Healthy gum tissue fits snugly around each tooth. In periodontitis the gum tissue stretches out and forms pockets. Plaque and food debris can collect in these pockets. The bacteria in the plaque multiply, grow below the gumline and produce bacterial toxins. With the disease progression, the pockets deepen and more gum tissue and bone are destroyed, and eventually tooth loss occurs.
The aim of periodontal treatment is to
- Control any infection that is present in the gums and the surrounding bone and connective tissue that hold the teeth in place, and
- Halt the progression of disease.
- Treatment options include;
- Home care: Such as healthy eating, proper brushing and flossing,
- Non-surgical therapy: Treatment and medications (antibiotics) to controls the growth of harmful bacteria and,
- Surgery: For people with more advanced disease to restore supportive tissues.
- Most people with mild periodontitis can be managed with home care and noninvasive therapies.
- If you have pockets between your gums and your teeth that are 5 mm or less in depth, you dentist may recommend scaling and root planing (SRP) alone or along with antibiotic therapy.
- Scaling removes plaque and tartar from above and below the gumline. Scaling is done using instruments or an ultrasonic device.
- Root planing smoothens irregularities on the roots of the teeth making it more difficult for plaque and germs to deposit that cause gum disease. The smooth, clean surface aids the gums to reattach to the teeth.
- Your dentist may prescribe antibiotics or other medications to help control bacterial infection along with SRP.
- Doxycycline hyclate an approved drug is often used in combination with SRP. SRP helps to remove the bacteria and doxycycline hyclate suppresses collagenase. This enzyme causes destruction of the teeth and gums.
- Oral or local antibiotics may be prescribed as required. Antibiotics that are approved as sustained-release doses to be applied into the periodontal pocket are doxycycline hyclate, chlorhexidine gluconate and minocycline.
- Your dentist may recommend chlorhexidine containing mouth rinse to help control plaque and gingivitis. At times antibiotic gels, fibers or chips may be applied in the infected pocket.
If you have more advanced periodontitis — the depth of the pockets between your gums and teeth is more than 5 mm — your dentist may recommend surgical treatments.
Surgical options include
Flap surgery: The gum is lifted to remove tartar. After this the gum is again sewn back in place so that it fits closely around the tooth. This removes the pocket and areas where bacteria multiply.
Bone grafts: The bone destroyed by periodontitis is replaced. The grafted bone forms the platform for the regrowth of bone, which gives stability to teeth.
Soft tissue grafts: Tissue is grafted in areas where gum is thin or places where gums have receded. Tissue for graft is often taken from the roof of the mouth.
Guided tissue regeneration: This procedure helps bone destroyed by bacteria to regrow. A special piece of biocompatible fabric is placed between the bone and your tooth. It prevents unwanted tissue from entering the treated area, and helps the bone to grow back. A newer technique involves application of a gel that has proteins found in tooth enamel to the diseased tooth root. This makes the body think that a new tooth is being formed, and it stimulates the growth of healthy bone and tissue.