Periodontal Disease – Part 3

Follow your dentist's recommended schedule for regular checkups. If you notice any symptoms of periodontitis, make an appointment with your dentist as soon as possible.

Here's some information to help you get ready for your appointment and know what to expect from your dentist. Your dentist may ask you questions about your symptoms, such as:

• When did you first start experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How often do you brush your teeth?
• Do you use dental floss? How often?
• Do you see a dentist regularly?
• What medical conditions do you have?
• What medications do you take?
• Do you use tobacco products?

Depending on the extent of your periodontitis, your dentist may refer you to a specialist in the treatment of periodontal disease (periodontist).

Diagnosis of periodontitis is generally simple. Diagnosis is based on your description of symptoms and an exam of your mouth. Your dentist will look for plaque and tartar buildup and check for easy bleeding. To determine how severe your periodontitis is, your dentist may:

• Use a dental instrument to measure the pocket depth of the groove between your gums and your teeth. Your dentist or a dental hygienist inserts a metal probe beside your tooth beneath your gum line, usually at several sites throughout your mouth. In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters (mm). Pockets deeper than 5 mm may indicate periodontitis.
• Take dental X-rays to check for bone loss in areas where your dentist observes deeper pocket depths.

If periodontitis isn't advanced, treatment may involve less invasive procedures, including:

• Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments or an ultrasonic device.
• Root planing. Root planing smoothes the root surfaces, discouraging further buildup of tartar and bacterial endotoxin.
• Antibiotics. Your periodontist or dentist may recommend using topical or oral antibiotics to help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary completely to eliminate infection-causing bacteria.

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, periodontitis treatment may require dental surgery, such as:

• Flap surgery (pocket reduction surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. After you heal, it's easier to clean these areas and maintain healthy gum tissue.
• Soft tissue grafts. When you lose gum tissue to periodontal disease, your gum line recedes. You may need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots, and give your teeth a more pleasing appearance.
• Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
• Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
• Enamel matrix derivative application. Another technique involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.

Try these measures to reduce or prevent periodontitis:

• Get regular professional dental cleanings, on a schedule recommended by your dentist.
• Use a soft toothbrush and replace it at least every three to four months.
• Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.
• Brush your teeth twice a day or, better yet, after every meal or snack.
• Floss daily.
• Use a mouth rinse to help reduce plaque between your teeth.
• Supplement brushing and flossing with an interdental cleaner, such as a dental pick, interdental brush or dental stick specially designed to clean between your teeth.

Care of your teeth is important!