Healthy gum tissue fits snugly around the tooth, which creates a protective cover that works to keep bacteria out of the gum tissue and tooth root. When periodontal disease sets in, the gum tissue and supporting bone of the teeth loosen and result in pockets being formed around the gum line. Over time, if left untreated, these pockets will continue to grow in depth, making them a more suitable environment for harmful bacteria. Bacteria produce acid as a by-product. This acid destroys gum tissue and bone. Left untreated, deep gum pockets will colonize with dangerous amounts of these harmful bacteria, and the acid produced will lead to bone and tissue loss. The first result is the loosening of the teeth, followed by tooth loss.
Reduction surgery is often recommended in an effort to reduce the risk of having to perform multiple tooth extractions in the future due to unhealthy levels of bone and tissue loss around the teeth. In advanced cases of periodontal disease, simply eliminating the bacteria through routine cleanings is not enough to maintain optimal oral health. This is because as the disease progresses the pockets will become deeper and deeper, making them more and more difficult for you and your oral health provider to keep clean. Pocket reduction surgery is used as a treatment and preventative measure to halt the progression of periodontal disease and to increase your chances of being able to keep your natural teeth. It also decreases your odds of developing serious health issues associated with gum disease.
Goals for Reduction Surgery
Osseous or reduction surgery is used to reduce the size of gum pockets in the alveolar bone that surrounds the teeth, as well as to reshape deformities. Reduction surgery is very common in patients with advanced periodontal disease. The ultimate goal of this procedure is to provide access to keep teeth clean and healthy on a daily basis and stop bone loss. Though this procedure is actually a surgery, most patients who undergo it compare it to more of a thorough cleaning.
The more specific goals of reduction surgery include:
| • | Preventing further bone loss – As periodontal disease progresses the body's natural immune system sends out an inflammatory response that prompts bone loss in the jaw. The result is tooth loss if not treated. Reduction surgery is performed in an effort to halt periodontal gum disease before it gets to the point that teeth are lost. |
| • | Reducing the spread of bacteria – Bacteria that cause periodontal gum disease is the same strand of bacteria that causes heart disease. One of the goals of reduction surgery is to remove tartar and eliminate bacteria buildup that could travel to other areas of the body and become life-threatening. |
| • | Enhance the smile – It is not uncommon for a mouth plagued by periodontal gum disease to be unsightly. Rotting teeth, brown gums, and indentations of the ridge are all commonly associated with periodontal gum disease. Reduction surgery aims at reversing the effects of the disease and thus restoring the natural beauty to the smile. |
| • | Facilitating home care – The longer periodontal gum disease is left to progress, the more difficult at home and even in-office care become. As the pockets deepen, it can become impossible to floss and brush effectively. Reduction surgery is aimed at making it easier to effectively and efficiently practice proper oral hygiene. |
How is reduction surgery performed?
Prior to the surgery, a local anesthetic will be administered to numb the area. To start the procedure, Dr. Scholes will make small incisions around the teeth to loosen the gum tissue. Loosening the gum tissue allows Dr. Scholes to have better access to the roots and bone around the teeth.
During reduction surgery Dr. Scholes will fold the tissue of the gum back and thoroughly clean the roots of the teeth and any infected bone surrounding the teeth, thus reducing the amount of disease-causing bacteria. Once Dr. Scholes has cleaned the root surfaces thoroughly, he will then secure the gum tissue back into place with a suture. Additionally, more advanced cases of periodontal disease may have resulted in bone loss, which will require bone grafting to correct the normal rise and fall of the bone. This smoothing of the tooth's surface and restoration of bone actually helps the gum to more appropriately attach to the tooth upon healing and thus promotes healing.
You can expect minor discomfort following your procedure. Take care to follow all of Dr. Scholes' post-operative instructions as to avoid further complications such as infection. You can gently apply ice packs to the area to reduce swelling and pain. In some cases, depending on the severity of the situation, you may be prescribed antibiotics and/or pain medication to prevent infection and reduce discomfort. The area will also be covered with a bandage, commonly referred to as a periodontal pack, to keep the site clean and covered. You will likely receive a special mouth rinse that contains chlorhexidine to help prevent infection and promote healing. You may experience some minor bleeding.
You can expect that you will be asked to return back to the office after your reduction surgery for follow-up visits. Following reduction surgery, it becomes important to practice proper oral hygiene, which for someone with periodontal disease, includes proper brushing and flossing as well as regular periodontal maintenance cleanings.