Treatment methods depend upon the type of disease and how far the condition has progressed. The first step is typically a thorough cleaning that may include scaling to remove plaque and calculus (tartar) beneath the gum line. The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.
Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases antibiotics may be placed in the periodontal pockets after scaling and planing, in order to control infection and to encourage normal healing.
When deep pockets between teeth and gums are present, it is difficult to thoroughly remove plaque and calculus. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.
Scaling & Root Planing
Scaling and root planing are the first line of defense against periodontitis. These procedures entail a careful cleaning of the crown and the root surfaces under the gums to remove bacteria, toxins, and calculus that have built up in the pocket. In order to maximize patient comfort, a local anesthetic is used. Sedation can also be utilized to help alleviate apprehension.
Periodontal Maintenance
Once a healthy environment has been established with the appropriate periodontal treatment, the most important phase of periodontal therapy begins with long term maintenance. The frequency of periodontal maintenance and cleanings is determined by the patient’s susceptibility to the disease. Most commonly these sessions are scheduled every two to four months, alternating between the general dentist and the periodontist.
Periodontal Pocket Reduction Procedure
The objective of this surgical procedure is to reduce the depth of existing pockets to a level that can be kept clean of bacteria with normal brushing and flossing. In addition, with reduced pocket depth the periodontal maintenance cleanings can be more effective.
Flap and Osseous Surgery
In the case of more advanced disease, bacteria and the associated inflammation can lead to changes in the shape of the bone around teeth. The normal contour of the bone must be reestablished in order to eliminate the pockets. The gum tissue is gently separated from the bone, making a “flap.” This provides better access to deeper areas of plaque and calculus, and makes it possible to reshape the bone, reducing areas where bacteria can grow. This procedure does not regenerate bone that has previously been lost.
Flap and Osseous Surgery
Periodontal Regeneration Procedure
These advanced techniques help restore the bone that has been lost to periodontal disease. While they can be effective alone, in some situations these procedures are used in combination with other procedures.
Guided Tissue Regeneration
This technique uses a “membrane” or barrier to block unwanted tissue from growing into the bone, and allows bone and ligament fibers to regenerate. The goal of this procedure is to regrow bone and improve soft tissue attachment to the tooth.
Guided Tissue Regeneration
Bone Grafting
Bone replacement materials are used to fill in bone defects and serve as a scaffold for regrowth of your own bone. Grafted bone can be taken from your own mouth, from a synthetic source, or from a tissue bank.
Bone Graft
Tissue Engineering (GEM-21 or Emdogain)
Tissue engineering is the most progressive concept, in which growth factors are utilized in regenerative surgeryeither in conjunction with a grafting material or alone. Commercially manufactured products that contain growth factors approved for regrowth of bone and attachment of soft tissue to the tooth include Emdogain and Gem-21.
Oral Pathology
The goal of oral pathology is to identify changes in the mouth that cause or are caused by a disease. These changes can be detected on the lips, cheeks, palate, gums, tongue, face and neck; and can be warning signs for disease, most seriously oral cancer. Some warning signs to look for are red patched, white patched, lumpy or thickened tissue, chronic sore throat or hoarseness, and difficulty chewing or swallowing.
