Periodontal Treatment

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal
literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional dental treatment and good oral home care.

Periodontitis

If left untreated, gingivitis can lead to periodontitis. In time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque then irritate the gums. The toxins stimulate a chronic inflammatory response in which the body turns on itself and the tissues and bone that support the teeth are breakdown and are destroyed. The Gums then separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, teeth can become loose and may have to be removed.

TREATMENT

Periodontal scaling

Periodontal scaling procedures "include the removal of plaque, calculus and stain from the crown and root surfaces of teeth. Root planing is a specialized skill involving scaling of the root of the tooth, made up of cementum. Because cementum is softer than enamel, it is affected more by ongoing build-up and inflammatory byproducts. A smooth cementum provides less opportunity for bacteria to hang out and form calculus, so root planing is an important part of stopping periodontal disease where it is at, and preventing periodontal disease from getting worse, specifically once deeper pockets have formed in the gums, which is really in the bone. So, root planing is a specific treatment that removes the roughened cementum and surface dentin that is impregnated with calculus, microorganisms and their toxins."[2]

Because in periodontal disease pockets form that are deeper than the usual gingival depth, such scaling and root planing are often referred to as deep cleaning or SRP, and may be performed using a number of dental tools, including ultrasonic instruments and hand instruments, such as periodontal scalers and curettes.

Scaling and root planing or deep cleaning is considered the basic treatment of periodontal diseases and may be the only treatment required to treat mild cases of periodontitis; however, it may also be the initial therapy prior to future surgical needs. For the procedure to be considered effective, the patient must be able to be maintained at a level of periodontal health that will prevent re-infection with periodontal pathogens. This requires optimal home care and ongoing maintenance therapy at more frequent intervals to sustain health. The dentist may also suggest a rotary tooth brush, more frequent flossing, and a change in diet.

Medications

Medications may be used with treatment that includes scaling and root planing. Long-term studies will be needed to determine whether using medications reduces the need for surgery and whether they are effective over a long period of time. Here are some medications that are currently used: