Periodontal or gum disease is an infection that causes bleeding gums, bad breath, loose teeth, and teeth that fall out. A bacterial film called plaque that continuously forms around the teeth and gums causes gum disease. An estimated 56 million Americans suffer from gum disease, and is the main reason that people lose their teeth.
Gum disease is treated a number of different ways, depending on how advanced it is. The main ways to treat gum disease is with deep cleaning under the gums, gum surgery, bone grafts, and antibiotics. Oral hygiene technique and instruction also plays a critical role in the treatment of gum disease.
Gingivitis, the earliest stage of gum disease, is the only one that can be cured. Gingivitis can be cured with improved oral hygiene, which includes brushing properly at least three times a day, for about three minutes each time, and flossing at least once a day. Antiseptic mouth rinses such as those containing Chlorhexidine Gluconate (Peridex) or those containing thymol such as Listerine can also help eliminate gingivitis.
Early gum disease is treated with a procedure known as scaling and root planning. The dentist or dental hygienist uses thin curettes and gently removes the plaque and tartar under the gum-line. The tooth roots may also be smoothed, to make it more difficult for plaque to adhere to them in the future. This procedure is rarely painful, but some patients may prefer local anesthesia to numb the area prior to treatment. The gums will heal in a few weeks, and the previously red, puffy gums will usually appear healthy; tighter and more stippled, like the surface of an orange.
Moderate and advanced gum disease is usually first treated with scaling and root planning as mentioned above. After the gums heal, the surgical procedure is scheduled, partly because the dentist cannot effectively remove plaque that remains deep under the gum-line. Treatment usually involves a quarter of the mouth at a time (from the last molar in the mouth, to the front [central incisor] tooth on the same side). The dentist numbs the mouth in the area that requires treatment. The gum is then gently separated from the bone, and the remaining plaque and tartar are removed, along with areas of diseased gum. In many cases, gum disease leaves the bone choppy and irregular, which requires it to be smoothed and shaped. If there are vertical areas of bone loss, for example, the dentist may consider a bone graft. The material used for the graft may be either artificial, synthetic, or from natural sources. The grafting material is placed into the area of bone loss, and a membrane, often Gortex, is used to cover the graft. The gum is then stitched up, and bubble gum like packing is placed over the area. Gum surgery is usually not painful. Believe it or not, I have had patients actually sleep through the procedure. There will be varying degrees of discomfort, however, after the anesthesia wears off. The dentist will usually prescribe narcotic pain medication as well as an antibiotic in some cases. Discomfort will generally persist for a few days. The patient returns in about one week to have the packing and stitches removed. If a graft was used, the patient may have to wait six weeks for removal of the graft membrane and specialized stitches.
After the packing and stitches have been taken out, the antiseptic mouth rinse Peridex is often prescribed for several weeks after surgery to promote healing. The teeth in the area that have been treated may be sensitive to cold for weeks or months after treatment. This is because the tooth roots are now exposed to the rest of the mouth. The dentist can use in-office desensitizers, prescribe high concentration fluoride gels, and recommend desensitizing toothpastes such as Sensodyne or Crest for Sensitive teeth to combat the sensitivity to cold.
Antibiotics are sometimes used in conjunction with surgical or non-surgical treatment of the gums. The most common antibiotics used are tetracycline, amoxicillin, and metronidazole. These drugs are used to kill some of the bacteria associated with gum disease.
The goal of surgical gum treatment is to bring the gums back to a level where the patient can effectively remove most of the plaque by himself or herself when brushing and flossing. After any gum treatment, the patient should come to the dentist every three months for maintenance. The dentist can then remove any plaque or tartar missed by the patient. There are several products on the dental market that are placed around the gums and provide a controlled release of antibiotics. One product that I use is a minocycline powder called Arestin (www.arestin.com). The ease of use and effectiveness make it a very useful adjunct in the treatment of periodontal disease.
Even though there is no cure for gum disease, appropriate gum treatment by your dentist can greatly reduce the likelihood of losing your teeth at an early age. How much time can gum treatment buy? That is hard to say exactly because there are so many factors that influence the outcome. One common estimate is that gum treatments can double the life expectancy of a tooth. In other words, if a tooth was going to last 15 years without treatment, gum therapy may extend it to 30 years.