If you are referred to a Periodontist, your first visit will be for an evaluation. This typically involves a review of your dental, medical and social histories. If you have any medical problems, it is crucial that you describe them to the Periodontist because so many systemic diseases can affect your mouth and the health of your gums. He or she also will want to know about any medications you are taking, since these also can affect your gums.If you smoke, your Periodontist will ask you to make an earnest effort to quit whatever the condition of your gums. This is especially important before a surgical procedure. Smoking increases the risk of periodontal disease, makes the disease worse once you have it, and decreases the effectiveness of periodontal treatment by affecting your body's ability to heal properly.The first visit always includes an examination of your head, neck and jaw joints (temporomandibular joints, or TMJs); a general oral examination of all of the structures in your mouth and throat (tongue, tonsils, cheeks, etc.); evaluation of your teeth; and a full examination of the health of your gums, called a periodontal examination.In addition to the examination, your Periodontist also will need X-rays of your teeth. A type of X-ray called a periapical X-ray helps the dentist or Periodontist determine the extent and pattern of bone loss around each tooth. These X-rays show the entire tooth from the crown (top) to the end of the root, which anchors the tooth in your jaw. You also may need an X-ray of your entire mouth,known as a panoramic radiograph (OPG). This type of picture provides information about other important structures in your skull, such as the maxillary sinuses and jaw joints.Once the examination is done, your Periodontist will develop a plan to treat your periodontal problems. Since people have different wants and needs, there is no single treatment that is best.In addition, you may find that Periodontist differ in their treatment philosophies. Some Periodontist believe in attacking the disease aggressively with surgical treatment, while others believe in more conservative, nonsurgical approaches. It's important that you understand why your Periodontist is recommending a particular form of therapy and that you feel comfortable with the proposed treatment plan.Regardless of the specific type of treatment, all patients will be placed in a maintenance program in which they will be asked to come in for regular follow-up examinations and cleanings. These cleanings and checkups are critical to maintain the health of your mouth and gums, and to help to prevent the disease from worsening again in the future. For someone who has gingivitis and no other problems, most Periodontist will recommend twice-yearly visits. For people with more significant periodontal problems, the schedule might be once every three months.Here's what your dentist will evaluate during a periodontal examination and what to expect:In addition to the periodontal examination, you also may need X-rays of your teeth. A type of X-ray called a periapical X-ray helps the dentist or Periodontist determine the extent and pattern of bone loss around each tooth. These X-rays show the entire tooth from the crown (top) to the end of the root, which anchors the tooth in your jaw. You also may need an X-ray of your entire head, known as a panoramic radiograph. This type of picture provides information about other important structures in your skull, such as the maxillary sinuses and jaw joints (temporomandibular joints or TMJs).Many dentists check all of these factors at every dental visit, but don't write down the results unless something has changed from the previous visit. Repeating these measurements helps your dentist track the progress of treatment. For example, if you need scaling and root planing, your dentist will chart these measurements before the treatment and again several weeks or months later to see if the treatment was effective.Each dentist has his or her own method for keeping track of periodontal measurements, although most charting methods probably look similar. Many offices today use computers to keep track of the measurements.Goals of periodontal treatmentTreatment of Gum DiseaseGum (or periodontal) disease includes a number of conditions caused by bacterial infections of the soft tissue and bone that supports the teeth within the jawbones.The disease can cause tissue and bone to be destroyed, and can lead to tooth loss.Acombination of professional treatment and your efforts can stop the progressionof gum disease and prevent further tissue destruction. Depending on the stageof gum disease, treatment ranges from a thorough cleaning to sophisticatedtypes of periodontal surgery.Treatment at any stage of periodontal disease can make your gums healthier. Some people assume that losing teeth is a natural part of aging, but if you work with your dental professional to keep your gums healthy, you should be able to keep your teeth for a lifetime.The main goals of periodontal treatment are to:The earliest stage of gum disease, gingivitis,usually can be stopped before it causes significant destruction of soft tissue or bone. Your general dentist or dental hygienist can treat most