Dr. Michael L. Cohen Specialist Periodontist Implants
periodontics gum disease dental implants

Our office is located on Main Street in Lakemont Park at 166 Lakemont Park Boulevard in Altoona, Pa 16602     Directions/Map

  Patient Information

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  Office Address

  Michael L. Cohen, D.D.S.
  166 Lakemont Park Blvd.
  Altoona, PA 16602

Patient Questions And Answers About Periodontal Disease (Gum Disease)

Table of Contents

  1. Our Pledge To You, Our Promise, Your Responsibilities
  2. What is gum disease?  I've never heard of it until lately.  Why haven't I heard of it before?
  3. Why wasn't it detected earlier?
  4. How long have I had this problem?  I brush and floss and have my teeth cleaned on a regular basis!
  5. How did this problem occur?
  6. Where does gum disease occur?
  7. Can this disease be stopped?  How is this disease stopped?
  8. Is treatment painful?
  9. What type of treatment is done?
  10. Once the bone has deteriorated around the teeth, is it lost forever?
  11. Why are visits needed after periodontal surgery?
  12. Why do I need periodontal surgery?  My mouth feels better since I had scaling and root planing and my gums no longer bleed!
  13. Will the periodontal disease reoccur?
  14. Why must I see my general dentist for cleaning if you are the specialist in gum disease?
  15. Will I miss work?  How long will this treatment take?
  16. Why are my teeth sensitive to hot and cold or sweets?
  17. Why are x-rays needed to evaluate my periodontal condition? My dentist takes x-rays on a regular basis!
  18. Why are there some residual pockets present following periodontal surgery?
  19. How are financial arrangements made?


Our pledge

We are committed to helping you gain control of your dental health and well - being.  The foundation for control is an individual, patient - centered approach to eliminate disease and maintain healthy teeth and gums for a lifetime.  We successfully meet this challenge with a unique combination of state - of - the - art techniques and the most sincere, tender loving care.  For looking and feeling good nothing works better than your natural teeth, they were meant to last a lifetime.

Our promise to you

  1. We are committed to providing you with the highest quality care with greatest professional ethics.
  2. Respect your humanity.  Each patient is an individual with specific goals and needs.  You have the right to understand all information regarding diagnosis, prognosis and treatment options. 
  3. We create superior value.  We will work with you to develop a plan that best meets your individual situation.
  4. We will respect your time and commitment by being on time.  Each appointment is scheduled and reserved specifically for you.
  5. We will be available for emergency care as well as any other needs you may have during treatment.
  6. We utilize the safest and newest technologies to insure the   highest professional standards.

Your responsibility

  1. Ownership and acknowledgement of the dental or medical problem. This will allow the most effective and efficient actions to a future for health.
  2. Participate as a co-therapist in the treatment of your periodontal disease.  Daily removal of plaque and regular visits once treatment is complete is the only way to ensure long term health.
  3. We request your honesty and cooperation during your visits to our office.  Communications is the key to understanding and best results occur when patients, staff and doctors work together.  Please ask questions if something is not clear or understood.
  4. We request that you schedule appointments that you will honor and will be on time.  Your appointment has been exclusively reserved for you so you may receive quality and individual care.
  5. Assume financial responsibility of paying for all services rendered.  Your dental insurance may be used to assist in paying for our services but you are personally responsible for fees incurred during treatment.
  6. Offer comments and suggestions to improve our ability to meet the needs of our patients and the community.

What is gum disease?  I've never heard of it until lately.  Why haven't I heard of it before?

"Gum" disease or periodontal disease is the number one cause of tooth loss in adults.  It usually begins to affect people in their late 30's.  It is an infection in the gums and jaw bone that destroys the support structure of the teeth, eventually causing teeth to be lost.  Dentistry has recently focused a lot of research to combat this disease.  It has done so because people are living longer with their natural teeth due to the decline in tooth loss from cavities. 

People are living longer with more teeth and as a result there are more people at risk.  In the past people didn't live as long and if they did they had fewer teeth than today.  At the same time dentistry has done a better job of restoring teeth with cavities and has helped patients keep their teeth through such procedures as root canal therapy, fluoride and replacing missing teeth.  Tooth decay is not as big a problem as it was in the past.  There are now more commercials on TV promoting products to kill plaque and keep the gums health than there are to prevent tooth decay.  This change has taken place within the last few years.

