Periodontal disease treatment

By Jack Wasserstein, DDS on May 11, 2010 in Periodontal (gum) disease 101
How Is Periodontal Disease Treated

The two main goals of periodontal treatment are the elimination of subgingival plaque and calculus, and to reduce the gum pockets to the 0-3mm range where they are cleansable. If a regenerative procedure is being attempted then an additional goal is to regenerate lost periodontal support around the tooth, primarily the supporting bone.

There is no cure for periodontal disease. However, the process can be arrested with periodontal therapy. Once treated, the gums must be diligently maintained with proper oral hygiene and regular professional teeth cleanings.

There are three phases of periodontal treatment.

  1. Scaling and root planing
  2. Surgical / reconstructive
  3. Maintenance
Scaling and root planing

The first phase is referred to as scaling and root planing. This nonsurgical procedure is typically done 1/4 of the mouth at a time with a local anesthetic to numb the gum and tooth. Hand instruments called currettes are inserted between the gum and toot root. The currette is used to scrape the root surface to remove calculus which is adherred to the root surface like barnacles stuck to a pier. Ultrasonic instruments may also be used which also aid in removing calculus. It will take about an hour for each quarter. This phase of treatment is usually performed by a dental hygienist though it can also be performed by a dentist or Periodontist. Oral hygiene instructionsare reviewed and demonstratedduring this phase of treatment. Scaling and root planing is predictable in treating pockets of 5mm or less.
Beyond 5mm the chances of resolving thepocket to a normal limit decrease dramatically with increasing depth. 6 weeks following scaling and root planing, a periodontal reevaluation is performed to determine the extent of the healing. Once again all of the teeth are probed at 6 points surrounding the tooth and the numbers are recorded on the periodontal chart. If the probing depths have resolved to normal limits, then maintenance therapy is all that is required, otherwise phase two is initiated.

Phase two is the surgical or reconstructive phase. In this phase a gingival flap is reflected back away from the tooth root surface. This exposes the tooth root surfaces as well as the surrounding bone. The root surfaces are visually inspected for residual calculus and cleaned. As the bone erodes from periodontal disease it tends to create a crater or mote like defect which surrounds the tooth. At the time of surgery, this bone may be recon toured to eliminate these bony defects and create a positive bony architecture, i.e. no bony concavities. These concavities tend to promote re-pocketing. This is the resective approach and in my opinion has the most consistent outcomes. The other approach for treating bony defects is to graft them. Bone grafting is done with the expectation that bone graft will regenerate the lost supporting bone. Bone grafting material is placed into the bony defect until the original bony contour is achieved. Occasionally a barrier is placed over the graft to help contain the grafting material as well as prevent gum tissue cells from invading into the graft so that the slower growing bone cells have time to recolinate the graft. The choice whether to regenerate or resect is usually based on the bony topography.

Phase three is the maintenance phase. Once periodontal disease has been arrested it must be kept in check. This is where you can win the battle but lose the war. Periodontal disease is chronic in nature. Even when arrested, plaque continues to develop and coat the tooth surfaces. Thus diligent brushing and flossing combined with regular maintenance visits are mandated to keep the disease under control. A typical cleaning schedule for someone with periodontal or post periodontal disease is every 3 months. Keep in mind that if proper oral hygiene is not maintained plaque build up will result in Gingivitis which can progress to Periodontitis so the whole cycle will repeat itself.

About Jack Wasserstein, DDS

I am a Periodontist in Valencia CA and I have been in private practice in since 1990. I am blessed to be able to say that my work is also my play. I hope to share my insights, with you, that I have cultivated over the last 20 years.
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2 Responses to Periodontal disease treatment

  1. Tiffany Williams January 21, 2012 at 10:09 pm #

    If my son has juvenile onset periodontal disease and his insurance does not cover it. If we have the teeth extracted and implant crowns instead will the periodontal disease continue to spread to other teeth. At this point it is only 2 of his teeth but with the thousands of dollars of expenses associated with periodontal treatment is it a cheaper alternative.

  2. Jack Wasserstein, DDS January 22, 2012 at 9:42 am #

    Hello,

    Juvenile Onset Periodontitis, although rare, is typically localized to the first molars and mandibular anterior teeth. Bacterial culturing is used to confirm the diagnosis as there is a strong correlation between this condition and Actinobacillus actinomycetemcomitans (Aa) (now classified in the Haemophilus family). If diagnosed in the early stages, this condition can be resolved with Tetracycline / Doxycycline antibiotic treatment. However, if left untreated it can result in severe bone loss around those teeth and possible tooth loss.

    Dental implants are the preferred way to replace missing teeth. Most insurance companies do not cover dental implants; greed being the only plausible explanation for that. However, as a general rule, males should not have implants placed till they are 18 years possibly younger depending on where they are in puberty. Females can are usually eligible for dental implants once they begin menstruation. Both of those relate to when the mandible and maxilla have dimensionally matured. In males growth will continue through puberty whereas in females this is usually true at the commencement of menstruation. The above is not certain for every male and female it is just a strong guideline. Other tests can be used such as a hand radiograph.

    I would recommend that you have your son diagnosed by a Periodontist, to determine the diagnosis and prognosis of the involved teeth. If tooth loss is a reality, then dental implants are the preferred method to replace the teeth. Juvenile periodontitis can evolve to a more generalized condition so it should be treated with conventional treatment and antibiotic treatment. Your son’s condition should be managed with 3 to 4 month hygiene recalls alternating between your dentist and periodontist.

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