Early Diagnosis and Non-Surgical Treatment of Gum Disease  
There are many factors which affect the health of gum tissue. These include home care like brushing and flossing, diet, systemic problems and the medications used. Even people who regularly go to the dentist can have an easily reversible inflammation called gingivitis, at the time of their regular six month cleanings.  When teeth are cleaned, this condition is generally resolved.  However, if gingivitis is left untreated it can progress to periodontitis and if still left untreated can lead to tooth loss and have other consequences to patient’s health.  Therefore, it is of grave importance that periodontitis be diagnosed and treated.  It has been documented that the use of periodontal probe for diagnosis and recording of periodontal status in treatment records in general dental practices has yet to achieve the level of a routine and consistent habit.  At Verma Cosmetics it is different as we believe that healthy gums are the foundation of good Oral health.  We have well-established office protocol for the diagnosis, treatment, maintenance, and monitoring of periodontal disease and involvement of the patient through education. Dr. Verma and the hygiene team typically utilize the results from the periodontal exam, radiographs, and the patient’s medical and dental histories to establish a diagnosis and evolve a goal oriented or diagnosis-directed treatment plan for each and every new or existing patients. Periodontal exam is done using a periodontal probe, which measures pocket depth allowing us to monitor the health of gum tissue and health of the supporting soft and hard tissue around your teeth.  When the pocket depth measured exceeds 4mm, the patient can no longer reach the depth of the pocket with dental floss or tooth brush where plague, tartar and bacteria collect and the disease will progress and can result in further erosion or loss of bone and gum supporting the roots of teeth making the tooth in its socket loose.

Development of a logical and properly sequenced treatment plan is a derivative of the periodontal (gum) assessment and diagnosis.  When it comes to periodontal disease Dr. Verma says one-size-fits all treatment plan approach is a wrong one.  However, scaling and root planning (deep therapy) is considered the gold standard in periodontal therapy. Beyond deep therapy no one treatment modality is the answer in every case.  At Verma Cosmetic we have specific endpoints that our hygienist will strive to achieve.   

Patients with pocket depth between 4 and 6mm usually receive excellent results with  the non-surgical treatment called scaling and root planning.  Using topical anesthetic and/or sometimes local anesthetic, the hygienist goes below the gum tissue using an instrument and cleans the tooth surface as well as the pocket lining. Once this occurs, the healthy tissue will re-attach and shrink to the clean tooth, reducing the pocket depth.  Dietary restriction, special oral rinses, and home care instructions after this procedure must be strictly followed to provide successful results. To ensure continued health, we like to see our patients three or four times per year for cleanings and exams to ensure patient compliance and tissue health..  During recall visits/periodontal maintenance appointments if we find areas that did not heal sufficiently we would consider the use of adjunctive chemotherapeutic agents  (locally or systemically administered antibiotics) and host response modification agents.  We also make available prescription medications that will help with home care of your gums.  Pocket depths that are more than 6mm and do not respond to treatment will be referred to a periodontist (gum specialist) for more advanced therapy options.

What does scaling and root planning (Sc/Rp) or deep therapy entail?
Usually Sc/Rp appointment should follow a full mouth debridement appointment during which gross removal of all the tartar (calculus) takes place - so that accurate measurements of pocket depths can be recorded.  Once debridement is done and pocket depths are accurately recorded.  Two appointments are usually made so as to treat one half of the mouth at a time.  During the appointments sc/rp is done by removing tartar from the root surface and fine scaling the teeth.  It is recommended that patients be anesthetized for this but at Verma Dental we have the latest technology available (Pro Select Platinum Ultrasonic Scaler and Irrigator) which helps make the procedure virtually painless.  So, that patient can opt to have no anesthesia at all.  90% of our patients have had sc/rp done without any anesthesia and other 10% have needed only localized anesthesia.

What are the risk factors for periodontal disease?
There are potentially many risk factors in the development of periodontal disease - Poor Oral Hygiene, Diabetes, Smoking, Osteoporosis, Compromised immune system, drug-induced gingival conditions, hormonal changes, genetics and stress.

What is the kind of specific instructions that you recommend to improve oral hygiene?
At Verma Cosmetic and Family dentistry we have a very treatment specific hygiene department where we comprehensively deal with gum disease.  We recommend the Rota-dent one step electric tooth brush, which is a therapeutic extension of our office care into the patient’s home.  The Roto-dent is not just an electric tooth brush it is a home periodontal therapy system clinically proven to reduce subgingival (below the gumline) flora associated with periodontal disease. The patented MicroAccess Filaments brush tips reach every area of the mouth. It is a prescription tooth brush which, unlike any other electric tooth brush available over the counter, has a life time warranty.

Is Rota-dent recommended only for patients with periodontal disease?
No, all of us at the office use it.  Rota-dent is excellent for superior stain removal for whiter teeth,  it reduces gingivitis and decalcification (white spots) during orthodontics and removes plaque twice as fast as manual brush. Over 30 university clinical studies have proven the rota-dent instrument to be just as effective as a combination of conventional toothbrush, dental floss and toothpicks in removing plaque.   

How do I know if I have periodontal disease?
Most of the times periodontitis is a silent disease, you may not have any sign or symptoms of it or some times you can have red, swollen, bleeding gums or teeth mobility.  Whether you are a new patient or an existing patient the hygienists at Verma Dental measure pocket depths once a year - any pocket that measures greater than 3mm is a sign that you have active periodontal disease.

Is periodontitis age related?
No, there are different classifications/types of periodontitis and age could determine the kind of periodontitis one may have.  Age is of relative value in that advanced amounts of peridontal destruction at earlier age tend to indicate a more aggressive form of peridontitis.  In contrast, chronic perodontitis may slowly progress towards severity over several years or decades.  Young age combined with moderate to severe bone loss presents a tenuous long-term prognosis and requires more aggressive therapy compared to older patients presenting with a chronic form.

Is it true that sc/rp is done with an instrument that makes a lot of noise and sprays a lot of water and is very uncomfortable?
Dr Verma is all about comfort for her patients.  We have the latest technology available called ultrasonic scaling and irrigation unit, the Pro-Select Platinum.  This is a great unit - it minimizes the need for anesthetics, it is very quite and sprays only a mist of water.  If your teeth are sensitive to cold water we can warm it up to make you even more comfortable

I have always had six month cleanings and now I am being told I have periodontal disease - what happened?
Changes in oral hygiene habits or in medical history are the two most common cause for periodontal disease but stress has also shown to have significant impact on gum health.

Why do I need to have my teeth cleaned every three months?
Healing and destruction is occurring at the same time in the periodontal pocket.  After a cleaning appointment the levels of bacteria is low and the destruction process is less than the healing process.  Bacteria repopulate the pockets shortly after three months when destruction overtakes healing and more of the bone destruction process occurs.  That is why you need your teeth cleaned every three months if you have periodontal disease.

What if my pockets don't get better even with three month cleanings?
If your pockets are maintained at 4mm we will continue to clean them every three months.  It your pockets are persisting at 5-6mm with bleeding on probing you will be advices to have antibiotics applied to the roots of your teeth, we will also require diligence from you in providing rigorous personal daily care.  If your pockets still persist it is in your best interest to be referred to a gum specialist (periodontist).