Treatment of chronic periodontitis is highly successful in keeping teeth and improving both comfort and confidence. Non-surgical therapy is the foundation of periodontal care and this can also be successful when the disease is thought to be unresponsive or refractory.
Effective self-care oral hygiene is the main key to success and we can help by equipping patients with skills and building their motivation and confidence to achieve this. In addition, meticulous instrumentation of the root surface (deep scaling/ Non-Surgical Periodontal therapy) will lead to substantial improvements in periodontal (gum) health.
Specialist surgical treatments for gum disease are also sometimes required following non-surgical treatment for areas that have not responded well to initial treatment. Sometimes bone grafts and special gels can be placed under the gums as part of the surgical procedure to help regenerate lost bone around the teeth.
Non- Surgical Periodontal Therapy
Non-Surgical periodontal therapy involves deep cleaning of the tooth roots under the gums to flush out the bacteria that are causing destruction of the bone around the teeth. Your mouth is numbed prior to the deep cleaning so it is not sore. Another essential part of the treatment is working with you to improve the efficiency of your home tooth and gum cleaning regime. Often patient’s cleaning between their teeth is the area requiring most improvement in order for them to control their gum disease.
Benefits of Treatment
Treating gum disease with periodontal therapy can help you save your teeth from being lost. Successful periodontal therapy reduces the inflammation in the gums and bone which can reduce the destruction of bone from around the teeth. Treating periodontal diseases may also contribute to general health by reducing the risk of diabetes and cardiovascular disease which can give rise to illnesses such as Heart Attacks and Strokes. Other benefits such as a reduction in bleeding from the gums, fresher breath and more confidence in chewing can also be noted by patients.
What if I decide against taking up treatment?
If no further gum disease treatment is sought, there is a high risk of further bone loss around the teeth. This eventually leads to teeth becoming loose, possibly abscessing with pus leaking from the gums and teeth either falling out of the mouth or requiring extraction due to pain or infection.
Risks of Treatment
The side-effects of gum disease treatment include the risk of gum shrinkage, giving longer looking teeth. Following treatment, when the gums heal and tighten against the teeth, part of the root of the tooth can be visible above the gums and some patients notice that food collects between the teeth more. Where crowns have been placed on teeth in the past, the root below the crown can become visible above the gum line after healing of the gums.
About half of patients treated will experience some increase in tooth sensitivity for one to three weeks after the deep cleaning (for example sensitivity to cold drinks). We will help you reduce the risk of tooth sensitivity and help you manage this. Teeth can feel more wobbly immediately after the treatment, but usually firm up after the healing period. Some mild pain, swelling or bruised feeling can be noted in the gums after the cleaning and it is usually advised to take some painkillers like you might for a headache (such as Paracetamol) for a few days as required.
Will further treatment be necessary?
Sometimes a non-surgical approach to treatment will not fully address the gum disease in certain areas of the mouth. This is more commonly a problem with back teeth. Sometimes specialist gum surgery can be useful in gaining control of gum disease affecting certain areas of the mouth where a non-surgical approach has not worked so well. Sometimes using surgery, bone grafts or special gels which stimulate your own body’s repair mechanisms can be placed to help to regenerate lost bone in carefully selected areas of the mouth.
Once active therapy is complete, there will be a need for long-term ongoing supportive periodontal maintenance care. This means professional help from your hygienist and general dentist to make sure your home cleaning remains excellent. It also means on a three to four monthly basis the teeth and gums are professionally cleaned to lower the risk of relapse of the disease. You cannot be cured of gum disease, but the disease can be stabilised.
Episodes of further disease activity causing destruction of bone around the teeth can occur in sporadic bursts of activity in patients who have previously stabilised their gum disease. This is why it is essential to have the regular long term “supportive periodontal therapy” monitoring and preventative care with the hygienist/ general dentist to recognise further disease activity early and arrange further active treatment.
A standard course of initial non-surgical periodontal therapy involves:
Stage 1: Recording a full mouth chart or map of your exact gum status (6 points around each tooth) to give a baseline record of your exact level of gum health, allowing treatment progress to be assessed later. Radiographs (X-rays) are taken to help to show the degree of bone-loss around the teeth.
Stage 2: Helping you to improve your home tooth cleaning regime by showing you where the plaque (bacteria and their sticky proteins that cause gum and bone inflammation) is building up in your mouth and how best to remove it.
Stage 3: Deep-cleaning/scaling of the tooth roots under the gum line. The teeth and gums are numbed so it is comfortable for you. The deep scaling will flush the bacteria out from under the gum line and your improved home cleaning regime should stop them rapidly reforming on the root surfaces under the gum line. This cleaner state of the tooth roots should allow the gums to heal and re-attach back onto the tooth roots over the following 8-12 weeks after the deep cleaning.
Stage 4: A full mouth gum chart re-evaluation is performed 8-12 weeks following the deep cleaning. In addition, oral hygiene is re-evaluated. This allows your response to the deep cleaning to be assessed and further treatment or maintenance care to be discussed with you and planned.
While you are undergoing treatment of your gum disease, you should continue your routine/emergency care to take care of your overall oral health.