This article will give you summary advice on what you might want to know about periodontal disease treatment. As you may have read in an introduction to gum diseases, periodontitis is the more severe and damaging form of the condition.
With this condition, the bone and other foundations that hold the teeth in place are stripping away from the dentition. If the problem is not dealt with, the teeth are at risk of becoming loose and eventually may fall out. Furthermore, the condition is increasingly linked as a possible risk factor to various medical conditions such as heart disease. Another reason to look after your smile!
Periodontitis is the #1 cause of tooth loss. Early detection and treatment is very important in terms of the outlook for the condition. The problem can be either localized to some areas of your mouth, or generalized, affecting all areas. It most often affects people over thirty, but more aggressive forms can occur in those who are younger.
Preventive Actions are Vital!
Before we discuss the management options, it should be emphasized that prevention is king when it comes to this dental problem. The main risk factors are poor oral hygiene and smoking tobacco. How you look after your oral health at home is vital (as is avoiding tobacco), in terms of:
- Preventing any gum disease in the first place
- Stopping or slowing it down if you do develop it
- How well your tissues respond to any dental work.
See our guide on oral hygiene for detailed advice, but the main points to bear in mind are:
- Brush twice daily, in the morning and again at night. Ensure that you employ a good brushing technique and spend at least two minutes brushing. Use a mouthwash after brushing. Check how well you are cleaning by using disclosing tablets.
- Clean between your teeth by flossing at least once a day. Alternatively your dentist may advise using inter-dental brushes
- Smoking should be cut down and ideally stopped altogether
- Diabetics need to ensure their blood levels are kept under control as best as possible
- Dentures must be kept clean (more here) and removed at night.
“What are the Aims of Treatment?”
The aims of dental management of the condition will include:
- Ideally to stop further progression of damage to the tissues
- Leave gums that are easy to keep clean (and ensure that you know how to do this properly)
- In some cases, to restore the lost tissues.
Periodontal Disease Treatment Options
“So, what can be done if I have this dental problem?” There are a variety of options, often used in combination. What exact work you require will depend on the extent (and aggressiveness) of your gum disease.
The main options are:
1. Non-surgical periodontitis treatment - scaling and root planing
This involves physically scraping i.e. ‘deep scaling’ the tooth roots. Scaling can be done using ultrasonic or hand scalers. This is usually done under local anesthetic.
Scaling acts to remove any tartar deposits from the teeth. Tartar (calculus) build-up is a key reason for the condition developing and it is vital that it is removed. Removal of tartar also accommodates better and easier oral hygiene.
The therapy may also include ‘root planing’. This will produce smoother root surfaces which are easier to keep clean. Read more on this here.
This work may be carried out by your dentist, hygienist (read about them here) or a specialist periodontist. Favorable outcomes include a reduction in bleeding, swelling and the size of the pockets (gaps around the tooth).
2. Antimicrobial agents (i.e. bug-killing medicines) have been used to improve the results of non-surgical procedures. They are only effective if used in combination with physical cleaning. In other words, these agents are an ‘adjunct’ to scaling and root planing.
There are a variety of agents available. Some are low-dose antibiotic tablets (such as doxycycline- Periostat), others are gels or dissolving fibres (like Actisite) placed in the gums. There are various studies to suggest that these antimicrobial agents are effective, particularly in cases of aggressive periodontal disease.
Chlorhexidine mouthwash is a gold standard, when it comes to antiseptic rinses to use at home for gingival infection.
3. Surgical treatment
Surgical management may be necessary for advanced periodontal disease treatment, but also involves a longer period of tissue recovery and usually increased cost (depending on your dental insurance cover etc.).
Here a ‘surgical flap’ is created, basically meaning the gum is cut and folded back from the tooth roots. This allows for direct access to the roots, before scaling and planing. This direct access means the dental surgeon can be more assured of completely cleaning the roots (ie increased effectiveness vs non-surgical methods). The gum is then sutured back into the desired place.
Some options are available that aim to restore the lost periodontal tissues (and thus repair recession). These options include ‘guided tissue regeneration’ and bone grafting. The techniques are still developing but in some cases are very successful.
“What if The Disease is too Severe?”
Ultimately, in the case of severe periodontitis, treatment may not be successful or even worth trying. ‘Splinting’ of very mobile teeth may help to maintain otherwise doomed teeth for some time. Splinting involves attaching the affected teeth together and/or to a more stable tooth nearby. This is often achieved using a piece of wire and some white filling material, attached to the back surfaces (not unlike a permanent orthodontic retainer).
Eventually, if extraction is necessary, the teeth will need to be replaced. The options for replacing them include dentures, bridges or implants.
Periodontal disease is a very common disease. With proper care it is a preventable condition. There are several facets to treatment, but the central goals are physical cleaning of the teeth (‘scaling’) at the dental office alongside proper oral hygiene at home.
If you have treatment for the condition, it is vitally important that you return to your dentist for regular maintenance. Likewise you must take extra special care of your oral health every day. See our guide on oral hygiene tips for more advice.