How is periodontitis diagnosed and treated?

How is periodontitis diagnosed?

In order for your dentist to determine whether or not you have periodontal disease and the severity of the infection, your dentist is likely to:

• Review your current medical status and medical history – This will help your dentist to identify any risk factors such as smoking or medications that may be causing your symptoms.
• Examine your mouth – This will allow your dentist to check for plaque and tartar and determine if your gums bleed easily.
• Measure the periodontal pocket depth – This is the measurement of the gap between your teeth and gums. This will be done by placing an instrument known as a dental probe beneath the gum line and next to a tooth, this is typically done at a number of different sites in your mouth. A healthy mouth will have a pocket depth of between one and three millimetres (0.03 to 0.11 inches). If your pocket depth is more than four millimetres (0.15 inches), this may indicate an infection associated with gum disease. If the pockets are deeper than six millimetres (0.23 inches), these are difficult to clean during a professional dental cleaning.
• Take dental X-rays – Dental X-rays will help detect any bone loss in the infected areas that your dentist identified as having deep periodontal pockets.

 

How is periodontitis treated?

The initial aim of your dentist, periodontist or dental hygienist in treating gum disease is to rid your mouth and periodontal pockets of any bacteria that have accumulated in order to prevent any further damage to tissue and bone.

To ensure that you achieve the best possible results, you will also need to maintain sound dental hygiene. This will involve brushing your teeth when you wake up and before going to bed as well as flossing once a day. In some cases, if your teeth have enough space in-between them, your dentist may suggest you use a Proxi-brush, also known as an interdental toothbrush. These are brushes that are designed to reach between the gaps in your teeth and the name is derived from inter-proximal which means “between your teeth”.

Soft-picks can also be used if the space between your teeth is smaller. Those who have arthritis, or others who suffer from issues with dexterity (issues in performing skills with their hands), may benefit from the use of an electric toothbrush as this will perform most of the movement needed to clean the teeth thoroughly.

It is vital that you understand what gum disease is and that it is a long-term (chronic) inflammatory infection, meaning that thorough oral hygiene will need to be maintained for your entire life. This will involve regular check-ups with your dentist.

The following information explains the different means of treatment for periodontitis:

Initial treatment

Nonsurgical treatments

If your gum disease has not yet advanced, then your treatment plan may involve some less invasive options, these include:

• Root planing – This procedure will involve smoothing out the root surfaces and cleaning them meticulously in order to prevent the accumulation of bacteria and tartar. The debris and bacteria will be removed from the root surface inside the periodontal pockets. This will also prevent further attachment of bacteria as the surfaces are smoother.
• Scaling – This procedure involves removing any bacteria and tartar from the surfaces of your teeth and beneath the gum line. Scaling can be performed through the use of dental instruments, an ultrasonic device or a laser.
• Antibiotics – Oral or topical (applied directly to the site of infection) antibiotics are administered to control the infection. Some topical antibiotics may include gels or mouth rinses. The gel will be applied to the pockets after they have been cleaned. Oral antibiotics are also sometimes necessary in order to completely rid the site of bacteria.

**My Med Memo – The difference between scaling and root planing is as follows:

• Both procedures will remove the calculus (tartar) and bacteria that are involved in causing the infection.
• Root planing focuses specifically on the root surfaces and will remove the soft and hard deposits from these surfaces through the use of a curette (a small dental hand tool in the shape of a small hook or scoop).
• The goal of root planing is to achieve smoother and glassy root surfaces in order to decrease the inflammation associated with the infection.
• Scaling, also known as debridement involves more than simply smoothing the root surfaces and will also include examining and treating the pocket wall, pocket space, the surfaces of the teeth and the underlying tissues.
• The focus of scaling is to control the infection caused by bacteria as opposed to only removing the bacterial deposits from the root surfaces.
• Scaling is normally conducted through the use of an ultrasonic scaling device to remove tartar from the surface of the teeth and beneath the gum line. Following this, a handheld instrument may also be used manually to remove any remaining debris.

