Diagnosis and Treatment of Periodontal Disease
Overview
Periodontal disease can be easily detected during regular dental examinations. A periodontal charting should be performed for all teeth. A periodontal probe, with ruled millimeter markings, is used to measure the depth of the space between the teeth and gums. Ideally, normal measurements range between 1 and 3 millimeters. Depths greater than this may signify the presence of periodontal pockets and associated gum disease. X-rays should be taken to see if bone damage has occurred as a result of the disease process.
Treatment of Periodontal Disease
The main goal of periodontal treatment is eradication of the disease process from the gums, ligaments and bones that surround the teeth, and restoration of health that can be predictably maintained in the future.
Non-Surgical Treatment
Initial treatment involves educating patients in the proper methods of effective, daily plaque removal and oral hygiene. This is a critical component of successful therapy.
Scaling and root planing are performed to clean the tooth structure and remove bacterial plaque and calculus deposits (the source of the infection) from the gum pockets. This may be the only treatment necessary in cases of gingivitis and very mild periodontitis. Ultrasonic instruments are often used to help clean the teeth.
Dental lasers may also be used to detoxify the diseased gum tissue and help promote healing, including re-attachment of the gums to the teeth. Laser gum treatment is a noninvasive, painless procedure that can treat a wide range of gum conditions with advanced laser technology. The laser is aimed directly at the targeted area without cutting any gum tissue and seals the area as it treats. Stitches are not necessary, and there is a minimal risk of infection or bleeding with this conservative treatment. More about dental lasers.
Surgical Treatment
In cases which demonstrate deeper gum pockets and underlying bone loss, it becomes necessary to eliminate the diseased gum pockets and bony destruction with osseous (bone) surgery. The gum is "flapped" and retracted away from the teeth to expose the underlying roots and bone deformities. The bone is contoured to approximate a normal physiologic profile, and the gum is sutured back to place. When the gum heals, normal probing depth is re-established between the gum and tooth (ideally 1-3mm). The attainment of minimal probing depth facilitates easy removal of plaque by patients at home and by hygienists during professional cleaning.
Additional treatment modalities may be necessary to treat periodontal disease and restore health.
These may include:
• Bone grafts for bone regeneration
• Gum grafts to treat gum recession and pathological root exposure
• Cosmetic plastic surgery of the gums to improve appearance
• Fabrication of night guards for bruxism ( tooth grinding )
• Splinting or bonding teeth together for increased strength and stability
• Orthodontics (braces) to straighten and realign teeth
• Removal of diseased roots on some types of molars
• Use of medications such as antibiotics, fluoride and antimicrobial rinses
