The main cause of periodontitis( gum disease) ,is plaque. The aim of treatment is to remove this plaque and prevent it from returning. Your prognosis, treatment success, and ultimately keeping your teeth will all depend upon your ability to do this and improving your brushing and flossing. This is true whatever the stage of your disease… so get cleaning properly- see our care section.
You play the most important part in gum treatment, as you are responsible for removing all plaque above the gum margin with your toothbrush and other cleaning aids. The dentist will help, by reducing plaque retentive factors that cause plaque to build up making it easier for you to keep your teeth clean, monitoring your gum treatment, progress and performing any necessary treatment to remove plaque and build up under the gum line.
CHOOSE YOUR WEAPON!
Initially the dentist will want to get any inflammation of your gums down, to allow a more accurate periodontal assessment (analysis) and measure the true attachment loss of your teeth. To do this, they will often do a general scale and clean over one or two appointments depending on the state of things and the amount of build up. I always recommend using a chlorhexidine mouthwash for this period to aid healing and help reduce the swelling of your gums.
The periodontal chart will let the dentist map out the areas where the disease requires further treatment. In areas of pocketing the dentist is likely to need to perform some sub gingival debridement ,(this essentially means -‘under gum cleaning’) and is likely to require the areas being made numb with anaesthetic to avoid the procedure being too sore.
Dentists may have slightly different approaches to gum disease treatment but the concept always remains the same. If periodontits is 'generalised' meaning pocketing affects most of the teeth then at least two appointments will be needed to do this. Most dentists like to keep these fairly close together to 'disinfect the mouth' but don't particularly like making your whole mouth numb at one time so you still have some idea of temperature and sensation when eating and drinking.
The ultrasonic scaler is the instrument most widely used to clean your teeth at your check up appointments. The tip vibrates forwards and backwards at high speeds to help break up plaque and calculus. It uses water to cool the tip and flush out all the debris from around your gum margin. The noise is not the most friendly to the ear and the feeling is that of a sort of mini- scratching on the teeth- I am sure we are not too far away from a more pleasant alternative, but for the time being it is the best we have got and from a dentist perspective is very effective.
When it comes to cleaning under the gums, we have special tips that we can attach to the ultrasonic scaler to allow us to get further down into the pockets to clean the root surfaces of your teeth. Most dentists will also use a specially designed set of hand instruments that scrape against the root surface. These are made at different angles to allow the different surfaces of the various teeth to be cleaned.
Treatment of your mouth becomes more difficult when you have pockets that extend over 6 mm and the further back in the mouth you go. Complex root shapes that are exposed- especially in between the roots of molar (back) teeth, limited mouth opening and teeth out of normal position can also provide problems. In these cases referral to a more experienced dentist can help or a specialist in this type of treatment- a periodontist.
Do I Need Antibiotics?
Antibiotics have their place in treating aggressive forms of periodontitis and some acute gum infections but in general are not used for the most common chronic forms of the disease. If your dentist feels it is necessary they will fill out a prescription for you.
The long-term benefit has been difficult to determine and we try to reduce wherever possible, the use of antibiotics (reserving it for the most necessary cases) so it stays effective for years to come. We don’t want to develop resistant forms of the bacteria that we are trying to target. Some patients think antibiotics are the solution to everything and this certainly isn't the case.
Some specialists will insert small chips into the gums in the affected areas that release a given antibiotic over time. If you are seeing a specialist then this is an approach they sometimes like to use- particularly in areas that don’t respond to the standard periodontal treatments.