Periodontal Treatment


What is Gum Disease?

Gum disease is a very common condition that affects more than half of adults with natural teeth. It can be treated by a dentist and in the early stages the effects can be reversed. Early treatment is essential since later on the effects can only be stabilised. 
There are three main types of gum disease: gingivitis, periodontitis and acute necrotising ulcerative gingivitis (ANUG).
Gum disease is triggered when plaque is left to build up around teeth, hardening into tartar (calculus) and causing the gums to become inflamed. You are more likely to get the condition if you smoke, during pregnancy (although usually reverses) or with conditions such as diabetes.

Recession

Receding gums are a common complaint from patients and the primary concern is that this is a sign of gum disease. This is not usually the case. Whilst recession can be a sign, there are many other reasons for this to occur. Heavy handed brushing and tooth grinding are common causes. When gums recede they often result is more sensitive teeth. This is because the dentine of the root surface becomes exposed. Dentine is made up of millions of tubes which go from the surface to the nerve and are filled with fluid. When stimulated the nerve senses this and the sensitive twinge is felt. There are Toothpastes that block these tubes and make the teeth less sensitive. Please ask your dentist for advice.

Gingivitis

Signs of gingivitis are usually bleeding gums. If you have gingivitis, your gums have become inflamed due to plaque being left on the surface of the teeth, often in between the teeth. If you don’t clean plaque off your teeth regularly, your gums will become red, swollen and will bleed. This is the early stage of gum disease and is reversible. If you brush well, floss or use interdental brushes to remove the plaque, your gums will recover. However, failure to do this, often a common reason is the bleeding, the gingivitis may develop into periodontitis.

Periodontitis

In some people gingivitis can develop into a condition called periodontitis. This is where the inflammation now starts to affect the tissues around the root of the tooth leading to loss of the bone support for the tooth. As the gums shrink back, roots are more exposed raising the risks of sensitivity and decay. You may also notice the teeth becoming loose. However, in some cases there are no obvious signs so it is important to have your teeth and gums checked regularly.

Left untreated, the teeth will eventually become so loose that extractions are the only option.
Treatment is largely about stabilising the loss, preventing it getting any worse. A large part of this is down to the commitment of the patient to enhanced oral hygiene measures, flossing, interdental brushes and good brushing.

Acute necrotising ulcerative gingivitis
This condition is characterised by a grey appearance on the tips of the papillae. These are the normally triangular bits of gum between the teeth. Often there is a bad taste and foul smell as well. Typically it occurs in smokers. It is important to treat quickly since the loss of gum around the teeth is often permanent, however, it responds well to antibiotics.

Diagnosis of gum disease

As part of a regular examination, your gums are also inspected and may also be probed with a special probe called a BPE probe. This is used to determine whether there is periodontal disease present rather than just gingivitis.

Measurements are made of the depth of the pockets around the teeth, i.e. how much loss of attachment / bone there has been. Sometimes X-rays are also taken.

The probing around the teeth sound painful but is at most mildly uncomfortable! Many do not even notice we have done it!

Treatment of gum disease

The type of treatment you have will depend on how severe your gum disease has become. We will usually start with simple treatment such as scaling your teeth, cleaning the surfaces and advising on how you can best brush your teeth. If you have severe gum disease, your dentist may suggest to refer you for treatment with a specialist periodontist, however, usually we will try to treat the condition ourselves first.

Scaling

Some practices use hygienists to do their scaling and polishing for them instead of the dentists, however, in our practice we do not. Dentists are obviously trained to a level beyond that of hygienists and any gum treatment must be prescribed by a dentist not a hygienist.

Scaling is the treatment that you will usually receive as part of your regular check up appointments to clean the stains and deposits from your teeth. In the treatment of gum disease we may go a little further:

Above the gums, the tartar is removed to reduce the inflammation of the gums and the bleeding.

Under the gums, there the tartar tends to be in smaller quantity but more damaging in type. Removal here is indicated if there is any sign of pocketing around the teeth.

The purpose of scaling is to remove these damaging deposits, not make then look better. Staining is unsightly but not usually damaging.

Scale and polish (NHS Choices)

"To remove plaque and tartar (hardened plaque) that can build up on your teeth, your dentist may suggest that you have your teeth scaled and polished. This is a ‘professional clean’ carried out by your dentist.
The dentist will scrape away plaque and tartar from your teeth using a special instrument, then polish your teeth to remove marks or stains. If a lot of plaque or tartar has built up you may need to have more than one scale and polish.
The price of a scale and polish can vary depending on what needs to be carried out, so ask your dentist how much it will cost beforehand. NHS dental treatment cost £17.50 for basic treatment (band 1) and £48.00 for more advanced treatment (band 2)."

NHS treatment is about ensuring optimal oral health.

"Scaling and polishing is the removal of sub and supragingival plaque and calculus." These are the "deposits" that cause disease. Stains are possibly unsightly but are not detrimental to oral health, i.e. not unhealthy.
We frequently get asked about stain removal and NHS treatment. Whilst we will endeavour to remove visible stains, it is not always possible to remove all stains in non visible areas in the time allowed. NHS treatment is focused on prevention and treatment of disease, stains are not a disease process. Root Surface Debridement
If gingivitis has developed into periodontitis you may need more extensive scaling called root surface debridement to remove plaque and tartar from the periodontal pockets. This can require several appointments usually closely spaced. A local anaesthetic will be used to numb the gums reducing the discomfort. The root surfaces are then cleaned and scraped to remove all the deposits rendering a clean smooth surface for the gum to reattach. Bone almost never regenerates however, the attachment is soft tissue only preventing further deterioration but more prone to breakdown in the future if oral hygiene is not excellent.

Monitoring will then take place usually at three monthly intervals. It is important to stick to this schedule since evidence shows the beneficial effect of regular scaling after treatment. 

Surgery

Surgery is a very rare occurrence, even specialist treatment will usually only involve root surface debridement. However, in some rare cases it is necessary and would be carried out in a specialist setting rather than in our practice.

Treatment Success

The success of treatment depends on many things, however, the single most important is good oral hygiene. This cannot be accomplished by a scale and polish alone. It is essential that no, or almost no tartar is building up, this is down to the efficiency of home care.

Successful treatment will not regenerate the bone around the teeth but aims to create a "soft tissue seal" between the tooth and the gums that will prevent the situation worsening. Some shrinking of the gums is inevitable and can result in some sensitivity and loss of aesthetics of the gums. The success of treatment depends on many things, however, the single most important is good oral hygiene. This cannot be accomplished by a scale and polish alone. It is essential that no, or almost no tartar is building up, this is down to the efficiency of home care.

Successful treatment will not regenerate the bone around the teeth but aims to create a "soft tissue seal" between the tooth and the gums that will prevent the situation worsening. Some shrinking of the gums is inevitable and can result in some sensitivity and loss of aesthetics of the gums.

To have the highest chance of success:
• Brush your teeth at least twice a day for 2 ½ minutes each time.
• Floss or use interdental brushes at least once a day.
• Quit smoking - success is very limited in smokers.
• Adhere to the recommended maintenance regime.
• Attend regular check ups for scaling and polishing. Evidence shows that 3 monthly scaling (even when no tartar is building up) has a protective effect from the disease restarting.