The main objective of treatment is to control the infection. Depending on the extent and severity of the gum disease, treatment can vary in number of visits and types of treatment. In order to achieve the best outcome for any type of treatment, good daily home care is required. Modifying certain lifestyle factors such as quitting smoking may also be recommended as part of the treatment.
Deep cleaning (Scaling and root debridement/ initial phase cause related therapy)
In order to effectively remove plaque and calculus below the gum line the teeth are scaled and the root surfaces cleaned to remove plaque and calculus. This is often done under local anaesthetic. Occasionally teeth may become sensitive to cold substances following this treatment but with good plaque control, this is usually a temporary phenomenon. The gums will also tighten up around the necks of the teeth which may result in recession of the gums making the teeth appear longer. Triangular spaces may also appear up between the teeth as the inflammation and swelling of the gums resolve.
Occasionally, your periodontist may reccomend medications in conjunction with treatment. Such medications include prescription antimicrobial mouth rinses, antimicrobial gels, oral antibiotics and others. These medications generally serve to control the bacteria present.
Sometimes, periodontal surgery (or gum flaps) may be needed in areas that have not responded to treatment. The number of surgical visits required will be determined by your periodontist after assessing the individual response to treatment.
- Flap Surgery
If inflammation and deep pockets remain following initial phase cause-related therapy, flap surgery may be recommended to provide better access to remove deposits in inaccessible deep pockets, or to reduce the periodontal pocket with the goal of making it easier for the patient, periodontist, dentist, and hygienist to keep the area clean. After surgery the gums will heal and residual inflammation will subside. This sometimes results in the teeth appearing longer.
- Bone and Tissue Grafts
Your periodontist may suggest procedures to regenerate bone or gum tissue lost in certain areas where the bone loss pattern is conducive for regeneration. Bone grafting is where natural or synthetic bone is used to provide a scaffold for promoting bone growth. Growth factors (proteins which encourage regeneration) may also be used in conjunction with surgical treatment. In some cases where gum tissue has been lost and tooth roots are exposed, soft tissue grafts may be recommended where tissue is taken from another area of the mouth and grafted onto the exposed roots. Results of treatment vary depending on multiple factors including the severity of disease, local site anatomy factors, the ability of the patient to maintain excellent plaque control, and presence of other risk factors such as smoking. Every case is unique and different and your periodontist will make recommendations based on your particular case.
As gum disease is a chronic disease, long-term supportive maintenance is necessary to prevent disease recurrence and progression. Much like other chronic diseases (e.g. diabetes or high blood pressure), on-going and continuous monitoring is required to determine the best management strategy to control your gum disease. The frequency of supportive maintenance visits is dependent on multiple factors. Your periodontist will determine the most appropriate interval for you. There is individual variation of responses to treatment, and any lifestyle and health factors which can affect the immune system can potentially also affect gum disease. Occasionally re-treatment may be required should there be a recurrence or progression of disease. Maintaining excellent plaque control and having healthy gums is the best defence to reduce the chances of losing teeth.