cases of gingivitis with a combination of in-office cleanings and instruction in good oral hygiene.In some people, gingivitis will progress to the more advanced stages of gum disease that involve loss of the structures that anchor the teeth to the jawbones. These more advanced stages are known as periodontitis and usually require more aggressive forms of treatment than gingivitis. In this case, it is likely that your dentist will refer you to a Periodontist (a gum specialist) for treatment.Treatment of Gum RecessionGums can recede,or shrink, even if there's no bacterial infection. One of the main causes of gum recession is improper brushing. Using a hard- or medium-bristled tooth brush can cause gums to wear away. Using too much force can also cause gums to recede over time. As the gums recede, the roots of the teeth are exposed. This may cause the teeth to become sensitive to hot and cold temperatures. In addition,teeth with significant amounts of gum recession are more prone to developing root cavities. Periodontist can treat recession by taking gum tissue from onepart of your mouth and moving it to the area where the gums have receded. This is known as a soft tissue graft.Treatment of Gum OvergrowthFor some people, the problem isn't too little gum tissue, but too much. Some people have what is known as a "gummy smile," in which the teeth look very small and the gums seem very large. Also, some medications, such as phenytoin (Dilantin and other brand names), cyclosporine (Neoral, Sandimmune) and nifedipine (Adalat,Cardizem), can cause an overgrowth of gum tissue. Periodontists can remove excess gum tissue through a procedure known as Gingivectomy.Scaling and root planingWhat Is It?Scaling androot planing is the most common and conservative form of treatment forperiodontal (gum) disease. Scaling is the removal of calculus (commonly calledtartar) and plaque that attach to the tooth surfaces, especially below the gumline along the root surface. Because plaque is more likely to stick to roughsurfaces, the root surface is smoothed down in a process called root planing.Root planing removes any remaining calculus and smoothes root-surfaceirregularities.Plaqueis a sticky substance, full of bacteria, that usually forms on your teeth. Whenplaque hardens over time, it is called calculus.What It's Used ForScaling and root planing are done to remove the irritants (plaque and calculus) that can cause periodontal disease. For early stages of the disease, especially gingivitis,this treatment may be all that is needed to get the condition under control.With more advanced gum disease, this may be the first step before moving on to surgical treatment.PreparationFor somepatients, scaling and root planing can cause discomfort. A local anesthetic maybe used to numb the portion of your mouth that is being worked on.How It's DoneScaling and root planing are done with a combination of ultrasonic scalers and hand instruments. Ultrasonic instruments are electric or air-powered devices that have two components: a relatively dull metal tip that vibrates at a very high frequency and "knocks" plaque and calculus off the tooth, and a water irrigation system that cools the tip and helps to flush out debris from around the teeth. Hand instruments are not powered. They have cutting edges and are pressed against your teeth by your dentist or hygienist. These instruments come in various shapes and sizes. Different instruments are used for different teeth, and even for different surfaces of the same tooth.Typically, ultrasonic instruments are used first to remove large deposits of plaque and calculus from the crowns and roots of the teeth. Hand instruments called scalers and curettes then are used to remove any remaining material and make sure that the tooth surface is clean and smooth. When working under the gumline, your dentist or hygienist cannot see the plaque or calculus, so he or she will rely on the sense of touch to feel for roughness on the root surface.If you have gingivitis (the earliest stage of gum disease) or localized periodontitis (more advanced gum disease located in only one part of your mouth), scaling and root planing usually can be completed in one visit.However, if you have periodontitis throughout your mouth, your Periodontist typically will do a quarter of your mouth (a quadrant) at a time. This means that four visits will be necessary to complete the scaling and root planing.Follow-UpFor two to three days after the treatment, you may have some soreness and sensitivity to hot and cold temperatures. Over-the-counter pain relievers can relieve this discomfort.You may be asked to use an antiseptic mouth rinse after scaling and root planing,especially when soreness of the gums prevents effective oral hygiene measures. However, brushing and flossing should be continued as usual. Some minor bleeding can be expected the first days after scaling and root planing, but this usually stops within a week.RisksTreating periodontitis decreases gum inflammation and also eliminates periodontal pockets,which can trap plaque. Therefore, if treatment is successful, your gums will shrink or recede. The extent of shrinkage depends on the initial depth of the pocket and the severity of