The first visit
The aim of the initial visit is to understand your problems and concerns and carry out a detailed examination. The consultation is normally scheduled for 1 hour.
At this visit a general assessment of the oral cavity with particular focus on the periodontal condition will be carried out. This will include a comprehensive examination of your dentition, gums and oral tissues. A considerable amount of clinical data will be collected.
Furthermore the status of your dentition and the tissues supporting the teeth will be evaluated on radiographs (x-ray). Up to 12 detailed small radiographs or a panoramic radiograph may be needed. Following the above investigations the diagnosis, prognosis and all treatment options will be discussed with you.
What can be done about it?
Diagnosis of the problem is an important first step and early diagnosis can lead to the best treatment outcome. Clinical examination can reveal whether the gums are healthy or diseased by their appearance, whether they bleed easily on gentle probing and if there are any periodontal pockets, indicating that the gums have become detached from their normal position against the tooth and bone had been lost. X-rays are a useful adjunct and can show more clearly the amount and pattern of bone loss around a tooth or teeth.
Treatment of gingivitis
If the gums are inflamed but there has been no loss of the supporting bone i.e. the condition is gingivitis only, this can usually be easily treated by careful removal of plaque and calculus by the dentist or dental hygienist, followed by regular and thorough plaque removal at home by brushing and flossing. The gums would then normally be expected to be back to good health after a couple of weeks. Thereafter it is important that good oral hygiene is maintained together with regular visits to the dental hygienist (the frequency tailored to suit your individual requirements) to maintain the health of the gums and prevent future problems.
Treatment of periodontitis - Pocket Depth Reduction
If there has been loss of the supporting bone around teeth, a careful record should be made of the extent of this - usually by measuring the depths of pockets with a measuring probe. This will help determine the extent of the problem and hence the treatment needed, and give a baseline record for later comparison to check the response to treatment. Treatment is again aimed at thorough removal of plaque and calculus, though this may be more difficult where pockets are present as the deposits will be on the root surface underneath the gum. A local anaesthetic is sometimes needed for this procedure. If there is generalised periodontitis throughout the mouth, a number of treatment sessions may be required to make sure treatment is thorough and the best conditions are in place for good healing. For advanced forms of periodontitis, gum surgery may be needed to obtain sufficient access to clean the roots of the teeth. The goals of treatment are to arrest the progression of the disease and create a stable gum situation which is easily maintained, though it is unusual for new bone to grow back around teeth. Maintenance of good health of the gums is again of great importance following treatment to prevent relapse.
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