Gum disease or Periodontal disease is a progressive inflammatory disease of the gingival and the surrounding tissue (bone) around the teeth. Periodontal disease is the number one cause of tooth loss after the age of 30 and it is believed that around 80% of the population above the age of 30 may suffer from this disease, with varying degrees of severity.

Best Candidates for Gum Treatment

There are many forms and stages of periodontal disease. Anyone experiencing symptoms of these diseases should receive a check-up to diagnose the proper treatment plan for their dental case.

Gingivitis

The first stage of periodontal disease, gingivitis, is the mild inflammation of the gingival caused by plaque build up. Your gingival will be red, swollen, and tender. You may also notice bleeding while you brush and floss. This stage of periodontitis is reversible.

Mild Periodontitis

Inflammation will spread to the supporting alveolar bone. Minor bone loss and the formation of periodontal pockets, or food traps, may occur.

Moderate Periodontitis

In this stage, there will be increased gingival recession, moderate to deep pockets, moderate to severe bone loss, and mobility of teeth due to the bone loss.

Severe Periodontitis

This is the most serious stage of periodontitis. Deep pockets, increased mobility of teeth, movement of teeth out of position, and visible fistulas (boils) will be present in this stage. Pus may develop; bone loss continues, and your teeth may loosen or fall out.

Preparing for Gum Therapy

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 vary from patient to patient depending 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.

Gum Disease Treatment Overview

Following are some of the procedures that periodontists use to treat patients diagnosed with a periodontal (gum) disease. A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire.

Non-Surgical Treatments

AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis.

Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Periodontal Surgery

If you're diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment.

Following are the four types of surgical treatments most commonly prescribed:

• Pocket Reduction Procedures
• Regenerative Procedures
• Crown Lengthening
• Soft Tissue Grafts

Flap Surgery/Pocket Reduction Surgery

During this procedure the gums are lifted back and the tarter is removed. 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 can 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 gum 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

This procedure 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 when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, 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 due to 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.

Lasers in Periodontal Therapy

Limited research suggests that the use of lasers as an adjunct to scaling and root planing (SRP) may improve the effectiveness of this procedure. In addition, when the lasers are used properly during periodontal therapy there can be less bleeding, swelling and discomfort to the patient during surgery. However, each laser has different wavelengths and power levels that can be used safely during different periodontal procedures. Damage to periodontal tissues can result if an inappropriate wavelength and/or power level is used during a periodontal procedure.

Dental Implants

If you've already lost a tooth to periodontal disease or other reasons, you may be interested in dental implants—the permanent tooth replacement option.

• More About Dental Implants

Cosmetic Procedures

In addition to procedures to treat periodontal disease, many periodontists also perform cosmetic procedures to enhance your smile. Oftentimes, patients who pursue cosmetic procedures notice improved function as well. Cosmetic procedures include:

• Crown Lengthening
• Soft Tissue Grafts
• Ridge Augmentation

Tray Delivery Devices

Recently, questions have been raised in regards to a tray delivery device that is marketed for the treatment of gum disease. The Academy has developed a fact sheet that aims to set forth some facts regarding this product.

Drugs 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 gum 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.