Dental science has given the dental profession new techniques to diagnosis periodontal disease.  In addition dentists now know how to treat periodontal disease as well as prevent it.  This was not always the case.  Also, dentists and most patients are more concerned about their health.  Prevention is more popular.  A healthy mouth enables better function and a higher quality of life, not to mention better cosmetics and speech.  More people are brushing, flossing, taking fluoride and having their teeth examined and cleaned on a regular basis.  Diets are improved and people want to keep their natural teeth.  Nothing works as well as your natural teeth.

Why wasn't it detected earlier?

Periodontal disease is difficult to detect disease at its early stages.  Disease progression is not slow and incremental.  It can occur in short periods of time and be episodic in nature.  It is painless.  Symptoms are not present early but only in the advanced stages of disease.

Most people have some early disease.  In some cases it may never progress.  Your dentist tries to maintain the problem but if he feels it has recently gotten worse he will refer you for a periodontal evaluation.

Rarely a few teeth can undergo rapid disease. 

For many years periodontal or "gum" disease was an unknown entity.  Most people lost teeth to cavities.  As a result most research and treatment was directed toward preventing cavities.  With the recent decline in tooth decay more research and knowledge has been gained about periodontal disease.  It is now the number 1 reason for tooth loss in adults over the age of 40.  Fortunately, detection methods have improved and this disease can now be treated.  There is no reason people cannot have their natural teeth for a lifetime.

How long have I had this problem?  I brush and floss and have my teeth cleaned on a regular basis!

I do not know how long this problem has been present.  All I can tell you is that there is a problem today.  (See "Why hasn't this detected earlier?")

Periodontal disease can occur in short periods of time. 

Recent information has changed/improved the way we detect, prevent and treat periodontal disease.

Methods for removing plaque have changed.  Most previous methods were designed to clean teeth and not the gums due to cavities being the most common dental disease.  We now know it is more important to clean the gums of plaque to prevent disease.  Most people still brush and floss to clean teeth not gums.

How did this problem occur?

Periodontal disease is caused by plaque developing below the gum line.  Plaque is soft and sticky.  Once plaque begins to accumulate, it becomes toxic to the gum tissue.  At some point it is so toxic it causes an infection that spreads from the gum to the jaw bone that supports the teeth.  The jaw bone begins to deterio­rate due to the infection.  Pockets or deep spaces develop between the gum and the teeth resulting in more plaque accumulation.  More plaque accumulation results in more disease and more disease results in deeper pockets, more bone loss and more disease.  It is a never ending downward spiral that will eventually result in tooth loss.  The plaque that accumu­lates below the gum line is like having a splinter between your finger nail and cuticle.  Until it is removed healing will not occur.

Not all types of plaque cause periodontal disease.  We used to think that the more plaque you develop the worse the disease.  We now know that certain types of plaque cause more disease then others.  Therefore, some people are more at risk than others because of the type of plaque they develop, not the amount.  That is why some people despite regular care can have periodontal disease while others who never seek dental care can have fewer problems.  Once a person is found to be at risk that person needs to be more aggressive and diligent in removing plaque.

Most warning signs are late in the disease process.  Periodontal disease is generally painless and will not be detected by the patient until it is very advanced.  Symptoms include but are not limited to:  bleeding gums, bad breath, bad taste, loose teeth, teeth shifting positions, change in the bite, gum recession, sensitivity to hot and cold, swollen gums and gum abscess.

Other factors that allow gum disease to occur are missing teeth, maligned teeth, clenching or grinding teeth, too aggressive tooth brushing, irregular visits for dental cleaning, irregular or incorrect flossing or not replacing missing teeth.

Gum disease does run in families.  Often many generations will suffer from gum disease.  This is due to having a plaque that causes more gum disease than another type of plaque. 

Cigarette smoking decreases the ability of the gums to fight "gum" disease.  Smokers have more gum disease than non-smokers and they do not heal as well during periodontal therapy.  Smoking adds heat and chemicals to the mouth that dry the gum tissue and cause it to under go a change that makes it more like scar tissue.  Scar tissue is less responsive to healing.  This process is reversible by eliminating cigarette smoking.

Some medical illness can allow gum disease to progress and be more destructive.  Diabetes is the main culprit, but others exist.  It is imperative that each patient's medical condition be healthy for the gum tissues to heal.

Where does gum disease occur?

