By Lee R. Cohen, D.D.S., M.S., M.S. –
Many of us have heard the phrase, “you have deep pockets” when visiting the dentist’s office. This is not a reference to your financial status, but a description of the health of your gums and bone. Part of a proper dental examination and routine dental hygiene appointment is the assessment of health of the gum tissue and bone surrounding your teeth. If evaluated on a routine basis, changes in status of these important tissues can be identified.
A typically painless evaluation includes the measurement of the space under the gum tissue. This is performed with the use of a “periodontal probe”, which is a fancy term for measuring stick. In health, a small space of 1-3mm exists between the top of the gum and the base of the area measured. This small distance is very reachable for the hygienist to debride (clean) at your recall appointments. A change in this distance can signify inflamed gums and possibly bone loss around your teeth. This change is typically related to factors such as improper oral hygiene (a buildup of plaque and tartar) or infrequent recall appointments. In certain situations, this can occur due to some medical conditions such as diabetes, smoking, autoimmune disease and other issues.
Assuming you have no medical issues causing any gum and bone problems, we typically see a progression from health to disease based on common factors such as plaque and tartar. Plaque is that light film we have on our teeth. Over time, if plaque is not removed it hardens into tartar (which cannot be removed with a tooth brush). This film is actually bacteria that are viewed by the body as an “infection”. As in any area of infection, such as a cut on your hand that becomes red and swollen, extra blood floods the area to fight the bacteria. In the mouth, swollen gums appear red and often bleed when touched. In addition, when measuring the swollen area under the gum, we see deeper than healthy gum pocket depths (often times 4-5mm).
This initial swelling is called Gingivitis. Typically, the area is treated with “Root Planing and Scaling”, which is a non-surgical procedure often referred to as a “deep cleaning”. In many cases, this is all that is needed to remove the plaque and tartar present which allows the area to heal and the gum to return to normal (Gingivitis is reversible).
If left untreated, Gingivitis can proceed to a more advanced situation called “Periodontitis”. At this level of disease, we see both bone and tissue loss around the teeth. Recent research has shown that periodontal disease can cause gum and bone loss from the initiation of an inflammatory process in our body. In simple terms, as our body attempts to ward off the infection, it also destroys the healthy supporting tissue and bone as well. When measuring these areas in the mouth, the periodontal probe often drops below the gum level anywhere from 6-10mm. These depths are not reachable by the hygienist and need to be addressed in other ways. If left untreated, this painless disease can progress until teeth are lost. In addition, a link between the bacteria from this disease and cardiovascular disease has been made. Therefore, those patients at risk for stroke or heart attacks are often advised to have a periodontal examination.
A complete periodontal evaluation usually includes a review of a recent (typically within 2 years) full set of dental x-rays and a full mouth periodontal probing. A clinical examination of your mouth and review of your radiographs are needed to determine your exact gum and bone health.
Lee R. Cohen, D.D.S., M.S., M.S., is a Dual Board Certified Periodontal and Dental Implant Surgeon. He is a graduate of Emory University and New York University College of Dentistry.
Dr. Cohen completed his surgical training at the University of Florida / Shands Hospital in Gainesville, Florida. He served as Chief Resident and currently holds a staff appointment as a Clinical Associate Professor in the Department of Periodontics and Dental Implantology. Dr. Cohen lectures, teaches and performs clinical research on topics related to his surgical specialty.
The focus of his interests are conservative approaches to treating gum, bone and tooth loss. He utilizes advanced techniques including the use of the Periolase Dental Laser (LANAP procedure) to help save teeth and treat periodontal disease without the use of traditional surgical procedures. Additionally, he uses in-office, state of the art 3D CT imaging to develop the least invasive dental implant and bone regeneration treatment options. Dr. Cohen and his facility are state certified to perform both IV and Oral Sedation procedures.
Dr. Cohen currently serves on the Board of Trustees for the American Academy of Periodontology and the Florida Dental Association. He is past president of the Florida Association of Periodontists and the Atlantic Coast District Dental Association. In addition, Dr. Cohen has been awarded Fellowship in the American College of Dentists, International College of Dentists and the Pierre Fauchard Academy.
Lee R. Cohen, D.D.S., M.S., M.S.
4520 Donald Ross Road, Suite 110
Palm Beach Gardens, FL 33418