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Periodontal Disease Treatments

The term "periodontal" literally means "around the tooth".  Most people consider periodontal tissues to be the gum tissues that surround the teeth and the underlying jawbone that anchors the teeth firmly in place. In addition to these tissues, however, there is a thin layer of cells on the tooth roots called cementum and a ligament that connects the cementum to the specialized bone that holds teeth, alveolar bone.  Periodontal diseases are those diseases that affect one or more of these periodontal tissues.

The term “periodontics” refers to the dental specialty that pertains to the prevention, diagnosis and treatment of periodontal diseases that affects the gums and jawbone.  Periodontists have completed several years of extra dental training and are specialists in the prevention, diagnosis, and treatment of periodontal disease and in the placement of dental implants. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease.

About periodontal disease

While there are many different diseases that affect the tooth supporting structures, plaque-induced inflammatory lesions make up the vast majority of periodontal diseases and have traditionally been divided into two categories, gingivitis or periodontitis.  They can affect one tooth or many teeth. 

Gingivitis is a milder and reversible form of periodontal disease that only affects the gums.  In many patients an inflammatory overreaction to the bacteria results in the body, in essence, turning on itself and destroying the supporting tissues around the teeth, including the bone.  At this point the condition has progressed to the more serious, destructive forms of periodontal disease called periodontitis.  The gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected.  As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.  Often this destructive process has very mild symptoms.  Eventually, teeth can become loose and may have to be removed.  

More than one in three people over the age of 30 have a form of periodontal disease that has advanced beyond gingivitis.  However, because periodontal disease develops silently and painlessly, the majority of people do not even realize they have it.  Periodontitis is the leading cause of tooth loss in adults living in the developed world, and should be taken very seriously for that reason, however, accumulating research also links periodontal diseases to general health conditions such as cardiovascular disease, stroke, diabetes, respiratory disease, and preterm low birth weight babies.

The main cause of periodontal diseases is bacterial plaque, a sticky, colorless film that constantly forms on your teeth.  However, factors like the following also affect your periodontal health:

  • Smoking/tobacco use
  • Genetics
  • Puberty, pregnancy, and menopause in women
  • Stress
  • Clenching or Grinding Your Teeth
  • Diabetes
  • Poor Nutrition

Symptoms of periodontal disease

Because symptoms may not occur until the disease is advanced, It is possible to have periodontal disease and have no warning signs. This is one of the reasons why regular dental checkups which include periodontal examinations are very important. When warning signs are present, they may include the following:

  • Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
  • Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
  • New spacing between teeth – Caused by bone loss.
  • Persistent bad breath – Caused by bacteria in the mouth.
  • Pus around the teeth and gums – Sign that there is an infection present.
  • Receding gums – Loss of gum around a tooth.
  • Red and puffy gums – Gums should never be red or swollen.
  • Tenderness or Discomfort – Plaque, calculus (tartar), and bacteria irritate the gums and teeth.

Types of periodontal disease treatment

Treatment methods depend upon the type of disease and how far the condition has progressed.  If diagnosed and treated in the early stages, simple nonsurgical periodontal therapy may be sufficient.  If periodontitis has advanced to the point where the periodontal pockets are deep and significant amounts of bone are lost, surgical therapy may be necessary.

Good oral hygiene at home is a vital step to help keep periodontal disease from becoming more serious or recurring. Home care alone, however, is usually insufficient for controlling the bacterial infection below the gum line where your toothbrush, dental floss, and other oral hygiene aides do not reach. Once the bacteria have colonized below the gum line specialized dental instruments are needed for their removal.

There are several different methods for treating periodontal diseases:

Nonsurgical treatments

  • Prophylaxis is a routine dental cleaning performed on patients with normal, healthy mouths to maintain health and prevent the initiation of dental diseases. Traditionally, it has also been utilized for the management of mild gingivitis patients who do not have significant calculus (tartar) built up below the gum line.
  • Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus (tartar) from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. It is considered an active treatment for periodontitis and the results of the therapy should be assessed for success at some point after adequate time for healing has been allowed. Nonsurgical therapy does have its limitations and areas that have not responded favorably to scaling and root planing (continue to show signs of periodontal disease) may require further treatment.  Because of the complex anatomy of the root surfaces below the gum line scaling and root planing is a much more demanding procedure than a prophylaxis. It is often necessary to perform the scaling and root planing treatment over the course of more than one appointment and with the adjunctive usage of local anesthesia so that a thorough job can be performed in a comfortable manner for the patient.
  • Periodontal maintenance is a specialized program developed for each patient once periodontal health has been improved.  It is designed to prevent periodontal disease from recurring in patients who have undergone treatment for periodontitis or dental implant therapy. This ongoing phase of treatment will allows Dr. Wilson and his hygienist to assess your periodontal health and make sure infection stays under control. Periodontal diseases are chronic diseases, just like diabetes.  Without careful, ongoing treatment, periodontal diseases can and often do recur.

 Surgical treatments

  • Laser periodontal therapy is an alternative to traditional periodontal surgical procedures in which a specialized laser fiber is placed into the periodontal pocket to remove diseased tissues and destroy the bacteria that cause periodontal disease.  An FDA approved protocol is followed in an effort to encourage the body to seal the periodontal pocket and provide an environment that may encourage the reattachment of the gum tissues to the roots and, in some cases, the regrowth of bone. 
  • Pocket reduction surgery, (also known as flap surgery or osseous surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums.  The surgery on the jawbone is another option which serves to eliminate or reduce craters in the jawbone, caused by the periodontal disease process, that further foster the colonization of bacteria.  During this process the ability to see and clean the roots of the teeth is greatly enhanced when compared with nonsurgical treatments.
  • Tissue regeneration can be performed when the bone and gum tissues have been destroyed.  The these procedures encourage the regrowth of bone and/or gum tissues using grafting procedures.
  • Dental implants are an alternative when a tooth or teeth have been lost due to periodontal disease.  The esthetics and functionality of the mouth can be restored by implanting prosthetic teeth roots into the jawbone.  Once the bone has bonded to the prosthetic teeth roots, your restorative dentist places a crown to complete the tooth replacement process.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the jawbone.

How can periodontal diseases be prevented?

Good oral hygiene and professional care are the keys to keeping your teeth for a lifetime.  The best way to prevent periodontal diseases and tooth decay is to remove the bacterial plaque by thorough brushing and flossing every day.  Good oral hygiene habits will help keep the formation of dental tartar to a minimum.  Regular dental visits that include a periodontal examination are also important to detect any changes in periodontal health and, if necessary, to remove hardened tartar in places that your toothbrush and floss may have missed.  A professional cleaning (prophylaxis) at least twice a year is recommended for patients with good periodontal health.  If you have had any form of periodontal disease or a high incidence of cavities in the past, you may need professional maintenance more frequently.

Congratulations on taking the first step to achieving periodontal health!  Preventing and/or controlling periodontal disease is a worthwhile commitment that will keep you smiling for life.

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