What are periodontal diseases?
Periodontal diseases are infections in the structures around the teeth, but not in the actual teeth themselves. These structures include the:
- alveolar bone
- periodontal ligament
It can progress from gingivitis, which is the first stage of periodontal disease and only affects the gums, to the other structures.
Periodontal diseases are caused most often by a combination of bacteria and dental plaque. Symptoms may include:
- bleeding gums
- swollen gums
- persistent bad breath
- painful chewing
- suddenly sensitive teeth
- loose teeth
- gum recession
Gum disease should be treated as soon as possible because it’s linked to increased risk factors for conditions like:
Phases of treatment
When treating periodontal disease, there will be three phases of treatment that your dentist will take you through. These include:
Phase I: The etiological phase
Treatment in this phase will focus on controlling the infection and restoring the healthy microbiota that should be there. Your dentist will also take a look at what they think is causing the periodontal disease so they can address the root of the problem.
During this phase, you’ll be educated about what you have to do for home care, which will include taking care of your overall health. You will also be required to stop smoking and to maintain excellent oral hygiene.
Procedures called “scaling” and “root planing” will also happen during this stage, where the dentist will clean your teeth deeply and remove plaque and calculus. Medications may also be prescribed.
Phase II: The surgical phase
If the more conservative treatments weren’t effective, treatments will move into the surgical phase. This will likely happen if the pockets of infection or plaque and tartar are too deep to clean. This phase will be assessed somewhere between four and eight weeks after the initial treatment.
Surgery could include leveling shallow bone defects or using regenerative surgical techniques for deep bone defects. The goal of these surgeries is to remove the pockets of space between the teeth and the bone that can be broken down or destroyed with periodontal disease. This, in turn, will eliminate the room for bacteria, plaque, and tartar to fester.
Surgery can be done under general anesthesia and many people don’t feel pain after the surgery. Most will miss only one day of work.
Phase III: The maintenance phase
The maintenance phase focuses entirely on preventing the periodontal disease from returning. Without careful maintenance, there’s a high recurrence rate.
Your dentist will carefully detail the oral hygiene practices you need to follow, including brushing your teeth properly and flossing daily. Clean your teeth carefully, making sure not to miss any of the hard-to-reach spots, and use mouthwash to help kill off any leftover bacteria. You’ll see your dentist for a three-month follow-up instead of waiting six months to make sure everything is in good working order.
Some individuals may also enter a restorative phase if extensive surgery was needed. Implants or prosthetics may be inserted if teeth were extracted or if a large amount of tissue or bone had to be removed. Orthodontic treatment can also help align your teeth properly, making them easier to care for.
Treatment options for periodontal disease
The exact treatments that your dentist or surgeon will choose depends on the severity of the periodontal disease.
Your dentist will first start with nonsurgical treatments.
Deep cleaning, which involves scaling and root planning, will likely be one of the first treatments your dentist uses. It’s not as invasive as surgery, and it’s often effective in treating minor cases of periodontal disease. During this process, they will scrape off all the tartar from above and below the gum line, along with rough spots on the tooth. This helps remove bacteria that contribute to the gum disease while also getting rid of areas where the bacteria may gather.
Deep cleaning may cost between $140 and $300, depending on your location and your dentist. Your insurance may or may not cover it. You may experience some bleeding, but you should be able to resume normal eating and drinking later that day.
Your doctor may also prescribe medications, including either systemic antibiotics that you’ll take orally or local antibiotics in gel form that you’ll apply topically. They are often not enough on their own to treat periodontal disease but they can help make scaling and root planing more effective.
Other medications your dentist may prescribe include:
- prescription antimicrobial mouth rinse
- antiseptic chip, which is a tiny piece of gelatin that contains medication
- enzyme suppressant, which contains a low dose of doxycycline to keep destructive enzymes from flourishing
Surgical pocket reduction
Surgical pocket reductions will help clean out tartar in deep pockets and eliminate or reduce those pockets. This will make the area easier to clean and prevent infections from developing in the future. This may be called “flap surgery.”
During this procedure, your dentist will clean the pocket carefully, removing tartar deposits after lifting up the gums to clean underneath them. The gums will then be sutured to fit more tightly around the tooth.
This procedure typically costs between $1000 and $3000 without insurance.
After surgery, you may experience swelling for about 24 to 48 hours. You’ll likely be prescribed antibiotics. Maintain a diet of liquid or soft foods for at least two weeks.
Bone and tissue grafts
If your periodontal disease has caused a loss of bone or gum tissue, your dentist may recommend bone or tissue grafts in addition to surgical pocket reduction. This will help regenerate bone or tissue lost.
During bone grafting, your dentist will place natural or synthetic bone in the area of the loss, which can help promote bone growth.
Your dentist may use guided tissue regeneration. During this procedure, a mesh-like material is inserted between the bone and gum tissue to prevent the gum from growing where the bone should be and allowing it to regrow properly.
During gum grafting, they’ll use a soft tissue graft. This graft may be either a synthetic material or tissue taken from another area of your mouth. It will be placed to cover exposed tooth roots.
A single procedure for bone or tissue grafts can cost around $600 to $1200.
During aftercare, don’t use straws. Eat soft or liquid foods for six to eight weeks, depending on your dentist’s recommendations.
What is the outlook for periodontal disease?
Periodontal disease can increase your risk for conditions like stroke, heart disease, diabetes, and respiratory diseases. Untreated, it can also result in tooth extraction. It’s exceptionally important to treat it. If you start early, it can even save you from needing more invasive treatments in the long run.
Periodontal therapies and treatments are often exceptionally effective, and as long as you follow the instructions your dentist provides you during the maintenance stage, your risk of recurrence is low. This includes careful oral hygiene and no use of any tobacco products.