periodontitis. The more severe the disease, the larger the recession of the gums after successful therapy. As a result, some part of the root is exposed, making the tooth look longer and making it more sensitive to hot and cold temperatures. To prevent root cavities, your dentist may prescribe a fluoride-containing gel, and will emphasize the importance of good plaque control.Ifyour medical doctor has told you that you need to take antibiotics beforecertain dental procedures, you should inform your dentist or hygienist aboutthis before you undergo scaling and root planing.Soft-tissue graftsWhat It InvolvesThere are three different types of soft-tissue grafts: free gingival graftsconnective-tissue grafts pedicle grafts.In a free gingival graft, a small strip of flesh is removed from the roof of the mouth. The tissue, called the "graft," is then stitched to the existing gum tissue in the area being treated. This is often used for people who naturally have minimal amounts of gum tissue around their teeth and need to have them enlarged.In a connective-tissue graft, a flap is cut in the roof of the mouth, forming a"trap door." The tissue under the flap is removed. The flap is then stitched over the area. The tissue that was removed, known as sub epithelial connective tissue, is then slipped under the gum tissue surrounding an exposed root surface and anchored in place with sutures. This is the most commonly used procedure for treating root exposure.In a pedicle graft, a flap of tissue from around an adjacent tooth is partially cut away with one edge still attached. The flap, also called a pedicle, is then slid sideways to cover the exposed root, and is stitched in place. A pedicle graft can be more successful than a free gingival graft because at least some of the blood vessels that feed the grafted section remain in place. However, a pedicle graft can be done only if an adjacent tooth has enough gum tissue to"share" with the tooth being treated.Withall of these procedures, many Periodontist will use periodontal packing tocover and protect the grafted tissue for the first week or two of healing.Discomfort FactorWith free grafts and connective-tissue grafts, you will have two wounds, near the tooth and on the roof of your mouth, where the graft tissue was removed. The wound on the palate is often described as feeling like a significant pizza burn. Prescription pain medication can help control discomfort after surgery.AftercareKeeping the mouthclean is important, so unaffected teeth will have to be brushed and flossed asusual. Mouth rinses that contain chlorhexidine usually are prescribed to assistin plaque control during the healing period. Antibiotics may be prescribed, butusually are not.Side Effects of TreatmentTypically, there are no long-term side effects aftersoft-tissue grafting. In some cases, the new gum tissue may need some reshapingusing a procedure called gingivoplastyto make the gum look as natural as possible.Crown lengtheningWhat Is It?This common procedure involves the removal of gum tissue, bone or both to expose more of a tooth's structure.What It's Used ForCrown lengthening is done when a tooth needs to berestored, but there is not enough tooth structure above the gum line to supporta fillingor a crown.This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. If your dentist wants to repair the tooth using a crown or a large filling, he or she may need to expose more of the tooth by removing some soft tissue or bone.In rare cases, a condition called gummy smile — when an unusually large amount of gum tissue shows around the upper teeth — can be treated using crown lengthening.PreparationYou will visit a Periodontist for a consultation before the procedure. During the consultation, the specialist will review your medical history and your X-rays,and set a date for the surgery.Your Periodontist will instruct you on how to keep the area clean after the surgery. You may receive a tooth cleaning before the procedure.If the tooth needs a crown, your Periodontist may have a temporary crown put on the tooth to protect it. This also makes the crown-lengthening procedure easier because the tooth is already prepared for the crown, and the Periodontist can see precisely how much soft tissue or bone will need to be removed.Oncethe area has healed completely — in about three months — your dentist willprepare the tooth again, and make a new temporary crown before making the finalcrown.How It's DoneThis procedure is done under local anesthesia. The amount of time it takes varies depending on the number of teeth that requires treatment. Although your problem may involve only one tooth, crown-lengthening surgery typically includes neighboring teeth so that the tissues can be reshaped gradually. If only soft tissue is removed, the procedure probably will take less time than if both soft tissue and bone are removed.The Periodontist will make incisions to "flap" the gums away from the teeth. This provides access to the roots of the teeth and the surrounding bone.In some cases, by simply removing a little gum tissue when the incisions aremade, enough tooth structure will be exposed for your dentist to place a crownof filling. However, in most situations it will also be necessary