Periodontal disease, referred to as periodontitis, is a form of gum disease. We explore the different treatment options for periodontal disease.
Periodontal disease usually starts with gingivitis, which simply means gum infection. This is normally caused by a build-up of plaque on the teeth which provides breeding grounds for bacteria. In turn, the toxins from the bacteria lead to gum problems. If left untreated, this condition advances to periodontitis which is where the gum starts to pull away from the teeth, creating pockets that collect yet more bacteria. This starts a vicious cycle whereby gums swell and detach, more plaque forms, and more bacteria grows. The body’s immune response to the toxins – basically taking steps to try and kill the bacteria – leads to further damage. Over time this breaks down the structures supporting the teeth and will affect the cementum (root covering), connective tissue, the periodontal ligament and the alveolar bone. Eventually it can lead to loss of teeth; the pockets increase in size, and the teeth get increasingly loose as a result.
Periodontal disease is believed to be caused primarily by plaque build-up on teeth. This can be because of poor dental hygiene, including infrequent brushing and flossing. There’s also different ways in which the body’s natural defenses can become compromised, leading to gum problems and from there onto periodontal disease. Illnesses such as HIV and cancer alter the body’s immune system, allowing gum disease to take hold. Medications can affect gum health or change saliva production, the body’s natural way of neutralizing bacteria. Also, hormone changes such as menopause can change gum behavior. Lastly, if you have a family history of gum disease, then genetics may mean you are more likely to develop it.
The symptoms of periodontal disease may be practically non-existent and painless. As such, it’s important to be vigilant if you think you could be at risk of developing it. Watch out for bleeding gums, especially when you brush your teeth. This can be more common than you think, and should never be ignored – recent studies by the US National Institute of Research showed that half of US citizens over 30 years old suffer from bleeding gums. Other warning signs include swollen or painful gums, receding gums, a change in the way your teeth feel (such as suddenly feeling looser), and any frequent bad breath or odd taste occurring. If you experience any kind of change in your gums you should consult your dentist to discuss it.
All treatment options for periodontal disease focus on removing bacteria, stabilizing the area and re-attaching gums (and where necessary bones & connective tissue) to where they should be. Steps may also be required to discourage bacteria from being able to form again later on. The selected treatment will depend on how far the disease has progressed. While non-surgical methods will cure many cases of periodontal disease, some more severe cases may require surgery to correct the damage.
This is often the first port of call for periodontal disease treatment. It removes the build-up of plaque and is done by a dentist or a specialized periodontist. The first step is scaling, which literally scrapes off the tartar (calcified or hardened plaque) from above and under the gumline. Root planing then smooths the root surface, removing the bacteria already there and discouraging further bacteria from gathering. Some dentists use a laser to do these procedures, which can be less invasive and more comfortable for the patient, though it’s very important that the correct power and wavelength is used to prevent potential damage.
This may be required depending on how severe the periodontal disease is. Flap surgery involves the gums being lifted back to allow for the tartar to be removed fro underneath them. Stitches will be used to secure the gums back in place and prevent pockets from forming again. This procedure is required when there are deep pockets to be cleaned, or the dentist wants to reduce the size of existing pockets; it can be performed by a dentist or a specialized periodontist. Afterward, it is much easier to keep the whole area clean and free from gum disease.
If the disease has progressed so far as to significantly damage the supporting structures of the teeth, then bone and tissue grafts may be used as well as flap surgery. These are designed to regenerate the affected area and may use natural or artificial materials to achieve this. The tissue is normally taken from the roof of the mouth: a soft tissue graft strengthens thin gums and can cover receding gums. It may also be needed to cover any exposed tooth root areas. Gum grafts have the additional advantage of improving the appearance of receding gums. Bone grafts are needed where bone has been destroyed by the gum disease, and can be artificial, taken elsewhere from the patient, or donated.
Guided Tissue Regeneration
This procedure is advised when bone has been destroyed to a moderate extent, and can be an alternative to a bone graft. It uses mesh to fill the gap between gum and bone, which allows bone and connective tissue to grow in its place rather than gum; more bone means more stability for the tooth. This treatment option is normally done in conjunction with flap surgery. Tissue engineering is a new method that speeds up the natural bone and tissue regrowth process.
If bone loss is severe, then bone surgery may be needed. The bone is shaped so that the surface is smoother, preventing bacteria from forming again. This procedure is more invasive than other treatment options and is usually only required when the periodontal disease has progressed to an advanced stage.
Antibiotics may be used to destroy the problem-causing bacteria. These also work to suppress the body’s immune response, which unfortunately can accelerate the destruction of the supportive tissue. Brands include Peridex, PerioChip, and PerioGard. These all contain the antibiotic chlorhexidine, though other antibiotics such as minocycline and doxycycline may also be used.
Statins, normally used for lowering blood cholesterol, have also been demonstrated in clinical tests to stimulate bone growth. These may act as a useful supplement to both surgical and non-surgical treatment options for periodontal disease.
Gum disease is almost always reversible if it is caught in time. Likewise, it can be prevented if appropriate steps are taken – meaning treatment options for periodontal disease are bypassed altogether! The best way to avoid gum disease in the first place is to brush and floss your teeth regularly. Don’t smoke, and make sure you have a well-balanced and varied diet with all the essential vitamins and minerals – particularly vitamins E and C. Visit a dentist every 6 months or at a minimum once a year. If gum disease strikes, professional plaque removal every 6 months may help, as can an antibacterial mouthwash used twice daily.
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