PERIODONTAL DISEASE

Periodontal disease is caused by bacteria in dental plaque. Plaque is the sticky substance that forms on your teeth soon after you have brushed. In an effort to get rid of the bacteria, the cells of your immune system release substances that inflame and damage the gums, periodontal ligament or alveolar bone.

This leads to swollen, bleeding gums, a sign of gingivitis (the earliest stage of periodontal disease). Damage from periodontal disease can also cause loose teeth. This is a sign of severe periodontitis (the advanced stage of disease).

Symptoms of gum disease include:

  • Bad breath that won’t go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Receding gums or longer appearing teeth

Any of these symptoms may be a sign of a serious problem, which should be checked by a dentist.

DIAGNOSIS

The dentist or hygienist should:

  • Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.
  • Examine your gums and note any signs of inflammation.
  • Use a tiny ruler called a “probe” to check for and measure any pockets. It is usually painless. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters.

The dentist or hygienist may also:

  • Take an x-ray to see whether there is any bone loss.
  • Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.

 

TREATMENT & MEDICATION

Control the infection is the main goal of treatment. The number and types of treatment varies depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. Certain behaviors, such as quitting smoking, may also improve treatment outcome.

Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.

Medications

Medications may be used with treatment that includes scaling and root planning. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time.

Some medications that can help are:

  • Prescription antimicrobial mouthrinse – it controls bacteria when treating gingivitis and after gum surgery
  • Antiseptic chip – A tiny piece of gelatin filled with the medicine chlorhexidine that control bacteria and reduce the size of periodontal pockets
  • Antibiotic gel – A gel that contains the antibiotic doxycycline
  • Antibiotic microspheres – Tiny, round particles that contain the antibiotic minocycline
  • Enzyme suppressant – A low dose of the medication doxycycline that keeps destructive enzymes in check
  • Oral antibiotics – Antibiotic tablets or capsules for the short term treatment of an acute or locally persistent periodontal infection.

Surgical Treatments

Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform the following:

  • Flap Surgery. It remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.
  • Bone and Tissue Grafts. This procedures helps to regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss to promote bone growth.

Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success.

You should think about getting a second opinion when considering any extensive dental or medical treatment options.

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