teeth. If pocket depths were reduced, then you will be directed to periodontal maintenance visits every 3 to 4 months to maintain the level of periodontal health you achieved. However, if the pocket depths were not reduced, then you will be directed to additional treatment such as osseous surgery to reduce the pocket surgically.
In patients with advanced periodontal disease, Dr. Hong will perform flap surgery to reduce the pocket depth, repair damaged areas and restore your mouth to healthy state.
The surgery consists of reflecting back the gum tissue, removal of infected tissue, removal of bacterial plaque and calculus (tartar) from the root surfaces, repair and reshape damaged bone to a more physiological contour and then closure of the gums so that they fit snugly against the tooth.
Without the flap surgery, the bacterial plaque and calculus that are embedded in the deep pocket cannot be removed, and the periodontal disease will continually progress, possibly leading to tooth loss.
Following active periodontal therapy (deep cleaning and/or periodontal flap surgery), an interval is established for periodic ongoing care that consist of disruption of bacterial plaque via scaling and polishing of teeth and review of oral hygiene, which continues for the life of the dentition, including implants.
An interval of three months between appointments is typically an effective treatment schedule, but this can vary depending upon the clinical assessment of the patient by Dr. Hong.
Periodontal health and reduction of tooth loss can be achieved with strict periodontal maintenance.
Dentist are committed to saving teeth by placing filling or restoration when teeth is affected by decay (caries) or when tooth is fractured.
Sometimes, the decay or tooth fracture may result in short crown height above the gum line making a placement of restoration very difficult due to insufficient tooth structure.
The procedure called crown lengthening is needed to lower the gum tissue creating adequate amount of tooth structure so dentist can easily place a filling or new crown.
Aesthetic Crown Lenghtening
Esthetic crown lengthening is a procedure where excess gum tissue is removed to expose more of the “crown”, the white enamel-covered part of the tooth. This procedure is performed on patients who have a “gummy smile” in which the teeth appear too short or the gum line seems uneven. The procedure, which can be administered to one tooth or to enhance your entire smile, reshapes excess gum and bone tissues to expose more of the natural tooth.
Root Coverage Procedure
Root coverage procedures are often used to treat gums that have receded to the point that the roots of a tooth are exposed. During a root coverage procedure, Dr. Hong will take gum tissue from the roof of your mouth (known as the palate) to cover roots, develop gum tissue where needed, or make dental implants look more natural. In some cases, this procedure can cover exposed roots to protect them from decay or to prepare your teeth for orthodontic treatment.
Surgical Exposure of Impacted Tooth
An impacted tooth is tooth that fails to emerge to oral cavity remaining “stuck” in the surrounding bone and gum tissue. Front teeth may become impacted leading to functional and aesthetic problems.
The procedure involve a small incision to reflect the gum tissue and removal of small amount of bone to expose the crown of impacted tooth. Dr. Hong also can use a dental bracket with chain so the orthodontist can guide the tooth into ideal position in the dental arch.
Frenum is a muscle that attaches on the upper and lower lips. A short frenum or a frenum that is in close proximity to the gum tissue margin can affect speech, difficulty to perform oral hygiene, interference with orthodontic treatment and might lead to progressive recession of gingival tissues.
A frenectomy is a very simple procedure that involves release, removal and repositioning of the frenum. This procedure is performed under small amount of local anesthetics with minimal post op discomfort.
The goal of the bite adjustment is to eliminate excessive biting forces that can lead to loosening or shifting of teeth, especially in patients that have periodontal disease. The combination of inflammation from periodontal disease and excessive biting forces might result in faster progression of bone loss around affected teeth.
The bite adjustment consist of using a marking paper between your teeth to identify areas of excessive forces, then fine and delicate dental drills are used to reshape your teeth allowing your upper and lower teeth to meet properly without any excessive pressure.
Reducing Dental Anxiety
Dr. Hong may recommend oral sedation to ensure that you are comfortable and relaxed during your procedure. Oral sedation uses medications that is taken orally that leave you conscious and pleasantly relaxed, yet free of fear, anxiety, and apprehension about undergoing dental treatment.
Source: American Academy of Periodontology - 2018