First Visit to a Periodontist

If you’ve been referred to a periodontist by your general dentist or have decided to schedule an appointment with a periodontist on your own, you may be wondering what your first visit will entail and how you can prepare for this visit. Your periodontist will let you know if there are specific things you need to bring with you, but in general, it’s helpful to make a list of all medications you’re currently taking, both over-the-counter and prescription, and to bring that to your first visit, along with a notation of any medical conditions you may have. The first step in a periodontal appointment is a review of the patient’s medical history and dental history, including all medications, so it can be helpful to compile this information in advance. You’ll also want to bring your dental insurance information with you to your first visit, and, if you received a referral form from your general dentist, bring that with you, too, along with x-rays or other materials your dentist provides with your referral.

At your initial visit, your periodontist will thoroughly review your medical and dental health history and will conduct a comprehensive examination including an oral cancer screening, and they will check for problems with your bite; signs of periodontal disease; and the presence of loose teeth, TMJ, or bone loss. The periodontal examination isn’t painful and should cause minimal discomfort at the very worst. If you weren’t referred to your periodontist by a general dentist, or if your dentist did not take x-rays, your periodontist may take x-rays during this initial visit.

During this first visit to your periodontist, the periodontist will use both clinical instruments and x-rays to assess the state of your oral cavity to determine whether periodontal disease is present. The periodontist uses a tool called a periodontal probe to carefully and gently measure the depths of the space between the gums and the teeth just below the gum line; this area of the gums is called the gingival sulcus. When the oral cavity is free from disease, the gingival sulcus should measure no more than three millimeters deep. When periodontal disease is present, the gingival sulcus can deepen beyond a healthy depth and develop into a periodontal pocket, and the periodontal probe will help determine the depth of periodontal pockets and therefore the extent of any periodontal disease; in general, deeper periodontal pockets correspond to more advanced periodontal disease. Healthy tissue should also withstand gentle probing without bleeding, and bleeding upon probing can be another indicator of periodontal disease. Bone loss is another indicator of periodontal disease, and dental x-rays taken at your initial visit can be used to determine the amount of healthy bone that remains supporting the teeth, and they can also help reveal problems that may not be visible beneath the gums and inside the jaw. The combination of data acquired through the visual examination, periodontal probing, and dental x-rays will be assessed in combination with the complete medical history to determine a diagnosis and to develop a treatment plan.

The cost of periodontal treatment will depend in large part on your diagnosis and planned treatment timeline, and these costs vary considerably from patient to patient, based on the complexity and estimated duration of the treatment plan. Usually, periodontists can provide an estimated cost for treatment at the initial consultation, though some patients require additional diagnostic testing or preparatory treatment before the treatment plan can be finalized. Most dental insurance policies cover at least a portion of periodontal treatment, so be sure to provide all insurance information to your periodontist’s office, and don’t be afraid to ask questions.

Sometimes, periodontal treatment involves surgery, and sometimes it doesn’t. When gum disease is detected early, it can often be reversed and controlled without surgical intervention. When gum disease is detected in its later stages, it cannot be reversed, though it may still be possible to manage it without surgery. Your periodontist will review the surgical and non-surgical options with you at your consultation. If it is possible to save the natural teeth, treatment will be geared toward this goal. If it is not possible to save the natural teeth, treatment will aim to rid the oral cavity of disease and plan for dental restoration options that will work well with the patient’s lifestyle, preferences, and budget, as well as their clinical needs. Because periodontal disease can be largely painless, you might be inclined to put off treatment, believing that it’s not a problem if it doesn’t hurt. In the case of periodontal disease, this is a very bad idea. Delaying treatment is likely to cause periodontal disease to worsen and progress, and delaying treatment can also mean the difference between preserving the natural teeth and replacing them with dental prosthetics.

Your periodontist will review your treatment timeline with you at your initial consultation and will also explain any surgical procedures that may be necessary to prepare the mouth for periodontal treatment. If there are teeth that need to be extracted in order to place dental implants, your periodontist will plan this preparatory surgery first, assessing your healing process as the second stage of treatment is planned. The frequency of maintenance visits will depend, at least in part, on how severe your situation is, your risk factors for periodontal disease, and your home oral health care habits. If your periodontist determines that you are generally in good oral health, you may be able to schedule maintenance appointments at six-month intervals; patients with higher risks of periodontal disease or patients who are just beginning treatment may be advised to schedule periodontal maintenance appointments every three or four months, and these appointments can become less frequent as treatment continues and the disease is controlled. Other factors that influence the timeline for maintenance visits include nutritional habits, certain medical conditions, the consistency of your oral hygiene habits, and whether or not you smoke or use tobacco. Your periodontist can also help you with smoking cessation programs or nutritional guidelines that can help reduce the risk of periodontal disease progressing or reocurring and can help ensure the success of dental implants and other types of dental restorations.

Periodontists specialize in diagnosing, treating, and preventing diseases of the gum tissue and the underlying bone that supports the teeth. In its early stages, gum disease may be largely asymptomatic, making it difficult to diagnose. Thankfully, periodic visits to your general dentist can help you detect gum disease early on, when it can still be reversed and successfully treated. When gum disease goes undetected, it can develop into periodontal disease, which destroys the gum tissue, the connective tissues that attach the teeth to the bones, and the bones that support the teeth. While this destruction can happen gradually, it is likely to result in the loss of the natural teeth if left unaddressed. Periodontists can use non-surgical treatment methods like dental scaling and root planning to clean infection from the gums and prepare the teeth to resist infection, and they can use surgical treatment methods like bone and tissue grafts and dental implants to help restore the oral cavity to a healthy appearance and function. While some of these periodontal treatments require multiple procedures performed intermittently over a relatively long period of time, they can also provide patients with long-lasting healthy smiles and fulfilling meals, and the investment of time is usually worth the outcome. Working closely with your periodontist can help you beat periodontal disease and maintain the health of your mouth and the function of your teeth for a lifetime.

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