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Gum diseases are treated in a variety of ways depending on the stage of
disease, how you may have responded to earlier treatments, and your overall
health. Options range from nonsurgical therapies that control bacterial growth
to surgery to restore supportive tissues.
Non-surgical treatments include:
- Professional dental cleaning: During a typical checkup, your
dentist or dental hygienist will remove the plaque and tartar (plaque that
builds up and hardens on the tooth surface and can only be removed with
professional cleaning) from above and below the gum line of all your teeth.
If you have some signs of gum disease, your dentist may recommend more than
twice-a-year cleanings.
- Scaling and root planing: This is a deep-cleaning, nonsurgical
procedure, done under a local anesthetic, in which plaque and tartar from
above and below the gum line are scraped away (scaling) and rough spots on
the tooth root are made smooth (planing). Smoothing the rough spots removes
bacteria and provides a clean surface for the gums to reattach to the teeth.
Scaling and root planing is done if your dentist or periodontist determines
that you have plaque and calculus (hardened plaque, also called tartar)
under the gums that needs to be removed.
Surgical treatments include:
- Flap surgery/pocket reduction surgery:
Involves lifting back the gums
and removing the tartar. In some cases, irregular surfaces of the damaged
bone are smoothed to limit areas where disease-causing bacteria can hide.
The gums are then placed so that the tissue fits snugly around the tooth.
This method reduces the size of the space between the gum and tooth, thereby
decreasing the areas where harmful bacteria grow and decreasing the chance
of serious health problems associated with periodontal disease.
Bone grafts: Involves using fragments of your own bone, synthetic
bone, or donated bone to replace bone destroyed by periodontal disease. The
grafts serve as a platform for the regrowth of bone, which restores
stability to teeth. New technology, called tissue engineering, encourages
your own body to regenerate bone and tissue at an accelerated rate.
Soft tissue grafts: Reinforces thin gums or fills in places where
gums have receded. Grafted tissue, most often taken from the roof of the
mouth, is stitched in place, adding tissue to the affected area.
Guided tissue regeneration: Performed in combination with flap
surgery, when the bone supporting your teeth has been destroyed, this
procedure stimulates bone and gum tissue growth. A small piece of mesh-like
fabric is inserted between the bone and gum tissue. This keeps the gum
tissue from growing into the area where the bone should be, allowing the
bone and connective tissue to regrow to better support the teeth.
Bone surgery: Smoothes shallow craters in the bone caused by moderate
and advanced bone loss. Following flap surgery, the bone around the tooth is
reshaped to decrease the craters. This makes it harder for bacteria to
collect and grow.
In some patients, the nonsurgical procedure of scaling and root planing is
all that is needed to treat gum diseases. Surgery is needed when the tissue
around your teeth is unhealthy and cannot be repaired with nonsurgical options.
Medications used to treat gum disease
Antibiotic treatments can be used either in combination with surgery and
other therapies, or alone, to reduce or temporarily eliminate the bacteria
associated with periodontal disease or suppress the destruction of the tooth’s
attachment to the bone.
Chlorhexidine (marketed as the prescription-only brands Peridex, PerioChip,
PerioGard and by numerous other over-the-counter trade names) is an
antimicrobial used to control plaque and gingivitis in the mouth or in
periodontal pockets. The medication is available as a mouth rinse or as a
gelatin-filled chip that is placed in pockets after root planing and releases
the medication slowly over about 7 days. Other antibiotics, including
doxycycline, tetracycline, and minocycline, may also be used to treat gum
disease, as determined by your dentist.
In addition, a nonprescription toothpaste that contains fluoride and an
antibiotic to reduce plaque and gingivitis, called triclosan, is often
recommended.
Are special preparations required prior to treatment?
Your dentist or periodontist is able to perform most procedures in his or
her office. The time needed to perform the procedure, your degree of discomfort,
and time needed to heal will depend on the type
and extent of the procedure and your overall health. Local anesthesia to numb
the treatment area may be given before some treatments. If necessary, a
medication may be given to help you relax.
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