Treating Periodontal Disease
The results of your dental screenings are in and the news is not good.
Your dentist says you need treatment and explains that it will be done
in stages. First, is a deep cleaning of the spaces between the affected
teeth and gums? If that doesn't control the infection, or if damaged
tissue has to be repaired, surgery might be needed. Afterwards, you'll
have to get frequent, regular cleanings to maintain control of the disease.
You'll also have to practice good oral hygiene at home and try to
reduce other risk factors for gum disease, like quitting smoking or eating
fewer sweets. Your dentist may explain that the goal of treatment is to
stop the progress of the disease, or at least to control it.
Other goals are to leave the tissues around your teeth in a state that
can be easily managed and, if possible, to restore the supporting structures,
which include bone, gum tissue and connective tissue. At this point, you'll
probably have several questions for your dentist. Will the treatment work?
And how much will it hurt? How much will it cost?
Does treatment work?
The answer is "yes" for 85 percent of patients who get treated
early. Treatment works best before there is severe damage to the tissue
that attaches the teeth to the bone, and before teeth are missing. This
is why it is so important for patients and dentists to be on the lookout
for the early warning signs of gum disease: red, swollen gums that bleed
easily. Treatment works better for nonsmokers than for smokers.
Treatment for periodontal disease may even help lower other health risks.
For example, research has found that treating gum disease helped people
with diabetes. It lowered their blood sugar levels and reduced their need
for insulin. Still, despite the best efforts, some patients with periodontal
disease do not respond to treatment at all.
Will treatment hurt?
You can expect some discomfort from periodontal treatment, but it will
probably be much less than you fear. The high fear factor is one of the
reasons why people don't see the dentist soon enough when they notice
symptoms. Although about half of patients reported feeling fearful of
pain before they were treated, less than 10 percent reported feeling any
extreme discomfort or pain from treatment, according to a poll by the
American Academy of Periodontology.
Recent advances in dental techniques and equipment, in addition to the
better use of anesthetics, have made periodontal treatment less painful.
Local anesthesia, pain medications and even sedation are used more frequently.
Most periodontists also now use various methods to help their patients
deal with their fear. After treatment, over-the-counter or prescription
painkillers are available to take care of most discomfort or pain.
The deep-cleaning procedure that starts treatment is called scaling and
root planning. You can expect the treatment to take three to four visits
spaced about a week apart. You might be given local analgesia. During
scaling, the dentist uses a vibrating ultrasonic device to scrape tartar
from the visible part of the tooth.
To get to the harder-to-reach tartar beneath the gum line, the dentist
uses a curette to probe and clean out the pockets formed around the tooth
by receding gums. At the same time, he or she removes any diseased soft
tissue. The dentist then uses the curette to plane the tooth root to make
the surface smooth. This removes sites where the bacteria lodge within
the pockets. It also reduces the chance of more bacteria taking hold because
it's harder for plaque to stick to a smooth surface. The dentist then
polishes the tooth with an abrasive paste and instructs the patient on
maintenance and home care, including the use of special anti-bacterial
Periodontists often use antibiotics alone, or in combination with other
treatments, to help get rid of bacteria. Studies show that taking antibiotics
after undergoing scaling and root planing reduces the need for surgery.
Children with periodontitis, young adults with rapidly progressing periodontitis
and others with gum disease not responsive to treatment usually need antibiotics
to control their disease. Some experts are concerned, however, that the
frequent use of antibiotics will backfire. When bacteria are exposed to
antibiotics, strains can develop that are resistant to the drugs. This
makes treating the disease harder and is a growing health problem around
New oral drugs, such as Periostat®, offer a solution. After researchers
discovered that low doses of tetracycline antibiotics could help block
the enzyme that destroys connective tissue and bone, Periostat® was
designed. Composed of a dose of antibiotic too low to fight bacteria so
that it doesn't pose a risk for developing resistant strains, it blocks
the enzyme that destroys the connective tissues holding teeth in place.
Research indicates that using Periostat® after deep cleaning significantly
improves tooth attachment and reduces pocket depth. Taking aspirin or
ibuprofen along with Periostat® may enhance its effectiveness.
Other new therapies involve ways of delivering antibiotics directly to
the site. Dentists can now insert a variety of threads and gels containing
antibiotics into the space between the tooth and gum. These include the
floss-like thread Actiside® and the gels Elyzol® and Atridox®.
PerioChip® is a product that is inserted into the pocket after deep
cleaning. It slowly releases chlorhexidine, the same substance used in
plaque-fighting mouthwashes. More research is needed on these products,
but they appear to help lower bacteria levels and may reduce the need
If you still have deep pockets after scaling and root planning, with or
without antibiotics, your dentist will likely recommend surgery to reduce
their size. You may also need surgery to remove diseased tissue, reshape
bone or regenerate new gum and bone tissue.
Pocket depth reduction
During pocket depth reduction, which is also called flap surgery, your
periodontist folds the gum back away from the tooth. After scraping away
the bacteria-laden plaque and tartar, the dentist removes diseased tissue
and smoothes the surface of damaged bones. Then the dentist sews the tissue
back into place. Removing or smoothing damaged tissue allows the gum tissue
to better reattach to healthy bone.
You may need a tissue regeneration procedure if your gums are damaged
or the bone supporting your teeth has been destroyed. To regenerate gum
tissue, your periodontist will do a soft tissue graft by taking tissue
from your palate and sewing it to the damaged site. This helps reduce
further gum recession and covers exposed roots, which protects them from
decay and makes them less sensitive to hot or cold foods and liquids.
The procedure may also be done for cosmetic reasons. Gums that have receded
make your teeth look too long. By bringing your gums down where they belong,
soft tissue grafts can correct the problem.
Bone, too, can be regenerated using grafts. After exposing the damaged
bone by flap surgery, your periodontist surgically places a bone graft
into the defect. The graft stimulates new bone growth at the site.
Periodontists have new weapons in their arsenal: special materials and
tissue-stimulating proteins that enhance regeneration. In one technique,
the periodontist sews a piece of special fabric around the tooth after
flap surgery. This keeps gum tissue from growing down into the area where
bone should be, and allows bone to grow instead. In another technique,
the periodontist applies a gel onto the diseased root surface during surgery.
It contains proteins found in tooth enamel that tricks the body into believing
a new tooth is being formed. That, in turn, stimulates the growth of tooth-supporting tissues.
Crown lengthening is the opposite of soft tissue grafting. Instead of
teeth that look too long because of receding gums, some teeth may look
too short because gums are overgrown. To repair that, your periodontist
removes some gum and bone tissue to expose more of the crown of the tooth.
After your active treatment, you must see your dentist for ongoing maintenance
therapy to prevent recurrence of the disease. During these visits your
dentist will examine your gums, check your bite and remove new plaque
and tartar. How often you have to visit the dentist depends on how well
controlled your gum disease is. A big part of this ongoing maintenance
program is practicing good daily dental care at home. Essentially it's
back to the basics: brush, floss and rinse to maintain that healthy smile.