Treatment
Your gum tissue should fit snugly around each tooth, much as a turtleneck sweater fits around your neck. But when periodontitis destroys supporting bone and tissue, your gum tissue stretches out, allowing bacteria-filled pockets to form around your teeth. Over time, these pockets become progressively deeper and more infected, leading to further tissue and bone loss. The goal of treatment for periodontitis is to thoroughly clean these pockets of bacteria and to prevent more damage.
Many people with periodontitis can be successfully treated with noninvasive therapies. If you have pockets between your gums and your teeth that are 5 mm or less in depth, you may be a good candidate for scaling and root planing, sometimes in conjunction with antibiotic therapy. If you consistently practice good oral hygiene at home, this may be the only treatment you need.
Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments or an ultrasonic device.
Root planing smoothes the root surfaces, discouraging further accumulation of tartar. In addition to these procedures, your periodontist may prescribe antibiotics or other medications to help control bacterial infection. Recent advances in topical antibiotic treatment may reduce the need for systemic medications that, in addition to the potential for side effects, increase the likelihood of antibiotic-resistant bacteria.
Some dentists, for example, recommend antibiotic mouth rinses. Others may insert threads and gels containing antibiotics into the space between your teeth and gums or into pockets after deep cleaning. Although more research is needed, these products appear to lower bacteria levels and may help prevent future problems.
Sometimes, though, you may have more advanced periodontitis - the depth of the pockets between your gums and teeth is more than 5 mm - and your gum tissue may not respond as well to nonsurgical treatments. In that case, your options may include:
- Flap surgery (pocket reduction surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia. Patients are often given sedatives to help ease anxiety prior to this procedure.
- Soft tissue grafts. When you lose gum tissue to periodontal disease or other pathologic processes, your gumline recedes, making your teeth appear longer than normal. Replacing the damaged tissue - which is usually accomplished by removing a small amount of tissue from your palate and attaching it to the affected site serves several purposes: It strengthens the gum to help reduce further gum recession; it covers exposed roots, protecting them from decay and making them less sensitive to heat and cold; and it gives your teeth a more cosmetically pleasing appearance. We now commonly use tissue from tissue banks (donor tissues) to accomplish the same goals. Using donor tissue prevents the need for taking tissue from your palate and allows the procedure to be much more comfortable.
- Bone grafting. This procedure is performed when disease has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone or the bone may be synthetic or donated. Not only does the graft help prevent tooth loss by holding your tooth in place, it serves as a platform for the regrowth of natural bone. In that case, it's usually performed in conjunction with a technique called guided tissue regeneration.
- Guided tissue regeneration. This allows bone destroyed by bacteria to regrow. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead. Another cutting-edge technique involves the application to a diseased tooth root of a gel that contains the same proteins found in tooth enamel. This fools your body into thinking a new tooth is being formed, stimulating the growth of healthy bone and tissue.