for the Periodontist to remove some bone from around the roots of the teeth. The bone is removed using a combination of hand instruments (resembling chisels) and rotary instruments (similar to the drill and burs used to treat cavities).Oncethe Periodontist is satisfied that enough tooth structure is exposed, thesurgical area will be washed with sterile salt water and the flaps will bestitched together. At this point, your teeth will look longer because the gumsare now sitting at a lower level then before the surgery. Some dentists use aperiodontal dressing — called an intraoral bandage — to cover the surgicalsite.Any temporary crowns will be removed before the procedure begins and replaced afterward.The Periodontist will make incisions to remove the soft tissue and to provide access to the tooth roots and the underlying bone. Bone removal allows more of the tooth structure to be exposed. If this is necessary, the bone is removed using a combination of hand instruments (like small chisels) and rotary instruments (similar to the drill used to treat cavities).After the soft tissue and bone have been removed, the incisions are sutured. This will cause more of the tooth or teeth to be exposed. Some dentists use a periodontal dressing to cover the incisions.You will be given prescriptions for pain medication and a chlorhexidine mouthrinse. Your dentist will review oral-hygiene instructions, and ask you to follow a somewhat soft diet. You can brush the teeth in the area that was worked on, but you should avoid the gums. You can remove food particles around the affected teeth with a toothpick or a water irrigator.Follow-UpFor the first day, use ice on your face to keep swelling down.After the procedure, you will return to the Periodontist in 7 to 10 days to have the sutures removed, and then return again 4 to 6 weeks later for a follow-up visit.Your gums should heal for at least three months before the tooth is prepared for the final crown. If you don't wait this long, the gums may shrink as they heal and the margins of the crown could show, or other problems could develop. You will visit your regular dentist to have the crown or filling placed, and then again for a follow-up visit.RisksAs with all surgical procedures, there is a risk of prolonged bleeding during crown lengthening, as well as a risk of developing an infection after the procedure.Additionally, many patients will experience sensitivity to hot and cold because the roots of the teeth are now exposed. This will go away when the roots are covered with new temporary crowns.Becauseof the tissue and bone removal, the affected tooth may look longer thanadjacent teeth. However, this is only a cosmetic consideration.Removing bone from around a tooth can loosen it. In addition, if the tooth is ever lost,the removal of bone could reduce the chances of successfully placing a dental implant in that area. Your Periodontist will consider these details during your consultation.Maintenance TherapyPeriodontal disease is a chronic (long-lasting) problem and can return without regular dental care and careful attention to oral hygiene at home. Therefore, one ofthe keys to successful nonsurgical or surgical treatment for periodontal disease is regular follow-up care.Maintenance therapy appointments are usually one-visit sessions with your dentist or periodontist or their hygienists. These visits can be scheduled between two and four times a year depending on the severity of your periodontal condition,whether you have a history of recurrent periodontal disease, and whether you demonstrate an increased susceptibility to the disease. You also may need more frequent visits if you smoke or have another disease that increases your risk of periodontal disease.A typical maintenance visit will include:If you have teeth that are very sensitive, your dental professional may need to apply a dental anesthetic in order to clean them. Either a topical or an injectable anesthetic can be used.If your dentist or Periodontist determines during your maintenance appointment that your periodontal disease continues to return, he or she will discuss appropriate treatment with you. Proper follow-up care should minimize the likelihood of the disease returning. Also, if your disease does return, it tends to be rather localized and more easily treated than in people who forgo maintenance care for long periods of time.Antimicrobial therapyWhat Is It?Antimicrobialtherapy refers to the use of chemical agents that either kill or inhibit thegrowth of bacteria that cause periodontal(gum) disease. The two most common forms of antimicrobial therapyare antiseptics and antibiotics. Products containing antiseptics are usuallyused to help prevent periodontal disease, while antibiotics are used to treatperiodontal disease. Antiseptics are found in oral rinses. This articlepresents information on antibiotics that are placed under the gums or given aspills, typically in conjunction with a procedure called scaling androot planing.What It's Used ForBecause periodontal diseases are caused by bacteria, dentists and Periodontist (who specialize in treating gum disease) may use antibiotics to help treat them. In dentistry, antibiotics are commonly prescribed for the treatment