Periodontal Treatment: Caring for Gum Disease

Periodontal disease is the leading cause of tooth loss in adults, and its defining characteristic is that it does not hurt until it is advanced. People lose the bone supporting their teeth over a decade or more without a single symptom they would think to mention.

It is also highly treatable, and stopping its progression is realistic at almost any stage. The damage already done does not usually reverse, which is why finding it early is worth so much.

How it progresses

It begins as gingivitis: plaque along the gumline provokes inflammation, and the gums become red, puffy and bleed when brushed. At this stage the bone is untouched and the condition is entirely reversible with thorough cleaning and improved home care. Bleeding gums are not normal and are not a sign you are brushing too hard.

If inflammation persists, the attachment between gum and tooth breaks down and a pocket forms. Bacteria colonize that pocket, which cannot be cleaned by brushing, and the body's inflammatory response begins destroying the bone around the tooth. This is periodontitis, and it is not reversible.

As bone is lost, pockets deepen, gums recede, roots become exposed and sensitive, teeth loosen and may drift or splay, and eventually they are lost. Bad breath and a bad taste are common. Pus from a pocket, gums pulling away visibly, and a tooth that has changed position are late signs.

How it is diagnosed

The measurement of pocket depth at six sites around each tooth, along with whether the tissue bleeds when probed, how much recession is present, and how mobile the tooth is, forms the clinical picture. X-rays show the bone level and give a record to compare against in future years.

One to three millimeters with no bleeding is health. Four to five millimeters indicates early to moderate disease, and six millimeters or more indicates advanced disease with substantial bone loss. Bleeding on probing is the earliest objective sign and often precedes measurable bone loss.

Risk factors that change how aggressively we treat include smoking, which is by far the strongest and also masks bleeding so the disease appears deceptively quiet; diabetes, which has a bidirectional relationship with periodontal disease; genetics; certain medications; hormonal changes in pregnancy; and stress.

Non-surgical treatment

Scaling and root planing is the foundation. Under local anesthetic, plaque and tartar are removed from the root surfaces below the gumline and the roots are smoothed so the tissue can reattach. It is usually done in halves or quadrants over one or two visits.

Adjuncts include locally delivered antibiotic placed into deeper pockets, systemic antibiotics in specific aggressive cases, and laser treatment of the pocket lining. These support the mechanical debridement rather than substituting for it.

A re-evaluation four to six weeks later remeasures the pockets. Most respond well, with shallower readings and no bleeding. Those that do not resolve, particularly deep pockets around molars, are candidates for surgical treatment.

Surgical and regenerative options

Pocket reduction surgery reflects the gum tissue back to allow direct visualization and cleaning of the root surface and reshaping of irregular bone, then repositions the tissue to reduce pocket depth so you can maintain it at home.

Regenerative procedures use bone grafts, membranes or biologic agents to encourage regrowth of bone and attachment in defects with favorable geometry. Results depend heavily on the shape of the defect and on the patient's control of plaque and smoking.

Gum grafting addresses recession, covering exposed roots to reduce sensitivity and prevent further loss. Crown lengthening reshapes tissue and bone to expose more tooth, either to allow restoration of a tooth broken near the gumline or for cosmetic reasons.

Maintenance is the actual treatment

Periodontal disease is chronic. The bacterial population in treated pockets returns over approximately three months, which is why periodontal maintenance is scheduled at three- to four-month intervals rather than twice a year. Returning to a six-month schedule is the most common reason treated cases relapse.

Home care has to be genuinely thorough, with daily cleaning between the teeth, usually with interdental brushes for the larger spaces created by recession. Quitting smoking improves treatment outcomes more than any adjunct we can provide. Controlling blood sugar improves gum health, and improved gum health in turn makes blood sugar easier to control.

If your gums bleed, or you have been told you have pockets, or a tooth has started to feel loose, get it evaluated now. Call Cedar Creek Dentistry in Portland. The disease is quiet, and the only way to catch it is to look.

Questions about your own care? The team at The Best Dentist In Portland, Oregon is happy to help — call us at (503) 646-1811.

This article is for general information only and is not medical advice.