Understanding Your Periodontal Treatment

Peter M. Friedman, D.M.D.
 Steven B. Grater, D.M.D.
4129 Locust Lane, Harrisburg, PA  17109
 Telephone: (717) 657-3326
 E-mail: FriedmanGrater@comcast.net
Map to the Family Dentistry Office

We are committed to controlling gum disease through a well planned, disciplined treatment. The ultimate success of your treatment is equally dependent upon your role and commitment as it is on ours. Without your cooperation and daily maintenance, the outcome is compromised. This pamphlet is designed to give you a better understanding of our treatment objectives.

What causes Gum Disease? 

Gum disease is caused by plaque and calculus (hardened and calcified plaque, also known as "tartar"), accumulating at the gumline and growing along the root.  When plaque hardens into calculus, it can only be removed with dental instruments.  As it invades deeper under the gums, your body reacts with inflammation.  

This includes redness, swelling, bleeding, and pocket formation. This is usually a painless condition, which continues to worsen over time.  At later stages, the bone supporting your teeth begins to shrink, ultimately causing tooth loss if left unchecked.

Diagnosis 

During your initial visit you will receive a comprehensive exam. This will include evaluation of your gums, teeth, bite, and overall oral health. 

In evaluating your gums, your dental hygienist will record numerous gum pocket readings.  These readings are a key indicator of the status of your gum health.  Any readings over 3 mm are considered a disease state and will require attention.  One of our goals for treatment is to reduce the depth of any existing gum pockets.  This healing will be evaluated at your 3-month recall appointment along with many other indicators of inflammation. 

Education

We will spend a great deal of time with you to help you to understand the problem.  This will greatly enhance your ability to control the disease. 

Oral Hygiene Instruction 

Through proper oral hygiene instruction you will be able to minimize or eliminate the reformation of plaque and calculus, but only after it is initially professionally removed.  We cannot stress enough how important your role is on a daily basis to control this disease, through proper brushing and flossing, and other measures recommended by our staff. 

Full Mouth Debridement 

This is the complete removal of all plaque and tartar by our dental hygienists, usually done using novacaine.  They are specially trained in deep scaling techniques performed ideally in one treatment session.  Typically, this is a longer than usual hygiene appointment, and requires a considerable time commitment, generally 2-3 hours. 

Oral Irrigation 

The dental hygienist will also irrigate under your gums with chlorhexidine liquid. Chlorhexidine inhibits plaque formation for 12 hours. 

Evaluation of Healing at 3 Month Recall 

You will be scheduled for a maintenance visit at 3 months.  We will reprobe your pocket depth and evaluate your gum healing to determine levels of improvement.  We will also clean your teeth and continue to do so at 3 month intervals.  Remember, periodontal disease is an ongoing process, and must be treated as such to keep it under control.  Many times it becomes necessary to perform the Full Mouth Debridement again after several years.  This is determined on an individual basis. 
 

Your Role and Commitment

Success 

The success of your treatment is ultimately dependant on whether you make the commitment to step up your home care on a daily basis as prescribed by your hygienist.  If you are not ready to spend the 10 minutes daily that are required, then we suggest you postpone treatment until you are ready. Without your daily homecare routine, the treatment is not going to be effective. 

Cancellation Policy 

Because the Full Mouth Debridement appointment commits a significant amount of appointment time (2-3 hours) for your hygienist, we respectfully ask for 48 hours notice of cancellation.  You will be asked to provide a payment of $75 toward the services at the time you schedule in order to hold the appointment time.  Anything less than 48 hours will result in a loss of the appointment deposit. 
 

Medications and Home Care Instructions
 

Chlorhexidine Irrigation 

You will receive a prescription for Chlorhexidine at your comprehensive exam appointment.  We recommend that you dilute the medication with a small amount of mouthwash to improve the flavor.  Your hygienist will give you a blunt tipped applicator syringe and instructions.  You are to begin irrigating twice daily, preferably once in the morning, and once before bed. 

This medication has the ability to kill the bacteria which form plaque, and inhibit the growth for 12 hours.  Therefore, it is imperative that you spend the 5 minutes required to effectively apply the liquid under the gums twice daily. 

Amoxicillin and Flagyl 

You will also recieve a prescription for Amoxicillin and Flagyl.  Both are full strength antibiotics.  If you are allergic, we can substitute Clindamycin.  The Amoxicillin and Flagyl are taken as prescribed starting 1-2 days before your Full Mouth Debridement appointment.  Please finish the entire prescription unless you have an unusual reaction.  When taking Flagyl, it is extremely important that you do not consume alcohol.  Doing so can make you violently ill. 

Periostat 

Periostat is a pill form prescription to be taken twice daily again for a three month interval.  It is a subclinical dose of tetracycline.  This means it is a very low dose of the antibiotic, not enough to kill bacteria.  Instead, it has been shown to work for you in low doses by decreasing your body's inflammation reaction to existing plaque.  By reducing the inflammation, it decreases the breakdown of your gum tissues, thereby increasing healing.

Dr. Friedman and Dr. Grater
Dr. Friedman and Dr. Grater Free Dental Day

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