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Treatment of periodontal disease

There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone.  The treatment methods for periodontal disease depend on the type and severity of the disease. A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Non-Surgical Treatment

1. Dental Cleaning- Prophylaxis

lower teeth before and after dental cleaning

If the disease is caught in the early stages of gingivitis, one to two regular cleanings will be recommended. The cleanings may be performed with either hand instruments (that will scrape off plaque or calculus) or ultrasonic tips (that uses water and vibrations that also scrape off plaque or calculus). This type of cleaning does not extend below your gum line, therefore it is superficial, not requiring anesthesia. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings. These measures can help prevent further damage to your gums and teeth.

2. Scaling & Root Planning

If the disease has progressed to more advanced stages of periodontal disease, a deep cleaning will be recommended. Your dentist, hygienist, or periodontist will refer to this cleaning as an “SRP,” which stands for SCALING AND ROOT PLANNING. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planning). Similar to Gingivitis treatment, hand instruments and ultrasonic tips are both used to scrape off the plaque and calculus and to smooth your teeth surfaces. Unlike a normal cleaning, this type of cleaning extends beyond your gum line, thus requiring local anesthesia for your comfort.

scaling and root planning

3. Periodontal Maintenance

This type of cleaning must be maintained every 3 months (4 times a year) with a cleaning called “PERIODONTAL MAINTENANCE.”  A periodontal maintenance cleaning is another name for a normal cleaning but termed differently to let your treating dentist or periodontist know that a deep cleaning was performed.

Your gums will be reevaluated four to six weeks after a deep cleaning. If improvement is seen, then Periodontal Maintenance cleanings (another name for a “normal cleaning” after having done deep cleanings) will be recommended. It only takes twenty-four hours for plaque that is not removed from your teeth to turn into calculus (tartar)!  Daily home cleaning helps control plaque and tartar formation, but those hard-to-reach areas will always need special attention. Additionally, medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

****However, if at the yearly exam, your gum disease has progressed or remains persistent, another round of deep cleanings may be recommended. Sometimes, surgical intervention may be recommended by your gum specialist if after deep cleanings, your gums show little to no improvement. This may happen if your pocket depths are very deep.

Surgical Treatment Options

  1. Pocket elimination surgery Surgical intervention is the next treatment option after having attempted deep cleanings with no success. The name of this surgery is called Osseous Surgery. This procedure consists of removing highly inflamed/diseased gum tissue as well as smoothing out of the bone that surrounds the tooth or teeth that have deep pockets and bone loss. After this procedure, deep pocket depths including inflammation and bleeding will be reduced or eliminated. Just like deep cleanings, Periodontal Maintenance Cleanings every 3 months will be advised after the surgery. Consistent reevaluation of your gums will be advised. As with any cleaning or surgery, patient compliance with cleanings and proper home oral care is critical to maintain the continued health of your gums.

  2. Bone graft via tissue regeneration – When the bone and gum tissues have been destroyed, regrowth of the bone can be actively encouraged and attempted using bone grafting procedures.  A membrane may be inserted into the affected areas to assist in the regeneration process of the bone.

  3. Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.

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