Medications

• Prescription antimicrobial mouth wash – An example of this kind of mouth wash or rinse is chlorhexidine. This will aid in controlling bacteria and treating the infection, it can also be used after surgery to further promote healing. Prescription mouthwashes are used the same way as a regular mouthwash is.
• Antiseptic chip – In some cases, your dentist may place a small chip that contains chlorhexidine in the form of a gel-like tablet. This will help to control the infection and reduce the size of the periodontal pocket. This chip will be inserted after you have undergone root planing and the medication will be released slowly over time.
• Antibiotic microspheres – These medications are in the form of tiny particles that contain an antibiotic known as minocycline. These are used to reduce the size of the infected pockets and control bacteria. These will be placed in the periodontal pockets and are a slow-release form of medication.
• Antibiotic gel – This is a very similar treatment method to antibiotic microspheres. This is a gel that contains an antibiotic known as doxycycline. This kind of medication will aid in halting the growth of the bacteria and in shrinking the size of the periodontal pocket. This gel will be placed into the periodontal pocket by your dentist or specialist after root planing or scaling.
• Enzyme suppressant – This form of medication aids in controlling destructive enzymes through the use of doxycycline. Enzymes are known to accelerate chemical reactions and are substances produced by our bodies as a natural response of our immune system to infection, which can cause gum recession in the case of periodontitis. Some enzymes are responsible for breaking down the gingival tissue, an enzyme suppressant will control and halt the body’s response in creating enzymes to fight off the infection. These medications are administered orally and are used in conjunction with root planing and scaling.
• Oral antibiotics – These will be taken orally in the form of a tablet or capsule. Oral antibiotics will be used for a short period of time to treat persistent or acute periodontitis.

Surgical treatments

Should you suffer from advanced periodontitis, then your dentist may suggest that you undergo dental surgery. Some of these include:

• Pocket reduction (flap surgery) – This form of surgery will involve your periodontist making small incisions in the gingiva (gum tissue) in order for a section to be moved or lifted back so as to expose your roots to allow for more effective root planing and scaling. Due to gum disease often resulting in bone loss, your periodontist may re-contour underlying bone, so that the gum tissue can be sutured back into its original place. Once you have healed from this surgery, it will be easier for you to clean the infected areas and maintain a healthy mouth and gum tissue.
• Soft tissue grafting – When gum tissue is lost due to bacterial infection, the gum line will recede. In these cases, your dentist may suggest that you have parts of the damaged tissue reinforced. In order for the soft tissue to be reinforced, your periodontist will remove a small part of tissue from your palate, or from another source and attach this to the infected site. This will aid in reducing future gum recession, give your teeth a more aesthetic appearance and also cover the exposed roots.
• Bone grafting – In some cases, gum disease may have destroyed the bone that surrounds the root of your teeth, when this has occurred, your periodontist may perform a bone graft. This will aid in preventing the loss of the infected teeth and hold the teeth in place and will also serve as a means for regrowth of the natural bone. The bone graft may consist of small pieces of your own healthy bone, this is known as an autograft, or it may consist of donated bone that has been frozen, known as allograft or it can be man-made, known as a synthetic The procedure involves transplanting new bone tissue to the infected or damaged site in order to repair the existing bone.
  
  For the procedure to be conducted, you will be under local anaesthetic and will feel no pain. The bone graft will be shaped and placed into, as well as around the affected area and will be held in place with plates, pins, or screws. The recovery time will depend on your body’s unique healing ability and it may take up to three months or more to fully heal.
• GBR (guided bone regeneration) or GTR (guided tissue regeneration) – This procedure will allow for the regrowth of bone that has been damaged and destroyed by a bacterial infection. The surgery will involve the use of a barrier membrane in order for new bone and gingival tissue growth to be directed to the affected sites that have insufficient dimensions or volumes of bone or gum tissue in order for their form and function to be restored. Simply put, your dentist or specialist will place a small piece of fabric that is biocompatible (not harmful to living tissue) between your tooth and the existing bone. This material will prevent any unwanted tissue from interfering with the area that is healing, thus, allowing for the bone to regenerate and grow back.
• Other regenerative materials – Proteins to stimulate gingival tissue can be applied through the use of a specialised gel to the infected tooth’s root. The gel contains similar proteins that are found in developing tooth enamel and will aid in stimulating the growth and regeneration of healthy tissue and bone.

How is periodontitis treated at home?

The following measures can be put into place in order for periodontitis to be prevented:

• Brushing your teeth twice a day, when you wake up in the morning and before you go to bed at night.
• Using a soft toothbrush as this will prevent gum recession, hard-bristled toothbrushes can be hard on the gums. You should replace your toothbrush every three months or so.
• Using an electric toothbrush (particularly if you battle with hand co-ordination caused by certain chronic conditions like arthritis or diabetes) can sometimes be more effective in the removal of plaque and debris.
• Flossing once a day.
• Using a mouth wash that will aid in reducing plaque build-up between the teeth.
• Making use of a dental pick, dental stick or interdental brush that is specifically designed to reach between the smaller spaces of your teeth. Bear in mind, some people do not have big enough gaps for these sorts of devices.
• Attending regular check-ups and cleanings with your dentist or oral hygienist. Depending on your own personal oral health, these cleanings should take place at least twice a year.
• Not smoking or chewing tobacco as this can decrease blood flow to the gums, increase the plaque build-up in your mouth, prevent healing from infection and mask the symptoms of infection until it has reached a point of severity.