of an acute (sudden and short-term) infection in the gums called an abscess. Antibiotics are also used to treat other conditions.Antibiotics usually are given to supplement the beneficial effects of scaling and root planing, a common treatment for periodontal disease. Although many forms of periodontal disease are successfully treated using this combined approach, other situations may require additional treatment, including periodontal surgery.Because periodontal diseases are caused by bacteria, you may be wondering why antibiotics aren't considered a routine part of periodontal therapy. In today's world, health professionals are extremely concerned about bacteria becoming resistant to the effects of antibiotics. This can happen when antibiotics are overused or when prescriptions are not taken exactly as instructed by your dentist or physician. Therefore, because most forms of gingivitis and periodontitis can be successfully treated without antibiotics, these drugs are avoided unless absolutely necessary.PreparationOnce yourdentist has decided on an antibiotic, you will have scaling and root planing.This procedure removes plaque and calculus (tartar) from under your gum lineand smoothes any bumps or irregular areas on your tooth roots, where plaque canaccumulate easily.Becausescaling and root planing, as well as local delivery of antibiotics, can besomewhat uncomfortable, these procedures usually are done under localanesthesia. You will be given an injection to numb the area.How It's DoneAntimicrobialtherapy for periodontal disease can be given in pill form or applied directly.If you are given antibiotics in pill form, you will take them for 7 to 10 days.Localtherapy is given in the dentist's chair and involves placing the antibioticdirectly into the affected parts of your mouth. There are several types oflocal therapy, including:Follow-upIt is extremely importan tthat you practice ideal oral hygiene. Brush at least twice a day for at leasttwo minutes per session, and floss at least once a day.Take your medication exactly as directed for the full amount of time prescribed.This reduces the risk that surviving bacteria will become resistant to themedication, and helps to make sure that the medication works as intended.Local antibiotic therapyAfter the placement of local antibiotics, you may feel something under your gums, but it shouldn't be uncomfortable. Avoid flossing the treated teeth so you do not dislodge the medication. Sometimes the dentist will place a covering called a periodontal pack around the gums. If you receive a periodontal pack, do not disturb it.Your Periodontist will want to examine you again in 7 to 10 days to remove the periodontal pack and/or the remnants of the antibiotic. After this, you can resume your standard brushing and flossing routine.Both types of antimicrobial therapyYour dentist will check you again after two or three months to see if the therapy is helping. If your disease does not respond to antibiotics, the next step will depend on several factors, including the severity of your disease. Your dentist can prescribe a different antibiotic or schedule periodontal surgery. Some people may receive several rounds of antibiotics before their disease responds.Once you have had successful treatment for periodontal disease, it's important to help keep the disease under control. Maintenance therapy involves regular visits to your dentist or Periodontist,which can include:RisksThe major risk of antibiotic therapy is an allergic reaction to the medication. If you know you are allergic to certain antibiotics, it is important that you tell your dentist. If you are not aware of an allergy and experience any adverse reaction (such as rash, hives or stomach upset) after you have taken an antibiotic, stop taking the drug and contact your dentist. You may need to switch to another antibiotic.Inappropriate use of antibiotics can lead to the bacteria becoming resistant to the antibiotics' effects. Therefore, it is up to your dental professional to use antibiotics appropriately. It also is important for you to follow instructions for taking the medication and take all of the medication prescribed.GingivectomyWhat Is It?Gingivectomy refers to the surgical removal of gum tissue (gingiva). Gingivoplasty is the surgical reshaping of gum tissue around teeth with healthy gums. Both procedures typically are performed by Periodontist, dentists who specialize in treating gums and the other supporting structures of your teeth.What It's Used ForGingivectomy originally was developed to treat periodontal disease. Today, Gingivectomy is more commonly used as a cosmetic technique. Gum tissue may need to be removed for two reasons:Reshaping the gums through gingivoplasty can help gums look more natural. This procedure can be used to correct malformed or asymmetrical gums caused by genetics,disease or trauma, and might be done solely for cosmetic purposes.Gingivoplasty often is done alone, but can be done during or after a Gingivectomy or a gum graft (which adds tissue to the gum line).PreparationBefore eitherprocedure, your Periodontist will talk to you about oral hygiene after theprocedure and any other instructions you will need to follow. Before a Gingivectomyor