Treatment of periodontal disease varies with the type and severity of the disease. Periodontal disease caused by plaque, gingivitis and periodontis, make up the majority of periodontal diseases. Gingivitis is the more mild form of the disease and is reversible, Gingivitis may occur without progressing to periodontitis but periodontitis, the irreversible form of the disease, is always preceeded by gingivitis.
With gingivitis the gum tissue becomes swollen, inflammed, and bleeds during flossing and brushing. Deep pockets (up to 4 millimeters deep) form around teeth but no loss of bone occurs.
Treatment for gingivitis
Treatment for gingivitis invloves removing the irritants (plaque and calculus) from surfaces above and under the gumline. This is done by a professional teeth cleaning procedure. Once irritants are removed by scaling and debridement plaque accumulation must be avoided by regular flossing, brushing and rinsing at home.
Treatment for periodontal disease
Treatment for periodontal disease is more involved because the disease has spread from the gum tissue to bone and supporting structures of the teeth. Deeper pockets (greater than 4 millimeters) form around the teeth and the attachment of the gums to the teeth fail. This causes the gums to pull away from the teeth and the tooth roots become exposed. Spaces between the teeth and roots appear and food becomes caught between them more easily. Because these places are more difficult to clean calculus (tartar) attaches to the teeth more readily, exacerbating the problem.
Initial treatment for mild to moderate periodontal disease usually involves:
- Scaling and root planning – Removal of bacteria laden plaque and calculus from the tooth and root surfaces in addition to the periodontal pockets. Also, smoothing the root surfaces to make it harder for calculus to adhere to the roots.
- Medicating the gingiva, periodontal pockets and root surfaces to help control the growth of bacteria and mediate sensitivity caused by the newly exposed root surfaces
- Instructing you in approriate home care techniques, especially in how to remove plaque from difficult to reach places, and how to apply medication to the areas being treated at home if needed.
- Periodic professional periodontal maintenance visits after scaling and root planing is complete. Your maintenance interval will be determined upon re-evaluation 4-6 weeks after scaling and root planing is completed.
Failure to continue with maintenance after initial therapy will allow the condition to recur and worsen. Periodontal disease can not be cured, it can ony be controlled. The success of your treatment depends largely upon your follow-up in home care and professional care.
Initial treatment for advanced periodontal disease
Initial treatment for advanced periodontal disease, in addition to the above, involves consultation with a periodontist (specialist in the treatment of diseases involving the supporting structures for the teeth). Surgery may also be necessary to reduce the depth of gingival pockets, add bone and/or tissue to various areas, and provide solutions to other problems presented by the disease. Tooth extraction may also be necessary to stop spread of the disease.
Subsequent treatment for both gingivitis and periodontal disease depends upon your response to intitial treatment.
As always, the best treatment is prevention.
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