The casues of periodontitis
To understand this we must look at what causes gum disease in the first place. The cause of gum disease (gingivitis and periodontitis) is bacteria (bacterial plaque) inside your mouth which has overgrown. This is known as the indigenous bacteria i.e. it comes from own body. Just like the bacteria which we have inside our gut. The treatment for plaque induced gum diseases is all aimed at reducing the bacteria above and below the gum. However, we cannot get rid of indigenous bacteria, as this resides in our own body. That’s why antibiotics have only a limited effect in reducing the symptoms and the effect does not last more than a few weeks.
Treatment for periodontitis : Surgery and non-surgical management
All of periodontal treatments are aimed at reducing plaque bacteria to such a level that it does not become harmful and cause any further problems. First line of periodontal therapy is called non surgical treatment. Firstly we need to reduce the plaque build up above the gum by improving brushing & flossing techniques. Then any hardened deposits of plaque bacteria (called calculus or tartar) are removed both above and below the gum line by the use of both hand and ultrasonic instruments. Finally any fine deposits of bacteria and calculus are removed from the root surface with the use of specialised hand instruments called gracey curettes. In addition any teeth/tooth which have moved out of position and cause any problems with the bite may be adjusted (occlusal adjustment).
Management of periodontitis
Reducing periodontal pocket depths and bleeding
A reassessment is carried out approximately two months later to check the success of the treatment. The vast majority of cases we have treated at the Birmingham Periodontal & Implant Centre show at least 90% improvement in reduction of pocket depths. Almost all of the bleeding gums should be eliminated and in most mild to moderate cases this should be all the treatment that is needed. At this visit if we still find problems, then there is the option to have gum surgery. Gum surgery enables the periodontist to see the actual roots and bone surrounding the roots and also to remove any plaque/calculus deposits and any infection. Secondly the gum could be lowered to completely reduce the periodontal pockets also.
The final phase of any periodontal treatment is called maintenance therapy. Here 3 monthly hygiene appointments are arranged and professional cleaning above and below the gum line is carried out. Periodontitis needs to be treated like other chronic diseases such as diabetes and high blood pressure which cannot be cured but can be controlled by medication. The medication for periodontitis is good home care and regular professional hygiene visits. With this regime one can expect to keep their teeth for hopefully rest of their life.
Severe Chronic Periodontitis together with drug induced gingival hyperplasia (Nefidipine). After liasing with the General Medical Practitioner to change medication, the patient underwent a full course of non-surgical therapy.
After treatment the periodontal condition has been stabilised with just non-surgical therapy and has been maintained by excellent plaque control by the patient.