Gum disease occurs around all teeth in the mouth, but not each tooth is affected to the same degree.  It is rarely localized in one area.  That is why when one area of disease is found it is important to evaluate the entire mouth for gum disease.

Gum disease is more prevalent around back teeth because they are more difficult to clean and remove plaque.  Back teeth also have multiple roots and grooves that allow gum disease to progress faster than front teeth.  Most people lose back teeth to gum disease before front teeth.  Many people are more willing to sacrifice a back tooth and more willing to treat front teeth.  Unfortunately back teeth are very important.  They support the bite and protect the front teeth during function.  Without back teeth front teeth often become more loose, shift and eventually need to be removed.  Back teeth also act as anchors to hold replacement teeth.

Can this disease be stopped?  How is this disease stopped?


There are three keys to stopping periodontal disease.  The first is to remove plaque on a daily basis.  This is the patient's responsibility.  Without plaque control via brushing, flossing and proxabrushing the gum disease will never be eliminated.  Secondly, treatment must be done to remove present accumulations of plaque and tartar and eliminate pockets that accumulate plaque.  Thirdly, the patient must have their teeth and gums cleaned on a regular basis.  For patients susceptible to periodontal disease the teeth must be cleaned every 3 months.  We do this on an alternating schedule with your general dentist.  It only makes sense that people who are more susceptible need to be seen more often.

Is treatment painful?

Patient tell us two things after treatment has been completed:

  1. It was not as bad as I thought.
  2. If I knew then what I know now I would have had this problems corrected a long time ago.

During treatment there is no need to be uncomfortable.  We can use local anesthetic or "novocaine" so there is no reason to feel anything.  We can guarantee you that.

Each person has a different threshold level to pain, some have none and others have more, most people are in between

What type of treatment is done?

Treatment is done in two stages.

The first stage consists of plaque control instructions and scaling and root planing.  Plaque control is essential because if plaque continues to accumulate healing will not occur.  Scaling and root planing is done to remove plaque and tartar that has already accumulated below the gum line.  This is a deeper cleaning that is done with special instruments.  We divide the mouth into four quadrants, the upper left, upper right, lower left and lower right.  Approximately 1 hour is spent cleaning in each quadrant.  Plaque and tartar are very difficult to remove from deep pockets.  Often it can not totally be removed in the deep areas.  As a result scaling and root planing offers short term healing but will not eliminate the periodontal disease.  If plaque and tartar are inaccessible to scaling and root planing periodontal surgery is necessary.

Periodontal surgery utilizes a technique that allows access to the deep areas to remove plaque. It also allows elimination of periodontal pockets and can allow for regeneration of lost bone.  Periodontal surgery is a definitive procedure with long term results.

Three to five post surgery visits are needed to complete the healing process per surgery.

Once the bone has deteriorated around the teeth, is it lost forever?

Bone can be regenerated around teeth with bone loss.  Bone is regenerated by adding a bone graft material during periodontal surgery.  The bone graft is placed in the bone defect caused by the plaque and tartar.  The bone graft acts like "fertilizer" to stimulate the bone that is already present to produce more bone.  The bone graft itself is destroyed by your body and does not remain in your mouth.  The newly regenerated bone is your bone.  Bone grafting will not regenerate bone in all types of defects only those defects with a vertical or moat type defect.  Bone grafting is not yet predictable in flat or horizontal types of bone loss.

Bone graft material comes from registered organ donors who are donating hearts, livers, kidneys, etc.  Unlike these organs bone graft material is a non-living powder similar in consistency to salt.  It is sealed in sterile bottles.  This material is safe due to its processing.  It is washed in acids, freeze-dried and purified.  Three steps in its processing have been proven to kill the hepatitis and AIDS viruses.

Gore-Tex regenerative material is also used to achieve bone regeneration.  Gore-Tex is a synthetic fabric that is tied around the tooth to isolate the bone graft in the bone defect.  It prevents gum tissue, plaque and bacteria from interfering with bone growth.  It is needed in large defects and in defects between roots of teeth.  It remains in the mouth 4-6 weeks after the periodontal surgery.  Removal of the Gore-Tex is a simple 2 minute procedure without the need for "novocaine".

Why are visits needed after periodontal surgery?

The first visit after surgery is needed to remove stitches and the dressing.  Patients are also taught how to care for their mouths in the early stage of healing.  Most times an end tuft toothbrush and a proxabrush are used in a gentle manner.  Subsequent visits may be needed every week or every other week until the initial stage of healing is complete.

