Treatment options

If you’ve been diagnosed with gum disease, there are a variety of treatment options available. The correct treatment depends on the particulars of your situation and the severity of the problem. We always start with the least invasive options, which are non-surgical. However, in more serious cases, surgery may be necessary.

Non-surgical treatment

The first line of defense against the presence of gum disease is a unique type of cleaning called “scaling and root planing.” In this procedure, an ultrasonic cleaning device is used to remove plaque and tartar from your teeth where regular cleaning devices can’t reach: under the gum line on the tooth and the root. Then the rough surface of the tooth and the root are smoothed out (planed). This provides a healthy, clean surface that makes it easier for the gum tissue to reattach to the tooth.

If you address your gum disease before it becomes severe, scaling and root planing may be the only treatment you need. However, as with any dental procedure, after-care is vital. In order to keep your teeth in good shape and able to resist future occurrences of gum disease, you must brush and floss daily, eat a healthy diet, avoid tobacco use, and undergo regular dental checkups. Even after a successful scaling and root planing, if you don’t attend to your teeth properly, it’s quite likely that you’ll develop gum disease again.

Some non-surgical periodontal treatment services we offer are:

• Scaling and root planing — This is the removal of hard and soft deposits from the teeth and their roots. They include bacterial plaque (germs) and the toxins they produce and the mineralized form of plaque called calculus (tartar). It is these deposits that cause irritation and infection of the gums and bone loss around the teeth. Scaling and root planing is a very technique-sensitive procedure that uses a combination of sonic, ultrasonic, and hand instruments.

• Chemotherapeutic irrigation — This is the direct delivery of an antibacterial or antimicrobial solution into an infected area. This procedure is often done in conjunction with scaling and root planing.

• Direct delivery of antibiotics — This involves the placement of antibiotic or antimicrobial fibers, chips, or gels into an infected area. Unlike irrigation, these vehicles that contain antibiotics remain in the infected site for several days to exert their effect.

• Supportive periodontal maintenance — Once your gums have been brought back to health, it is imperative that a maintenance schedule be designed to fit your needs. Typically, your teeth will be cleaned, scaled, and polished every three months. Three-month intervals help keep the plaque levels around the gums minimal and thus significantly reduce your risk of re-infection. Maintenance is the key to successful treatment.

Surgical treatment options

If the tissue or bone surrounding your teeth is too damaged to be repaired with non-surgical treatment, several surgical procedures are available to prevent severe damage and restore a healthy smile. We will recommend the procedure that is best suited to the condition of your teeth and gums. The following is a list of common types of periodontal surgery.

• Pocket depth reduction — In a healthy mouth, the teeth are firmly surrounded by gum tissue and securely supported by the bones of the jaw. Periodontal disease damages these tissues and bones, leaving open spaces around the teeth that we call pockets. The larger these pockets are, the easier it is for bacteria to collect inside them, leading to more and more damage over time. Eventually, the supportive structure degrades to the point that the tooth either falls out or needs to be removed.

  During pocket reduction procedures (also known as “flap surgery”), we fold back the gum tissue and remove the bacteria hiding underneath as well as the hardened plaque and tartar that have collected. We may also remove any tissue that is too damaged to survive. We then sew the healthy tissue back into place. Now that the tooth and root are free of bacteria, plaque, and tartar, and the pockets have been reduced, the gums can reattach to the teeth.

• Regeneration — When the bone and tissue supporting the teeth have been lost due to severe gum disease, we can restore these areas with a regeneration procedure. During this process, we begin by folding back the gum tissue and removing the bacteria, plaque, and tartar. Depending on your situation, we may then perform a bone graft to stimulate new bone growth, or we may place a special kind of protein that stimulates tissue growth to repair the areas that have been destroyed by the disease.

• Soft-tissue graft — A frequent symptom of gum disease is gum recession (also called gingival recession). As the gums recede, more of the roots are revealed. This can make teeth appear longer and can also create sensitivity to hot or cold liquids or food. It also exposes the tooth to increased damage from gum disease, since bacteria, plaque, and tartar attack the surface of the tooth and the root.

  During a soft-tissue graft, tissue from the top of your mouth or another source is sewn to the gum area, covering the roots and restoring the gum line to its original, healthy location. This procedure can also be performed for cosmetic reasons.

• Bone grafting/tissue regeneration — This surgical procedure replaces bone that has been lost around the teeth as a result of advancing gum disease. Various types of bone grafting materials, from synthetically derived bone and collagen-type materials to the patient’s own bone, are used during this procedure. Often, a “membrane” of some type is used to help contain the graft within the prepared bone site and help the graft to heal properly.

• Gum grafting — This is a surgical procedure designed to add protective gum around the root of a tooth. Protective gum is often lost as a result of recession of the gum or trauma. Most often, the protective gum used for the graft is taken from another area of the patient’s mouth where the protective-type gum is abundant. Once the graft heals, the area will continually maintain the new protective gum. Gum grafts are very predictable and usually need to be done only once.

• Root coverage procedures — These types of gum grafts are designed to cover the roots of teeth that have been exposed due to recession or trauma. These procedures are often done as cosmetic procedures in areas of aesthetic concern. .

• Crown lengthening — This surgical procedure is designed to assist your restorative dentist in getting a restoration (cap or filling) to fit your tooth properly. When decay or tooth fracture goes beneath the gum line, your dentist may require that more tooth structure be exposed surgically so that he or she may properly restore the tooth.

• Cosmetic Gum Sculpting — This procedure is generally done for cosmetic purposes to eliminate a “gummy smile” and to even out the gum line prior to cosmetic dentistry.