Diagnoses

Periodontitis

Common treatment options

Current treatments for periodontal disease are considered "non-specific". This means they are not generally targeted at any particular species of periodontal bacteria. The majority of periodontal treatment consists of mechanically eliminating as many bacteria as possible from the affected periodontal pockets, and thoroughly cleaning the tooth surfaces to eliminate calculus, pits, ledges and other root surface irregularities in which bacteria tend to thrive. This non-specific protocol continues to be practiced because it is currently the most effective way available to treat the illness.

Research demonstrates that current periodontal therapy is successful at decreasing inflammation, and improving vascular health—both locally and systemically. There is significant variability in the success of treatment, because of the lack of certainty about specific causative factors, contributing factors, and host-defense factors. The most important factors in assuring long-term success with periodontal treatment are the patient's understanding about the significance of their illness, their motivation to prevent its progression and their own oral hygiene efforts to control the disease.

Depending on the severity of the periodontal disease when diagnosed, treatment options may be surgical or non-surgical. Non-surgical periodontal treatments include scaling & root planing to remove bacterial plaques and calculus, and establish smooth root cementum which is less conducive to bacterial colony formation; localized antibiotic administration, to help eliminate bacteria or their destructive acids and enzymes from sites which continue to be inflamed; and periodontal splinting, to stabilize loose teeth which have lost a significant amount of bone. When periodontal disease is under control, it is usually necessary to undergo regular periodontal maintenance to prevent progression of the disease.

Surgical periodontal treatment may involve open flap curettage ("debridement"), in which the gums are surgically elevated off of the underlying bone to allow access for specialized cleaning instruments. Unhealthy bone may be removed as part of that procedure, and the gums may be re-positioned to allow the patient and dental professionals better access for cleaning the teeth (known as apical positioning of the gums). For areas of localized periodontal disease, Guided Tissue Regeneration (GTR) may be performed. This generally involves surgical removal of diseased tissue, and placement of bone and/or soft tissue grafts in the affected area.

If the gums recede as a result of periodontal disease (or following treatment for it), the dentist may recommend applying topical fluoride gel to the exposed tooth roots, to reduce the chance of developing decay. Exposed tooth roots lack the benefit of a dense enamel covering. Topical fluoride can be applied in the dental office, by the patient at home, or both, depending on the patient's risk factors for getting gumline cavities. Exposed tooth roots can also be sensitive—especially to temperature changes and sweets. Desensitizing medications can be applied to sensitive teeth, and the dentist may recommend using sensitivity formula toothpaste until symptoms improve.