gingivoplasty, you should receive a thorough cleaning and, possibly, root planing,to remove tartar (calculus) from existing pockets.How It's DoneGingivectomyand gingivoplasty usually are done with scalpels, but also are done with electrosurgery units, lasers and/or diamond dental burs. Your Periodontist also mightuse specialized instruments that were designed for Gingivectomy, with angledblades to help them get around teeth.Beforeeither procedure, you will receive a localanesthetic by injection to numb your gums. A Gingivectomy can takefrom a few minutes to more than an hour, depending on how much tissue is beingremoved. Gingivoplasty typically are done in a couple of minutes.Follow-UpAfter a Gingivectomyor gingivoplasty, a type of bandage called a periodontal dressing will beplaced on your gums. This usually is left in place for a week to 10 days,during which you will need to follow a somewhat soft diet and avoid spicy andcrunchy foods. Your dentist might give you prescriptions for pain medicationand a chlorhexidine mouthwash.Itis very important to keep your mouth clean during the healing period. You willbe advised not to brush your teeth in the surgical area while the pack is inplace. You will be able to brush and floss the rest of your mouth normally.When the pack comes off, you can brush and floss your teeth normally, butgently. It is not uncommon for the healing tissues to bleed when you floss orbrush immediately after the dressing is removed.After7 to 10 days, you will return to your Periodontist to have the pack removed.Your gums will begin to look normal in three to four weeks, but it can take twoto three months for the tissue to heal completely.RisksThere are no major risks to either procedure. Infection is very rare. Bleeding is a possibility, but also is rare. The affected area might ooze blood for the first 24 to 48 hours, but after that, it should not bleed much, if at all.Osseous surgeryWhat Is It?Osseous surgery is a procedure that reshapes the bone that holds a tooth or teeth in place.What It's Used ForOsseous surgery is a treatment for the gum disease called periodontitis.People with periodontitis develop holes called defects in the bone surrounding their teeth. Osseous surgery reshapes the bone to get rid of the defects. This procedure is often used to treat bone loss around multiple teeth.PreparationYou need toundergo initial periodontal therapy (scaling and root planing) before yoursurgical appointment. You also must have a good level of oral hygiene. A localanesthetic is used to numb the area for surgery.How its DoneThe Periodontistwill separate the gums from your teeth to gain access to the roots andsurrounding bone. After the roots have been thoroughly cleaned, a drill(similar to the one used to treat dental decay) and sharp hand instruments areused to reshape the bone around the teeth. Bone is removed in certain areas torestore the normal rise and fall of the bony cup, but at a lower level. Imaginethat you have a scarf that has frayed along one edge and you decide to trim offthe frayed part. The damage is gone, but the scarf is shorter. The gums arethen placed back over the remaining bone and stitched in place.Follow-UpPain medications may be prescribed to ease discomfort after surgery.Itis very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack,you can use a toothbrush to gently remove plaque from the teeth. Antimicrobial mouth rinses containing chlorhexidine are commonly prescribed after periodontal surgery. Although these rinses do not remove plaque from the teeth, they kill bacteria and help your mouth heal.You may also have some swelling after surgery. This can be minimized by applying a nice pack to the outside of your face in the treated area. In some situations,antibiotics may be prescribed to prevent an infection and these should be taken as instructed. Your Periodontist will want to reexamine the area in 7 to 10days.RisksAfter the surgery, you may have some bleeding and swelling. There is a risk that you could develop an infection.Your gums in the area that was treated are more likely to recede over time. The teeth that were treated may become more sensitive to hot and cold and may develop cavities in the roots.Gingival flap surgeryWhat Is It?Gingival flap surgery is a procedure in which the gums are separated from the teeth and folded back temporarily to allow a dentist to reach the root of the tooth and the bone.What It's Used ForGingival flaps urgery is used to treat gum disease (periodontitis).It may be recommended for people with moderate or advanced periodontitis,especially if the initial, non-surgical treatment (scaling and root planing) has not eliminated the gum infection. It may also be done in conjunction with another procedure known as osseous(bone) surgery.PreparationYour periodontist or your dental hygienist will first remove all plaque and tartar (calculus)from around your teeth and make sure that your oral hygiene is good. Before flap surgery, your periodontist will determine whether your general health or your current medications allow for a surgical procedure to be carried out.How It's DoneAfter numbing the area with a local anesthetic, the Periodontist will use a scalpel to separate the gums from