Treatment

According to the American Academy of Periodontology, treatment for periodontal disease should focus on achieving oral health in the least invasive and most cost-effective manner. Your dentist or periodontist will usually begin with a non-surgical approach (scaling and root planning) and then reevaluate your condition in follow-up visits. If infection or deep periodontal pockets remain, surgical treatment may be recommended. Periodontal treatment approaches can basically be categorized as:

Nonsurgical Approaches . Scaling and root planning (deep cleaning of tartar and bacteria from gum line and tooth root surfaces), which may include the use of topical or systemic antibiotics. Surgical Approaches . Periodontal surgical techniques include flap surgery (periodontal pocket reduction), bone grafts, and guided tissue regeneration. Restorative Procedures . Crown lengthening is an example of a restorative procedure that may be performed for cosmetic reasons or to improve function. For patients who have already lost teeth to advanced periodontitis, dental implants are another option.

In addition to treatment in a dentist office, regular dental visits and cleanings (usually every 3 months) are important for maintenance as is practicing good oral hygiene at home (see Prevention section of this report).

Non-Surgical Treatment
Scaling and Root Planing . Scaling and root planning is a deep cleaning to remove bacterial plaque and calculus (tartar). It is the cornerstone of periodontal disease treatment and the first procedure a dentist will use. Scaling involves scraping tartar from above and below the gum line. Root planning smoothes the root surfaces of the teeth. The dentist may apply a topical anesthetic to numb the area before beginning the procedure. Both ultrasonic and manual instruments are used to remove calculus. The ultrasonic device vibrates at a high frequency and helps loosen and remove tartar. A high-pressure water spray is then used to flush out the debris. The dentist will use manual instruments called scrapers and curettes to scrape away any remaining plaque or calculus and smooth and clean the tooth crown and root surfaces. Finally, the dentist will polish the tooth using abrasive paste applied to a vibrating instrument with a rubber cap. Polishing produces a smooth surface, making it temporarily harder for plaque to adhere. Antibiotics . At the time of scaling and root planning, your dentist may recommend the use of antibiotic medications. Because of the risk of developing antibiotic-resistant infections, antibiotics are recommended only when necessary (for example, in cases of severe active infection). Antibiotics for periodontal disease come in various forms. They may be taken as a prescription mouthwash rinse, or placed topically as dissolving gels, threads, or microchips into the periodontal pockets. In some cases, the dentist may prescribe a short course of systemic antibiotics in a low-dose of doxycyline taken in pill form.

Surgical Treatment
Flap Surgery (Periodontal Pocket Reduction). Surgery allows access for deep cleaning of the root surface, removal of diseased tissue, and repositioning and shaping of the bones, gum, and tissues supporting the teeth. The basic procedure is known as flap surgery: It is performed under local anesthesia and involves:

The periodontist makes an incision and folds back the gum surface away from the tooth and surrounding bone. The diseased root surfaces are cleaned and curetted (scraped) to remove deposits. Gum tissue is sewn back into a position to minimize pocket depth. The gum is covered with gauze to soak up any blood. The periodontist may also contour the remaining bone or attempt to regenerate lost bone and gingival attachment through bone grafts or guided tissue regeneration.

For several days following surgery, patients should rinse their mouths with warm salt water to help reduce swelling. Gauze pads should be changed. Post-surgical discomfort is usually treated with over-the-counter medications such as ibuprofen or the application of ice packs. Bone Grafting . In some cases of severe bone loss, the surgeon may attempt to encourage regrowth and restoration of bone tissue that has been lost through the disease process. This involves bone grafting:

The surgeon places bone graft material into the defect. The material may come from the patient (autogenous), from a cadaver (allograft), or from an animal such as a cow (xenograft). An autogenous graft is considered the best approach. The gum is then sewn back into place. During the next 6 9 months, the bone regrows in the jaw area helping to reattach the teeth to the jaw.

Guided Tissue Regeneration. Guided tissue regeneration is a more advanced technique that may be used along with bone grafting:

A specialized piece of fabric called a barrier membrane is is placed between the gum and the existing bone. The gum is then sewn over the fabric. The fabric prevents the gum tissue from growing down into the bone and allows the bone and the attachment to the root to regenerate.

Restorative and Cosmetic Treatments

Crown Lengthening . Crown lengthening is a surgical procedure performed to expose more of the tooth. It involves readjusting the gum and bone levels by removing small sections of bone and resewing the gums into a new position to allow more tooth exposure.

Dental Implants . For patients who have lost teeth to periodontal disease, dental implants are an option, although an expensive one. Dental implants are an artificial type of tooth root used to create permanent prosthetic teeth. Implants are screws placed into the jawbone. Prosthetic teeth are attached to the implant.