What are the treatment options for periodontitis?

The main aim of the periodontist, dentist or dental hygienist, when treating periodontitis, is to clean out bacteria from the pockets around the teeth and prevent further destruction of bone and tissue.

For best treatment results, the patient must maintain good oral hygiene and care. This involves brushing teeth at least twice a day and flossing once per day. If there is enough space
Read more ...
between the teeth, an interdental brush (Proxi-brush) is recommended. Soft-picks can be used when the space between the teeth is smaller. Patients with arthritis, and others with dexterity problems may find that using an electric toothbrush is better for a thorough clean.

It is important that the patient understands that periodontitis is a chronic (long-term) inflammatory disease - this means oral hygiene must be maintained for life. This will also involve regular visits to a dentist or dental hygienist.

Initial treatment

It is important to remove plaque and calculus (tartar) to restore periodontal health.

The healthcare professional will use clean (non-surgically) below the gumline. This procedure is called scaling and debridement. Sometimes an ultrasonic device may be used. In the past Root Planing was used (the cemental layer was removed, as well as calculus).

Medications

• Prescription antimicrobial mouthrinse - for example chlorhexidine. It controls bacteria when treating gum disease, as well as after surgery. Patients use it like they would a regular mouthwash.
• Antiseptic "chip" - this is a small piece of gelatin which is filled with chlorhexidine. It controls bacteria and reduces periodontal pocket size. This medication is placed in the pockets after root planing. The medication is slowly resealed over time.
• Antibiotic gel - a gel that contains doxycycline, an antibiotic. This medication controls bacteria and shrinks periodontal pockets. It is placed in the pockets after scaling and root planing. It is a slow-release medication.
• Antibiotic microspheres - miniscule particles containing minocycline, an antibiotic. Also used to control bacteria and reduce periodontal pocket size. They are placed into pockets after scaling and root planing. A slow-release medication.
• Enzyme suppressant - keeps destructive enzymes in check with a low-dose of doxycycline. Some enzymes can break down gum tissue, this medication holds back the body's enzyme response. Taken orally as a pill, and is used with scaling and root planing.
• Oral antibiotics - either in capsule or tablet form and are taken orally. They are used short-term for the treatment of acute or locally persistent periodontal infection.

Advanced periodontitis

If good oral hygiene and non-surgical treatments are not enough, the following surgical interventions may be required:

• Flap surgery - the healthcare professional performs flap surgery to remove calculus in deep pockets, or to reduce the pocket so that keeping it clean is easier. The gums are lifted back and the tarter is removed. The gums are then sutured back into place so they fit closely to the tooth. After surgery, the gums will heal and high tightly around the tooth. In some cases the teeth may eventually seem longer than they used to.
• Bone and tissue grafts - this procedure helps regenerate bone or gum tissue that has been destroyed. With bone grafting, new natural or synthetic bone is placed where bone was lost, promoting bone growth.
  
  In a procedure called guided tissue regeneration, a small piece of mesh-like material is inseted between the gum tissue and bone. This stops the gum from growing into bone space, giving the bone and connective tissue a chance to regrow.
  
  The dentist may also use special proteins (growth factors) that help the body regrow bone naturally.
  
  The dental professional may suggest a soft tissue graft - tissue taken from another part of the mouth, or synthetic material is used to cover exposed tooth roots.

Experts say it is not possible to predict how successful these procedures are - each case is different. Treatment results also depend on how advanced the disease is, how well the patient adheres to a good oral hygiene program, as well as other factors, such as smoking status.

What are the complications of periodontitis?

The most common complication from periodontitis is the loss of teeth. However, patients with periodontitis are also at a higher risk of having respiratory problems, stroke, coronary artery disease, and low birth weight babies.

Pregnant women with bacterial infections that cause moderate-to-severe periodontal disease have a higher risk of having a premature baby.

Periodontitis can make it harder for patients with diabetes to control blood sugar.

Written by Christian Nordqvist