What is Periodontal Disease?

Periodontal disease is a bacterial infection.  In the early stages, the infection is limited to just the soft tissue or the gums.  As the disease progresses, the infection gets deep into the bone that holds the teeth in the mouth.  Periodontal disease is one of the main reasons that people over 35 lose their teeth.

How do you treat Periodontal Disease?

If detected and treated early enough, all that may be needed is a super-cleaning called Scaling and Root Planing.  If treatment is put off and the disease is allowed to progress, more advanced therapy may be needed.  If the disease is ignored for too long, tooth loss may be the only option.  Early detection and treatment is extremely important.

How do you cure Periodontal Disease?

Periodontal disease is controlled, not cured.  If you are susceptible to periodontal disease, you must take care of your teeth and gums.  The main factors involved are brushing daily, flossing daily, and regular cleanings.  Beyond that, if you only brush or floss once a day or less, that means bacteria is getting underneath your gums and causing infection until you brush or floss again.  It is important to brush and floss after meals to help stop the continuing infection.

Do I have to floss?

It is necessary to clean all around the tooth.  If you get your hands dirty, you don't just clean the outside of your fingers, you also clean in between.  The same is true of teeth.  Brushing just cleans the outside of the teeth, not the surfaces in between.  While floss is one of the best methods for cleaning between your teeth, there are other products that can be used.  Dr. Dale can help recommend something that may be right for you.

What is the deal with "laser" treatment of Periodontal Disease?

There are a lot of ads for laser treatment of Periodontal Disease.  This is basically an unproven technology.  You can visit perio.org, the official website for the American Academy Of Periodontolgy, and type in "laser" into the search box.  You will find the official statement papers for the AAP.  One paper discusses ENAP (excisional new attachment procedure).  Ads for ENAP claim  it helps reduce pocket depths.  There was an old procedure called curettage that is no longer used or deemed acceptable because it demonstrated no benefit whatsoever.  From the AAP position paper: "It should be noted that the preponderance of evidence indicates that curettage fails to achieve any clinical result that cannot be accomplished by routine scaling and root planing. The Academy is not aware of any published data that indicates that the ENAP laser procedure is any more effective for these purposes than traditional scaling and planing."  It continues: "In addition, there are no published data that demonstrate that either curettage or ENAP are effective in periodontal regeneration. To the contrary, there is peer reviewed evidence, both in vivo and in vitro, that use of lasers for ENAP procedures and/or gingival curettage may place patients at risk for damage to root surfaces and subjacent alveolar bone that, in turn, could render these tissues incompatible to normal cell attachment and healing.

If lasers can cause damage to teeth, why are they used?

There are other uses for lasers besides treating Periodontal Disease.  Lasers can be used in restoring teeth.  They also can be used to trim tissue.   If you need excess tissue removed, a laser can do a fine job trimming it.  It will be slower than traditional methods.

From a statement paper from the American Academy of Periodontology: 

"At this time, there is insufficient evidence to suggest that any specific laser wavelength is superior to the traditional treatment methods of the common periodontal diseases, such as periodontitis." 

If someone is making claims that their laser treatment will solve all of your Periodontal Disease problems, you need to do your research.  Is the doctor a specialist in treating Periodontal Disease?  Are they claiming "laser" treatment will work on every tooth of every patient?  Is this just a marketing gimmick with no science based evidence that it will work AND not cause damage to the teeth or supporting bone?  Is there FDA clearance for the use of the laser they are advertising?

The bottom line is there is currently no evidence that proves any benefit to use of a dental laser in treating Periodontal Disease.  It is possible that in some patients or on some teeth, improvement is noted.  The question is whether this is predictable for every tooth and every patient.  Even the website for one of the leading manufactures of lasers who market their laser for periodontal disease does not provide compelling evidence for the benefits of a laser in treating Periodotnal Disease.  At the top of their research page, they make sure to include the disclaimer that they do not currently possess FDA clearance for some or all of the claims made in these articles.

What is a Dental Implant? A Dental Implant is a  replacement for a missing tooth.   The implant is basically the root of a new tooth.  On top of the implant, there is an abutment and a crown.

Who does dental implants?

There are two parts to a dental implant.  The first part involves placement of the dental implant.  This is a surgical procedure that occasionally involves regeneration of lost bone thru bone grafting and other advanced techniques.  Placement of a dental implant should be done by someone who has been thoroughly trained in surical and regenerative therapy.  Specialists such as Periodontists have gone thru extra years of training in the form of residency in order to learn surgical techniques.  There are classes offered to non-specialists where they can learn to place dental implants.  Some of these are more extensive then others.  There are some programs that take several weeks to complete, while others attempt to train doctors to place implants in 1 weekend. 

If you are having a surgical procedure, feel free to ask if the doctor you are working with is qualified.  Some potential questions to ask include:

  • Do they have specialty training
  • How extensive was their training for implant placement
  • Can they handle every level of difficulty associated with implant placement or do they just do the easy or straightforward cases
  • How much additional training they do annually
  • Are they involved with teaching dental implants either to dental students, residents, or fellow dentists
  • Is their practice dedicated to surgical treatment or is it comprehensive in scope of care


The second part of the implant involves placing the crown.  Having a crown properly done is every bit as important as the placement of the dental implant.  You should make sure the dentist restoring your crown has experience working with crowns.

A dental implant can be analogous to having a medical procedure.  If you need heart surgery, do you go to your primary care doctor, or do you find someone who does the surgery all the time?  An implant surgeon is well trained to handle any and all complications associated with implant surgery.  A general dentist with proper training and knowledge is a specialist in making the crown for the implant.

How long does a dental implant take?

There are many different situations that determine how long it will take to complete a dental implant and have a crown placed.  The best advice is to do it right the first time and not try to rush it so you don't spend more time trying to correct an error.  Most implants take 2-4 months to complete, but in advanced cases this could be longer.

What about those ads for "teeth in a day"?

The real question is what type of teeth are you getting in a day?  Is it the final restoration?  Or is it something temporary?

If a tooth has been missing for awhile, the implant can be placed right away if there is good bone available to anchor it.  If the tooth was lost due to trauma or severe Periodontal Disease, there may not be a good quality of bone available for the implant.  In this case Bone grafting may be needed.

If a tooth needs to be extracted, it is sometimes possible to remove the tooth and immediately place the implant on the same day.  There are a lot of variables that go into this decision such as quality of bone, size of the tooth, and esthetic concerns.

It is also possible in select case to put a crown on the tooth the same day the implant is placed.  A lot of variables go into this as well.  It may be a temporary crown and it may be cut down so that it is not in any sort of function.  You can use the analogy of breaking your arm.  Bone needs time to heal, so a cast is used to keep the arm from moving.  If you put a crown on an implant and then subject it to biting and movement, the healing of the bone is challenged.

One of the main "teeth in a day" advertisements is for the all on four system.  In this set up, all of the teeth are removed in the upper or lower arch and the patient receives a full denture.  Four implants are placed, some angled, and locked together with a giant bar to help minimize movement.  If you need full dentures, and you need them right away, this can work;  although the angled placement is not the best design mechanically or biologically.

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