Periodontitis: Diagnosis and Treatment

Many people will experience some sort of periodontal (gum) disease at some stage in their lives, with US statistics suggesting that every second person over 30 is likely to fall victim to the discomfort, sensitivity and occasional bleeding that marks its milder forms like gingivitis. The figure for those over 60 who battle with this inflammatory reaction to a build-up of bacteria in the gums rises to around 70 percent.

Catching gum disease early

The importance of regular dental check-ups and professional cleaning by a hygienist are vital to stopping gum disease in its earliest stages. These professionals are likely to spot the early signs of gum problems by noticing the presence of receding or swollen gums that are red, tender or bleeding, and sensitive or loose teeth. Persistent bad breath and pain when chewing can also raise a red flag.

If treatment is given and maintained during the gum inflammation stage known as gingivitis, dentists have a good chance of preventing it reaching the more serious levels of the full-blown gum disease, periodontitis. However, if it’s left too long before treatment is sought, the odds on preventing the once uncomfortable problem turning into an extremely serious disease are lowered, and the outlook worsens.

The dangers of periodontitis

Periodontitis can damage the gums’ soft tissue and the bone it covers, resulting in the loss of teeth that the damaged bone and tissue can no longer support. And that’s not all. Indications are it can also impact on general health by increasing the chances of oral cancer and possibly causing a serious bacterial disease in the valves of the heart. Research also shows it to have links to other diseases such as osteoarthritis, strokes and diabetes.

Gum disease treatment

Dental treatments for gum disease will vary according to its level of severity but the initial approach will be to reduce inflammation (possibly with the use of antibiotics) and remove the build-up of bacteria which grows and multiplies in sticky plaque which forms on the teeth. This plaque can eventually push down into the pockets which hold the teeth in the gums, and harden into tartar on the roots, forcing the pockets to become looser and deeper, and increasing the risk of damage to the soft tissue and bone.

Treatment options

If the gum disease has not developed too far, dentists take a non-surgical approach. Instruments, ultrasonic devices or lasers are used to remove the tartar and bacteria from teeth above and below the gums in a process called scaling. The root surfaces are then “planed” or smoothed to discourage the tartar from building up again before the gum reattaches to the surface of the teeth. At the same time any by-products left by the bacteria are also removed to help reduce inflammation.

In more advanced cases surgery may be the recommended approach. Surgical options include using pocket reduction surgery when ordinary scaling and planing are not able to clean away the bacteria and tartar entirely, and the pocket tissue does not re-attach to the teeth. This surgery involves lifting sections of the gum for more thorough cleaning and to allow for reshaping of the bone if necessary. In some instances, surgical grafts of bone or tissue will be needed to prevent further gum recession or to enable the bone to support the teeth.

As periodontitis cannot be cured, dentists will provide advice on how to control it by adopting habits which would in many cases have prevented the periodontitis from occurring in the first place. These involve adopting good oral hygiene practices, including regular brushing and flossing; avoiding acidic and sugary foods; and quitting smoking. They will also recommend regular check-ups and professional cleanings, and will urge patients to become alert to any changes in their gums.