Periodontal Disease and Treatment
Periodontal disease is an infection caused by the accumulation of bacterial deposits – plaque and calculus (‘tartar’) – on the tooth surface. Initially this causes gingivitis, a reversible change in the superficial gum tissue. However in susceptible individuals the infection can progress down the root of the tooth and cause periodontitis, a destruction of the attachment of the gum to the tooth and the underlying bone. Unfortunately periodontal destruction is irreversible, but the infection itself can be treated effectively and the disease halted.
Non-Surgical Periodontal Treatment
Where in past years it may have been necessary to consider periodontal surgery to treat your gum disease effectively, we can now use less invasive measures in many cases to achieve the same result. The treatment is called subgingival debridement, a process where the roots of the teeth are cleaned as thoroughly as possible to allow the gums to heal.
Subgingival debridement is usually undertaken with local analgesia (injections to numb the area being treated) and can therefore be completed with minimal discomfort. However for anxious patients sedation is available. In mild cases the treatment may be completed without injections.
It is normal to experience some discomfort for a few days following your treatment. Pain relief such as aspirin, paracetamol or similar medication is usually adequate to control the discomfort.
The aims of treatment are to eliminate the infection, resolve the gum inflammation and to reduce the depth of pockets underneath the gums. As the tissues heal following treatment, there will be a degree of gum recession, the extent of which will depend on the severity of the gum disease. Two consequences of this gum recession are that teeth will look longer, with more space developing between the teeth and the gum margin, and that teeth may become more sensitive to hot/cold/sweet sensations. The recession is a result of the damage caused by the gum disease and unfortunately it cannot be reversed easily. The sensitivity will usually settle on its own, but may require the application of desensitizing varnishes or the use of a desensitizing toothpaste.
It is more difficult to treat deeper pockets, especially at the back teeth, so the result of treatment at these sites is less predictable. If healing is incomplete, the treatment can be repeated at that site or other options may be considered such as periodontal surgery.
When periodontal disease is advanced, where there are factors which complicate the disease or where the disease has not responded well to non-surgical debridement, it may be necessary to consider surgery to achieve good healing. Periodontal surgery is undertaken to allow the area to be viewed directly and to provide good access for removal of the accumulated plaque and calculus, allowing the gums to heal.
Surgery is usually undertaken with local analgesia (injections to numb the area being treated) and can therefore be completed with minimal discomfort. However for anxious patients, sedation is available. After surgery there will usually be stitches in place to hold the tissues together for good healing and dressings may be used to protect the area. It is important that the area of surgery is not disturbed during healing – some changes in diet may be necessary and use of a mouthwash rather than normal tooth-brushing routines is essential during the immediate period following surgery. Any dressing and sutures are usually removed one week after surgery at a brief postoperative visit.
There will be some discomfort for some days following surgery and advice on appropriate pain relief will be given. Most patients find that they are able to return to their normal routine with minimal disruption after surgery.
Gum recession and sensitivity will follow surgical treatment. Please see above section on non-surgical treatment.
Periodontal disease is caused by bacteria which are normally resident in the mouth. A cure for the disease is not possible as the bacteria cannot be eradicated completely from the mouth. Treatment can halt the disease and result in healthy tissues which will be easier to maintain in a healthy state. Some risk factors which increase individual susceptibility to periodontal disease can be reduced or eliminated, but others, such as family history of disease, cannot be changed.
What can you do to maximise the success of periodontal treatment?
- Maintain a high standard of daily oral hygiene including the use of a soft toothbrush or electric toothbrush. You should brush your teeth at least twice daily, for a minimum of two minutes, together with the use of appropriate cleaning between your teeth with dental floss or interdental brushes as recommended.
- Smoking is a major risk factor for developing periodontal disease as it affects the blood supply to the gums and other supporting tissues of the teeth. The outward signs of gum disease, such as redness or bleeding, are often not seen in smokers. Smoking also impacts healing and the outcome of periodontal treatment is less predictable in smokers compared with non-smokers. As such, smokers should consider reducing their cigarette consumption, or stopping altogether. This will benefit not only oral and periodontal health, but many aspects of general health.
- Returning as recommended (usually after three months) for a reassessment of the healing following treatment and planning of your future periodontal care. Regular assessment of your periodontal tissues and thorough maintenance scaling (usually at intervals of 3-6 months) will help you maintain healthy gums once the initial phase of treatment is complete. Commitment to such a programme of supportive periodontal care is essential if treatment is to yield long-term benefits and this will improve the long-term prognosis of your teeth. In many cases it will be important for at least some of this care to be undertaken in our practice, but continued care with your general dentist for your other oral health needs is critical.
For further information refer to: www.perio.org