Periodontal (Gum) Disease Treatment
What is periodontal (gum) disease?
Bacteria in plaque cause periodontal (gum) disease. If allowed to stay on the teeth, plaque can cause your gums to become red and swollen. This is called gingivitis.
In some cases, the disease will progress to a more severe form of gum disease known as periodontitis. This is where the gum next to the plaque peels away from the tooth, forming a “pocket”. The bone beneath this pocket is eaten away and lost permanently.
Unlike gingivitis, periodontitis is not reversible, and if allowed to progress, more and more bone loss will occur. This bone supports your teeth, so this destructive process can result in loosening of the teeth and eventually even their loss.
1. Inflamed Gum 2. Plaque & Calculus 3. Pocket 4. Bone Loss
Do I have gum disease?
The extent of periodontitis can vary from person to person, and its rate of destruction can vary within that individual. In some cases, the individual is free from any symptoms, but in those that do, the most common symptoms are the following:
Red, swollen gums
Tender gums, which are prone to bleeding
Spontaneously bleeding gums. For instance, blood may be noticed on the pillow.
Loose teeth
Receding gums, resulting in the apparent lengthening of teeth.
Drifting teeth, possibly leading to a change in which the teeth meet when biting together.
Bad taste
Persistent bad breath
Sensitive teeth.
What are the benefits of treatment?
Improved health of your mouth
No bleeding when you brush your teeth
Fresh breath
Food that tastes better
Healthier gums, reducing the risk of tooth loss
Gums that are resistant to further recession
There is also evidence that controlling periodontitis can help improve the blood sugar levels in diabetics.
Treatment
As the cause of all gingivitis and periodontitis is plaque, meticulous cleaning is essential for its control. It is essential that you see your hygienist very regularly; I will decide on the precise frequency of visits following the assessment and review appointment.
Gingivitis:
In the case of gingivitis, treatment consists of professional dental cleaning and plaque control advice; without the patient achieving an adequate level of daily cleaning, gingivitis will return.
Periodontitis:
As periodontitis is also caused by plaque, the deposits need to be removed, often under local anaesthesia, with specially adapted scalers – we refer to this as ‘deep scaling/cleaning’. However the patient must adopt an excellent standard of daily cleaning, including between their teeth, before the clinician should consider cleaning the tooth surface below the gum line; plaque will otherwise re-form at the gum line and, without thorough cleaning, the bacterial deposits to spread along the tooth again, reaching the tooth surface within the pocket (i.e. below the gum line) and starting the whole process again. In addition, regular hygienist visits for routine cleaning are essential in periodontally susceptible patients, and this, along with an excellent daily standard of plaque control, needs to be a lifetime commitment.
Non-surgical treatment: deep scaling
For patients with periodontitis, the plaque and tartar below the gum line (within the pockets) also need to be removed. Since it is not possible to remove these deposits deep within the pockets with a toothbrush, professional care is necessary for their removal (either from a hygienist or periodontist, depending on the complexity of the case).
Deep scaling involves scraping the plaque and tartar off the roots of the teeth using hand and ultrasonic scalers. This often requires numbing the gums with an injection to ensure painless treatment.
Surgical treatment: flap surgery
This procedure may be necessary if deep pockets remain after deep scaling has been performed.
Flap surgery involves lifting the gums away from the teeth to remove the deposits and sometimes reshaping the gums to reduce the depth of the pocket. The flap of gum is then repositioned against the teeth and stitched together.
Although gum and bone destruction caused by periodontitis is permanent, stabilising the condition can help prolong the life of teeth, often indefinitely, if the disease is caught early enough.
More information
Is it guaranteed that periodontitis can be stabilised completely?
Unfortunately, although your periodontitis is very likely to improve with professional treatment, the degree of improvement varies from person to person. This response will depend on several factors, including your plaque control, whether you smoke and your genetic susceptibility.
Once it has been controlled, will periodontitis ever return?
Unfortunately, this is a condition which can recur. It is therefore essential that you are carefully monitored and that you see your hygienist regularly for routine scaling appointments.
If I am under the care of a Periodontist, should I stop seeing my general dentist and hygienist?
Not. Your general dentist still needs to routinely check your teeth. In addition, once an active course of treatment has been completed by your periodontist, you must see your hygienist or general dentist for regular scaling visits, if we are to achieve long-term success.
It is important to remember that treatment of your gum disease involves teamwork, requiring your dentist, periodontist, hygienist, and you coming on board. However, you are the most important team member, and we need your long-term commitment and motivation, both in daily cleaning and attending regular visits for professional cleaning and monitoring, if we are to achieve a successful outcome.
If teeth fall out or need to be removed due to the extent of tissue destruction, the spaces can be restored if the patient so wishes. The treatment options are a denture, a bridge (if the teeth supporting the bridge are strong and healthy enough) and dental implants; a thorough assessment is required to establish which restorative treatment options are appropriate. Please note that the placement of dental implants should only be carried out once the periodontal condition of the whole mouth is stable. Without gum health around all remaining teeth, there will be an increased risk of developing the equivalent of periodontitis around the dental implants and increase the risk of failure around them.
Our specialist periodontist with over twenty years’ experience treating gum disease. She has built up an excellent reputation with both dentists and their patients in Sussex, where she has worked for many years.
She is well known for her caring and sensitive approach with periodontal patients and also for the outstanding results she achieves with her treatment.
“My periodontist, Sarah, could not have been more considerate, professional and talented. Sarah and her staff made sure I was comfortable and sufficiently numb. They understood the procedures and were very encouraging, as good progress was made on restoring my gums to good health and saving those teeth Sarah had identified as at risk.”