Periodontal Treatment Explained

Periodontal treatment is specialist cleaning of the gums to disrupt dental plaque which causes gum and periodontal diseases. Being told you need periodontics treatment can be a shock and you may wonder what treatment involves.

Treatment of periodontal disease is essential to control periodontitis and halt the destruction of bone and ligaments. It also prevents gum recession.

In brief, periodontal treatment involves daily performed self-care at home in combination with advanced surgical and non-surgical gum health treatments.   

This post aims to explain what treatments are available for periodontal disease and what they entail.

The Goal of Treatment

Periodontal treatment aims to control and reduce the amount of plaque above and below the gum line. This stops the inflammatory response that destroys the bone and soft tissues that hold the teeth in place. 

What Does Periodontal Treatment Involve?

There are a variety of periodontal treatments available including surgical and non-surgical options. Treatment can vary from a simple approach requiring one or two visits, to more complex and prolonged care. 

Diagnose & Treat Acute Issues

To create a treatment plan, a dentist will

• Review your Medical History – This will determine any factors that may be contributing to your periodontal disease. For example smoking, diabetes and some underlying health conditions and medications are known risk factors for periodontal disease

• Check the health of your gums and teeth – your mouth will be examined to look for the build-up of plaque and tartar and see if your gums bleed when light pressure is applied

• Determine Pocket depth – the dentist will measure the depth of the gap between the gums and the teeth. In health, the pocket is between 1 and 3mm. Pockets that are greater than 4mm could indicate periodontal disease.

• Check for bone loss – the destruction of the bone holding teeth in place is a typical compilation of periodontal disease. The dentist will use X-rays or 3D scans to determine the degree of bone loss if any. 

• Look for and treat acute issues – if you have any infection, abscesses, excessive bleeding or pain the dentist will treat this first. 

• Split teeth – you have any loose wobbly teeth the dentist may split (join) them to more secure teeth in your mouth.

Non-Surgical Treatment of Periodontal Disease

Non-surgical approaches aim to disrupt the sticky film of plaque above and below the gum line.

Self Care Treatments

Poor oral hygiene results in the build-up of bacteria that leads to periodontal disease. The dentist will give you personalised advice on how to disrupt the plaque each day at home. Advice on brushing techniques and interdental cleaning using a gum pocket brush, floss or interdental brushes will be given. 

Lifestyles Choices

The dentist may also suggest that you

• stop smoking
• control blood sugars
• eat a healthy, nutrient-rich diet
• reduce the amount and frequency you consume refined sugars

Scaling & Root Surface Debridement

This is a professional gum hygiene treatment consisting of two elements. 

• ‘Scaling’ refers to the professional treatment that removes tartar and disrupts plaque above the gumline. 
• ‘Root debridement’, sometimes referred to as root planing or a deep clean to remove tartar and disrupt the bacteria and toxins within deep gum pockets 

Hand instruments such as curettes or ultrasonic cleaners are used to break up large chunks of tartar (calculus). They also remove plaque and stains from the surfaces of teeth.

Make Cleaning Easier

If you have poorly fitted or bulky crowns the dentist may suggest that these are removed or modified. This will ensure you can effectively perform daily self-care treatments. 

They may also suggest tooth realignment if you have wonky, crooked teeth at some stage during the treatment. Mouthguards may be recommended if you grind or clench your teeth overnight. 

Anti-microbial therapy and antibiotics

In a very small number of cases, mouth rinses containing fluoride, cetylpyridinium chloride or chlorhexidine or antibiotics may be prescribed. This will be a short-term measure to help reduce bacteria. 

How Long Will This Treatment Take

After scale and root debridement, the gums will be given time to heal and recover.  You will be asked to return in a few weeks to determine if your gums have healed. Healthy gums are pink in colour (sometimes slightly darker depending on the amount of melatonin in your skin) and have a firm texture.

The exact number of treatments and length of time given for recovery will depend on your individual case.  

If the gums do not heal following non-surgical approaches and in more complex cases, surgical treatments may be required.

Surgical Treatments

Surgical treatments allow the dentist to access the tooth roots below the gumline. 

Flap Surgery (Pocket Reduction)

To access the tooth roots and soft tissues below the gum line dentist create a flap in the gums. They lift the gum away from the tooth roots. This allows the

• effective removal of tartar and plaque from the tooth roots
• elimination of periodontal pockets (deep spaces between the teeth and the gums) by repositioning the gum tissue
• recontour jagged areas of bone caused by bone resorption
• perform bone or tissue grafts and guided tissue regeneration

Treatment may be done in stages, for example, the top and bottom jaws may be treated during separate appointments. Time is left between surgeries to allow for the gums to heal. 

LANAP

Laser-assisted new attachment procedure is a new treatment for periodontal disease which employs a laser to treat and remove tissue damaged by plaque bacteria. It also stimulates the growth of new tissue.

The tiny laser contained within a fibre optic cable is inserted under the gum. Short pulses of light are directed at the tissue. When the light touches infected tissue, heat is generated and the damaged tissue is destroyed.

The procedure is less invasive than the flap surgery above but is not available in all locations. The success of the technique is still being evaluated by dentists around the world.

Additional Treatments

Depending on the severity of your periodontal disease you may have experienced tooth loss, bone loss, ligament damage and gum recession. 

• Replace Lost Teeth – Dental implants in some cases are a viable option to replace lost or wobbly teeth however sufficient bone and gum tissue are required. The treatments indicated below may be needed before implants can be fitted.

• Restore Lost Bone – If you have experienced significant bone destruction or require dental implants bone grafts or guided tissue regeneration may be performed.

• Replace Lost Gum Tissue – As bone is destroyed by disease the gums recede exposing tooth roots. The tissue can be replaced with soft tissue grafts or tissue-stimulating proteins.  

Maintenance Treatment

Once periodontal disease has been treated and disease progression halted regular dental visits will be advised. This will allow quick detection and treatment of any emerging problems. Good oral hygiene to maintain plaque levels and keep periodontal disease at bay is also required. 

In Summary

Periodontal disease is a common complaint in the western world. Treatment plans depend on the extent and stage of the disease. Treatment aims to remove tartar and disrupt plaque. This stops irritation by the bacteria, bacterial products and the body’s inflammatory response.  

Once treatment has successfully stopped the progression of the periodontal disease daily performed self-care treatments are essential. Good oral hygiene with twice-daily brushing and careful cleaning between the interdental spaces is necessary. Using the correct technique is vital.