How Do You Treat Gum Disease?

Gum disease, also referred to as periodontal disease, is an infection of the tissues that surround and support your teeth. It is a major cause of tooth loss and can occur when bacteria is not removed from under the gum line and then builds up over time. If the bacteria is not removed by typical at-home care such as brushing and flossing, it can begin to form plaque, a sticky and destructive substance that forms on our teeth. If left untreated, plaque turns into a harder substance called calculus, which can eat away at your gums and bone, causing loose, and ultimately lost teeth.

There are two levels of gum disease that can affect the gums: gingivitis and periodontitis. Gingivitis, characterised by red and irritated or bloody gums, is the milder form of gum disease. Without proper treatment it can lead to the more serious periodontitis, which is defined as inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and the tooth sockets.

Both types of gum diseases are fairly common among adults in the United States and both generally can be reversed, or their symptoms lessened, with effective care consisting of professional cleaning at your dental office followed by daily brushing and flossing. The first step to treat gum disease is to contact your dentist to discuss the best treatment options for your individual situation.

How to Treat Gingivitis
Treatment methods for gum disease depend upon how far the condition has progressed. While this first-stage of gum disease usually gets better or reverses after a professional cleaning, proper oral hygiene must be continued at home, or the condition can easily and quickly return.

During a therapeutic deep cleaning, the dentist or dental hygienist will remove all plaque and tartar (hardened plaque) with processes called “scaling,” and “dental root planing”. Scaling is the process of removing built-up bacteria above and below the gum line. Dental root planning goes a bit deeper and actually smoothes and cleans the tooth root to help unhealthy gums reattach to the tooth. Your dentist may need to complete this deep cleaning in more than one visit, and will most likely use a local anesthetic like Novocaine to manage your discomfort level during the procedure.

Your dentist may also discuss fixing misaligned teeth or poorly fitting fillings, crowns or bridges to help reduce the chance of plaque building up in hard-to-reach places. They may also recommend an over-the-counter or prescription mouthwash to help reduce and remove bacteria and plaque on your newly-clean teeth. Diligent home care, and twice-yearly professional cleanings will help to keep gingivitis at bay.

How to Treat Periodontitis
If gingivitis is not treated, it may lead to periodontitis, which is a much more serious level of gum disease. Periodontitis can lead to the destruction of gums, mouth bones, tissue, and teeth, and is the number one cause of tooth loss in adults.

If plaque spreads too far below the gum line, toxins can cause the tissues and bone that support the teeth to break down and pull away from the teeth and form spaces called pockets. Pockets can become infected, and if not treated, teeth may cause teeth to become loose, fall out, or have to be removed. There are several types of periodontitis, including:

• Chronic periodontitis is the most common form and characterised by pocket formation and gum recession. Chronic periodontitis can occur at any age but is most common in adults.
• Aggressive periodontitis is characterised by rapid loss of gums and bone destruction.
• Periodontitis as a manifestation of systemic diseases is associated with heart disease, diabetes and respiratory diseases. This form usually presents at a young age.
• Necrotising periodontal disease is characterised by necrosis (death) of gum tissue, periodontal ligaments and alveolar bones, which cause lesions. It is most common in people with systemic conditions like HIV, malnutrition and immunosuppressive conditions.

There are both non-surgical and surgical treatments for periodontitis, depending on its severity. Non-surgical treatments are similar to the treatments for gingivitis: scaling, deep root planing, and prescription antibiotics. More severe cases may require surgical intervention including:

• Flap surgery (pocket reduction surgery) is the lifting back of gum tissue and exposing the tooth roots for more effective scaling and root planing. The underlying bone may be recontoured to make it easier to clean the area around the gums.
• Soft tissue grafts are used to reinforce soft tissue lost to gum recession. A small amount of tissue from the roof of the mouth is relocated to the gum line in order to reduce further gum loss, cover exposed roots, and improve appearance.
• Bone grafting is done when the bone around the tooth root has been destroyed and helps prevent tooth loss by holding the tooth in place. It also promotes bone regrowth.
• Guided tissue regeneration promotes regrowth of bone through the use of a biocompatible material placed between the bone and affected tooth. The material prevents unwanted tissue from growing so that the bone can grow back.
• Enamel matrix derivative application is another form of guided tissue regeneration that involves the application of gel to a diseased tooth root. The gel contains the same proteins that naturally exist in developing tooth enamel. Its application stimulates healthy bone and tissue growth.

After a deep cleaning or surgical procedure, you may have pain for a day or two and teeth sensitivity for up to a week. Your gums also may be swollen, feel tender and bleed. To prevent infection, control pain or help you heal, your dentist may prescribe a pill or mouth rinse.

Your dentist may also insert medication directly into pockets that were cleaned. Your dentist will likely schedule another visit to see how your gums have healed and how your at-home dental regimen is working. Remember, you don’t have to lose teeth to gum disease. If you suspect you have gum disease, or if your dentist has diagnosed you with gingivitis or periodontitis, there are ways to treat – and in many cases, reverse – it. The best first step is to consult with your dental professional and get started on a treatment and prevention plan. The sooner you get started, the better.