Treatment of Periodontal Disease

Gingival Grafts and Crown Lengthening

While the main goal of periodontal therapy is to preserve the health of the supporting structures of the teeth, there are several procedures that we perform to enhance dental aesthetics and improve the look of a patient’s smile. For patients presenting with gum recession or a “toothy” smile, gum grafting procedures may be performed to cover the areas of recession. For patients with a “gummy” smile or teeth that appear to be short, crown lengthening procedures are a relatively simple answer to solve this aesthetic problem.

Periodontal Scaling & Root Planing

Periodontal disease is caused by the buildup of plaque and calculus around the gum line and between the teeth. In order to prevent disease, it is imperative to remove these etiologic agents. This will prevent bacterial growth which leads to bone breakdown and advancement of the disease process. The objective of scaling and root planning is to physically remove the plaque and calculus which causes the disease. Scaling and root planning is a non-surgical procedure which is particularly effective in dealing with gingivitis and early stages of periodontitis. If performed effectively at these stages, no further periodontal treatment may be necessary.

What do scaling and root planing treatments involve?

After conducting a thorough examination of the oral tissues and viewing radiographic findings, we may suggest scaling and root planning treatments. Depending on the severity of the disease process and the amount of plaque and calculus, local anesthesia may be used to make the treatment more comfortable.

Scaling involves the removing of debris from the crown and root surfaces. This may be accomplished with the use of a combination of ultrasonic and hand scalers. After all the plaque and calculus are “scaled” away, root planning may be undertaken using hand instruments to smooth the root surfaces of the tooth. Smooth root surfaces help prevent the buildup of the agents which cause periodontal disease.

After scaling and root planning procedures eliminate the causative factors, the remaining pockets may be treated with antibiotics.

Antibiotic Treatment

Periodontal disease is caused by bacterial growth. This bacteria breaks down the periodontal lining of the gum and as the disease progresses, bacteria will begin to break down the supporting tooth structure which surrounds the teeth. One of the most effective ways to kill bacteria is to introduce antibiotics. These antibiotics may be prescribed orally, in pill form, or may be applied locally directly to the areas of the mouth that are periodontally infected.

Over the past several years, direct application of antibiotic into the periodontal pocket has proven to be very effective in halting the disease process if done in combination with other periodontal procedures.

Systemic antibiotics can be prescribed at a low dose for long term periodontal use, or as a short term medication to treat acute periodontal infections.

Oral and Locally Delivered Antibiotics

Several different antibiotics have proven to be useful and particularly effective in the treatment of periodontal disease.

• Tetracycline antibiotics: The tetracycline family of antibiotics, which include tetracycline hydrochloride, doxycycline, and minocycline are generally thought of as the primary drugs used in periodontal treatment.

• Macrolide antibiotics: Known for their effectiveness in reducing gingival inflammation, this family of antibiotic is often used for patients suffering from periodontitis.

• Metronidazole: This antibiotic is generally used in combination with amoxicillin or tetracycline to combat inflammation and bacterial growth in severe or chronic periodontitis.

• Arestin®: This antibiotic, which is delivered right into the gingival sulcus (pocket within the gum) has proven very effective in slowing the disease process and inhibiting bacterial growth.

Periodontal Surgery

Periodontal disease is caused by bacteria which infect the periodontal lining of the gum. If not removed, this bacterial growth will spread and will begin to destroy the bone that supports the teeth. As bone is destroyed by the bacteria that is found on plaque and calculus, pockets form between the teeth and gums. As these pockets become deeper, it is almost impossible to clean the bottom of the pockets using toothbrushing and flossing techniques. If the pockets are not adequately cleaned and debrided, they will continue to deepen and more bone will be destroyed. This destructive cycle will continue and will eventually lead to tooth loss. The goal of all periodontal surgical procedures is to eliminate the pocket and to allow the patient to keep the gums and teeth clean using proper brushing and flossing techniques.

What does pocket reduction surgery involve?

While a surgical procedure, periodontal surgery is generally very well tolerated by patients and in most cases can be performed under local anesthesia.

An incision will be made to allow us to gently pull the gum tissue away from the teeth. All calculus and plaque will be meticulously removed and all root surfaces will be smoothed. Antibiotic may be placed in the surgical site. The gum tissue will then be sutured back into place eliminating the pocket. In many cases a protective packing may be placed to keep the area clean and to facilitate faster healing.

The suture material (stitches) generally will remain in the mouth for 7-10 days.

Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.