Losing teeth is often listed as a fear many people have as they age. Periodontal disease (the progressive loss of gum and bone around teeth), a leading cause of tooth loss, impacts 1 in 2 adults over the age of 30. Much can be done to help retain our teeth, often with minimal to no discomfort. If our goal is to save our teeth, then slowing the progressive loss of jaw bone holding our teeth becomes critical.
A simple understanding of the disease will allow us to make sense of the treatment options.
Bone Loss (Periodontal Disease):
In simple terms, jawbone holds our teeth in place.
If this bone deteriorates, teeth can become loose and ultimately be lost. The bone can be destroyed for a variety of reasons, but periodontal disease is a main factor. In health, the gums sit on top of the bone. In health, when the hygienist measures the space below the gum the depth is small (the gum is right next to the bone) In this silent disease, the bone below the gum line is destroyed leaving a deeper space between the gum and bone. This area allows aggressive bacteria to hide and cause further bone loss. Unfortunately, as the bone is destroyed and the depth increases, the area is not reachable when the hygienist attempts to clean the teeth (this includes a “deep scaling”). As this process continues, the teeth can eventually be lost.
Goals of Treatment:
The clear-cut goal of periodontal treatment is to slow the progression of the bone loss. In order to do this, the deep space below the gum line must be minimized back to a small and cleanable level (we call this pocket reduction). If we can return this space to a small (healthy) one, the hygienist will be able to clean the area to its entire depth and help maintain it properly.
An effective therapy for periodontal disease is called pocket reduction surgery. In its simplest form, the procedure involves opening the gums around the involved teeth. Now that the area and teeth are completely exposed, the area can be cleaned completely and any irregularities in the bone smoothed. The gums can then be closed and sutured. The key element is that when the gums are closed, they are sutured right next to the bone (not at its initial location). In essence, we minimized the deep pocket by lowering the gums down to the current level of the jawbone. Due to the lowering of the gum, teeth can often seem longer as more of it is now exposed to the mouth. In some cases, bone graft material (or other agents) are used to help try and redevelop jaw bone. This treatment allows for both the minimizing of the deep pocket and the access for cleaning by you and your hygienist.
LANAP (Laser Assisted Treatment):
Technological advances have allowed us to perform procedures in a much more comfortable manner with the same results. LANAP is the only FDA approved laser procedure documented to slow periodontal disease and regrow jawbone and supporting tissues. The LANAP procedure does not utilize a scalpel, suture or bone grafts. The goal of the treatment is still the same, decrease the space between the gum and jawbone. In this case, rather than lowering the gumline closer to the bone and exposing more tooth, we are using the body’s healing to help grow tissues and bone back up toward the gumline. The laser has unique properties that allows it to sterilize the area and then help regrow our natural tissues.
Imagine a fractured arm. A clot forms and from that clot our body can redevelop bone, skin and all the supporting tissues. LANAP uses the same type of mechanism. Once the area is sterilized, a clot is formed allowing the opportunity for new bone and tissue to grow. Instead of cutting things away to shrink the deep pocket, we are allowing the clot under the gum to grow tissue and bone to help refill the deep space.
A full mouth evaluation with a complete set of current dental x-rays is needed to determine if you indeed have periodontal disease. A consultation with a periodontist can help determine what treatment options best suit your individual needs.
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, dental implants, regenerate supporting bone and treat periodontal disease without the use of traditional surgical procedures. Additionally, Dr. Cohen is certified in Pinhole Gum Rejuvenation, which is a scalpel and suture free procedure to treat gum recession with immediate results.
Dr. Cohen 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. Botox® and Dermal Fillers are also utilized to enhance patients’ cosmetic outcomes.
Dr. Cohen formerly served 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. Dr. Cohen is a member of the American College of Maxillofacial Implantology and the American Academy of Facial Esthetics. In addition, he has been awarded Fellowship in the American College of Dentists, International College of Dentists and the Pierre Fauchard Academy.
Palm Beach Center for Periodontics & Implant Dentistry