the teeth and then lift or fold them back in the form of a flap. This gives the Periodontist direct access to the roots and bone supporting the teeth. Inflamed tissue is removed from between the teeth and from any holes (defects) in the bone. The Periodontist will then do a procedure called scaling and root planing to clean plaque and tartar. If you have bone defects, your Periodontist may eliminate them with a procedure called osseous recontouring, which smoothes the edges of the bone using files or rotating burs.After these procedures are completed, the gums will be placed back against the teeth and anchored in place using stitches. Some Periodontist use stitches that dissolve on their own, while others use stitches that have to be removed a week to 10 days after the surgery. Your Periodontist may also cover the surgical site with an intraoral bandage known as a periodontal pack or dressing.Follow-Upyou will have mild to moderate discomfort after the procedure, but the Periodontist can prescribe pain medication to control it. Many people are comfortable with just an over-the-counter pain reliever.Itis very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack,you can use a toothbrush to gently remove plaque from the teeth. Anti microbial mouth rinses containing chlorhexidine are commonly prescribed following periodontal surgery. Although these rinses do not remove plaque from the teeth,they kill bacteria and help your mouth to heal.Youmay have some swelling, and this can be minimized by applying an ice pack to the outside of your face in the treated area. In some situations, antibiotics maybe prescribed to prevent an infection, and these should be taken as instructed.Your Periodontist will want to reexamine the area in 7 to 10 days.RisksAfter the surgery, you may have some bleeding and swelling. There is a risk that you could develop an infection.Your gums in the area that was treated are more likely to recede over time. The teeth that were treated may become more sensitive to hot and cold. The teeth also are more likely to develop cavities in the roots.Bone graft (regenerative surgery)What Is It?A bone graft(regenerative surgery) is a procedure that is used to recreate hard and soft supporting tissues lost due to gum disease.What It's Used ForRegenerative surgery is a treatment for the gum disease called periodontitis.People with periodontitis lose gum coverage and bone support around their teeth. Regenerative surgery regrows these lost tissues.PreparationYou need to undergo initial periodontal therapy (scaling and root planing) before your surgical appointment. You also must have a good level of oral hygiene. A local anesthetic is used to numb the area for surgery.How It's DoneThe goal of regenerative surgery is to coax the body into rebuilding the structures that attach a tooth to the jaw, including bone. The Periodontist will separate the gums from your teeth to gain access to the roots and surrounding bone. The roots will be thoroughly cleaned. The holes (defects) in the bone are filled in with a graft material and covered with a physical barrier.Bone grafting materials commonly used include bits of a patient's own bone, cadaver bone, cow bone and synthetic glasses. The patient's own bone is preferable. The barriers, used to prevent soft tissue from growing into the bony defect, are made from human skin, cow skin or synthetic materials.The gums are then repositioned over the treated site and secured in place with stitches. During the next six to nine months, your body fills in the periodontal defect with new hard and soft tissue, effectively reattaching the tooth to your jaw.Follow-UpPain medications may be prescribed to ease discomfort after surgery.Itis very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack,you can use a toothbrush to gently remove plaque from the teeth. Antimicrobial mouth rinses containing chlorhexidine are commonly prescribed after periodontal surgery. Although these rinses do not remove plaque from the teeth, they kill bacteria and help your mouth heal.You may also have some swelling after surgery. This can be minimized by applying a nice pack to the outside of your face in the treated area. Antibiotics usually are prescribed to prevent an infection and these should be taken as instructed.Your Periodontist will want to reexamine the area in 7 to 10 days.RisksAfter the surgery, you may have some bleeding and swelling. There is a risk that you could develop an infection.Your gums in the area that was treated are more likely to recede over time. The teeth that were treated may become more sensitive to hot and cold and may develop cavities in the rootsPeriodontal Examination and ProbingA periodontal examination and probing is one way your general dentist or dental specialist can evaluate the health of your gums and teeth. They help your dentist diagnose the gum diseases gingivitis and periodontitis and also check for receding gums, exposed roots, tooth grinding (bruxism),and other problems.Periodontal measurements can be taken by any dentist or dental specialist, as well as by dental hygienists. If you are referred to a Periodontist (gum-disease specialist) for evaluation, these measurements will be taken during your first visit.