Post-operative visits allow us to remove plaque that would prevent the best results in healing.  We can remove plaque you cannot reach or plaque that is not removed because most patients are anxious not to hurt the gums in the initial phase of healing and not aggressive enough in removing plaque.  Studies have shown the more post-operative visits the better the healing, the shallower the pocket depths and the more bone that is regenerated. 

Patients who do not keep their post-operative appointments in the recommended time intervals risk poorer healing.  Visits are only 15 minutes long but their value is great.

Why do I need periodontal surgery?  My mouth feels better since I had scaling and root planing and my gums no longer bleed!

Scaling and root planing has allowed healing to occur at the shallow levels of the gum tissue.  At this level, close to the gum line, plaque and tartar was removed and you are able to maintain the area free of plaque.  As a result this area will no longer bleed, be sore, or be red.

Unfortunately the deep areas still have plaque and would bleed if you could access them.  But floss and brushes only reach minimal distances below the gum line.  When periodontal probing is done and pockets are measured they do bleed.  These areas are not being cleaned and they are accumulating plaque.  Disease will progress without the elimination of these pockets.

Will the periodontal disease reoccur?

Periodontal disease will not reoccur if the following three keys to successfully treatment are maintained:

  1. Patient removal of plaque on a daily basis including flossing twice a day.
  2. Periodontal therapy in the office.
  3. Regular alternating 3 month cleanings.

Periodontal health will be maintained.  Any disruption in one of the above factors may allow periodontal disease to return.

There is no cure for periodontal disease.  It is a chronic illness. Preventive behaviors such as daily removal of plaque and regular cleanings are essential to long term health.

Why must I see my general dentist for cleaning if you are the specialist in gum disease?

A healthy mouth needs healthy gums and healthy teeth.  Your general dentist is the best person to evaluate the health of your dental restorations and make sure no new cavities are developing.

Your periodontist needs to monitor your periodontal condition.  He will measure pockets, tooth mobility, bleeding during probing and bone levels around your teeth.

Both your general dentist and periodontist can clean new deposits of plaque and bacteria around the teeth and gums.

Will I miss work?  How long will this treatment take?

During the initial phase of periodontal therapy, plaque control instructions and scaling and root planing, there is no need to miss work or change you plans for the day.  These treatments are not uncomfortable.  Most people do not even need "novocaine" or local anesthetic.  For those who would be more comfortable with "numb­ness" it is available.

Periodontal surgery does have some discomfort after the procedure is completed and the "novocaine" has worn off.  There is no discomfort during the procedure due to the "novocaine".  We guarantee this promise.  Usually this discomfort after the surgery is handled by prescription medications.  We ask that after the procedure you go home and relax.  There are things that need to be done after periodontal surgery to minimize discomfort and if they are done the post-operative period is usually uneventful.  The next day 90% of all patients return to work.

Why are my teeth sensitive to hot and cold or sweets?

Teeth are sensitive to cold or sweets when roots of teeth are exposed in the mouth.  The tooth has two parts, the crown and the root.  Crowns, the part of the tooth that is usually above the gum line, have no nerve innervation and therefore they will not be sensitive to hot, cold or sweets.  The crown is like you finger nail in this regard.  On the other hand the root has nerves that feel hot, cold and sweets.  It is usually protected below the gum tissue so sensitivity is not a problem.  Unfortunately, aggressive scrub-like toothbrushing or periodontal disease may make roots exposed.  Also, roots may be more sensitive temporarily after periodontal treatment.  The root has microscopic openings that allow hot, cold and sweets to be felt when the root is exposed.  The sensitivity feels like pain and usually only lasts while the hot, cold or sweets hit the tooth.  The pain usually is gone seconds after the cold liquid or food is gone.  This sensitivity can be reduced and usually eliminated by blocking the microscopic pores with fluoride which will desensitize the tooth.  Fluoride has an affinity for the pores and "hardens the tooth."  It also makes the tooth less susceptible to cavities.  Unfortunately, it may take 6 weeks of applying the fluoride for the sensitivity to decrease.  The fluoride must be used twice a day each day for improvement to occur.  Often improvement will not be seen for 4-6 weeks, but it will get better.  It is also important to make sure plaque is not allowed to accumulate.  Plaque will keep teeth sensitive.

Why are X-rays needed to evaluate my periodontal condition?  My dentist takes X-rays on a regular basis!

X-rays are needed because periodontal disease is a disease that occurs below the gum line.  The only way to have an accurate evalua­tion of your periodontal condition is to have x-rays of each tooth, with an emphasis on the part of the tooth below the gum line.  Your general dentist's primary interest is the teeth above the gum line and the teeth most susceptible to cavities.  Since periodontal disease occurs below the gum line and can affect all teeth it is critical to have current x-rays of all teeth.

The type of x-rays we use have a high magnification and provide great detail.  Other types of x-rays such as a panorex do not provide the detail of a complete periodontal radiographic survey.

Fortunately, the complete periodontal radiographic survey is very low in radiation due to the high speed nature of the x-ray film, the lead apron you wear, and the benefit our office has with the newest and most advanced x-ray machine.  Your body absorbs as much radiation from a day in the sun as it does from our radiographic survey.

Why are there some residual pockets present following periodontal surgery?

Residual pockets are uncommon following periodontal surgery but can occur for the following reasons:

  1. Poor or irregular plaque control.  If plaque is not thoroughly removed from your mouth twice a day with your toothbrush, floss or proxabrush in the recommended fashion plaque will get below the gum line and prevent the gum from attaching to the tooth or allowing bone to regenerate.
  2. Irregular post-operative visits following periodontal surgery.  Post-operative visits allow our office to remove plaque that you may have missed in the early stages of healing.  Without professional removal of this inaccessible plaque healing can be compromised.  Studies have proven that patients with irregular post-operative visits heal with more pockets than patients who follow the recommended plan.  These visits are included in the surgical fee and are 15 minutes in duration.
  3. Cigarette smoking does not allow for optimal healing.  The heat and chemicals from smoking can limit the amount of gum that can attach to the teeth and the amount of bone that can be regenerated.  Your periodontal tissues are fragile in the early phases of healing and cannot withstand the heat and chemicals of cigarette, cigar or pipe smoke.
  4. Host response.  Approximately five percent of all patients are more susceptible to periodontal disease than other patients and do not heal as well.  The host response is how your body reacts and fights disease.  Each person is slightly different.  A great amount of research is now being done to help this group of patients and more information is available each day to make their treatment more successful.
  5. Certain anatomic factors prohibit total pocket elimination.  Sinuses, nerve canals, muscle attachments and vascular beds cannot be violated.  If periodontal disease is located near one of these structures treatment is often compromised but not neces­sarily unsuccessful.
  6. There are certain types of bone defects where bone regenera­tion is unpredictable and defects cannot be eliminated by conventional means.  These types of defects are areas where disease has spread between two roots of a multirooted tooth (Class III furcation) and bone defects with few walls to hold the bone graft material (1-wall and some 2-wall defects).  These areas may be unpredictable with regenerative therapy and conventional surgery would cause too much bone loss on adjacent teeth.  It is best to treat those areas by thorough root debridement and main­tain­ing some residual pocket depth.
  7. Combination bone defects with vertical bone loss (areas where bone can be regenerated) and horizontal bone loss (areas where bone cannot be regenerated).  In this type of area bone will regenerate in the vertical defect and provide more support for the tooth but pocket depth may remain on another part of the tooth or above the newly regenerated bone where the horizontal bone lost occurred. 

The goals of surgical treatment include:

  1. Elimination of plaque and tartar for a biologically acceptable root surface.
  2. Regeneration of lost bone or gum tissue.
  3. Pocket reduction/elimination.

Each patient and each area of the mouth presents different challenges.  The majority of surgical produces achieve their planned goals.  In areas where compromise was necessary and some pocket depth remains our alternating three month supportive maintenance program can maintain health.  This is due to a disease free root surface and reduced pocket depth, with or without bone regeneration. 

How are financial arrangements made?

We are willing to work with people who want to preserve their natural teeth for a lifetime.  If it is important to you it is important to us.  There are a few ways to enable all people the advantage of keeping their natural teeth.

  1. Payment plans.
  2. Prioritized treatment.  More involved areas are done first and less involved areas are delayed.  A long term plan for health with incremental completion of treatment can be done.  This will also maximize the insurance benefits that are renewed on a yearly basis.  If treatment is to be done in phases cleaning should be done during the different periods between treatment.
  3. Our treatment coordinator can discuss more specific option with you.