If left untreated gum disease can lead to pain, halitosis, bleeding gums, recession and eventually tooth loss. In addition, there is now strong evidence to support the link between periodontal disease and systemic health conditions such as stroke, cardiovascular disease, diabetes and Alzheimer’s.
There are several different types of periodontal treatment available depending on the type and severity of the disease.
Understanding Periodontal Disease
Periodontal disease, also known as gum disease, is a broad term for conditions that cause inflammation of the gum and bone that supports the teeth. It is caused by poor oral hygiene habits that allow plaque to build up on the teeth. Some people are more prone to the inflammation and risk factors include family history, stress, smoking, and certain diseases such as diabetes.
Periodontal disease is broadly divided into two stages: reversible and irreversible. Reversible gum disease is called gingivitis and only affects the outer gum tissues.
In the case of gingivitis, the bone has remained intact and hasn’t been destroyed by the disease. Gingivitis can be quickly reversed with the right treatment however if left untreated can progress to periodontitis.
Irreversible gum disease is called periodontitis and in this case the bone underneath the gums that holds the teeth in place has been partially or destroyed by the disease process. The bone can’t be regenerated, and the resulting damage means the support around the tooth is permanently compromised. If left untreated, periodontitis may lead to tooth loss.
Common signs that you may require gum disease treatment include bleeding gums, puffiness or swelling, tenderness, bad breath, receding gums, gaps appearing between the teeth that didn’t used to be there and wobbly teeth.
Non-Surgical Periodontal Therapies
Plaque is a sticky film of bacteria also known as dental biofilm, that grows on the teeth and gums. If left undisturbed, it starts to harden and form calculus deposits on the teeth often referred to as tartar. Once tartar has formed, it can’t be removed with regular oral hygiene and needs to be removed with professional dental cleaning. Leaving it in place can help more bacteria to grow by increasing the areas where plaque can stagnate. The more plaque there is, the more gum inflammation you’ll have and the higher the risk of disease.
Non-surgical periodontal therapies aim to concentrate on disturbing the bacterial plaque biofilm and removing hardened deposits without having to cut the tissues. The aim of treatment is to eliminate the toxins released by the bacteria which in turn reduces the inflammation. By teaching the patient how to control the amount of plaque bacteria sitting around the gums every day, it allows the inflammation to resolve naturally. As it does so, the gums tighten up to form a protective seal around the tooth and the disease activity resolves. The earlier the disease is caught, the more likely it is to respond to non-surgical periodontal therapy.
Adjuncts such as antibiotics and medicated mouthwashes might also be used if the system has become too overwhelmed to fight the bacterial invasion. These would be timed specifically to coincide with non-surgical periodontal therapy to ensure maximum impact. Antibiotics and antimicrobials won’t work long-term if they’re not used alongside mechanical disruption of the plaque and tartar.
Surgical Periodontal Therapies
In cases of advanced periodontist where the disease has progressed deep into the tissues and non-surgical therapy has failed to eliminate the disease, surgical periodontal therapy options may be considered. Surgical intervention is invasive and would always follow a course of non-surgical therapy as oral hygiene needs to be impeccable before attempting any surgical procedure. There are different surgical periodontal therapy options of which Flap Surgery and soft tissues grafts are the most utilised.
Flap surgery. During this procedure, the periodontist makes small cuts in the gum to create a flap that can be peeled back to reveal the surface of the root of the tooth. It allows improved vision and access to the area where bacteria are harbouring. Any bacteria, tartar, and plaque are cleaned away and any rough spots on the bone are smoothed before the gum is stitched back into place.
Soft tissue grafts. The periodontist places gum grafts over spots where your own gums have receded. They take a small piece of tissue from the roof of your mouth or from a donor and attach it to the exposed tooth roots to cover them.
Bone grafting. Periodontitis can wear away the bone around your teeth. This procedure implants pieces of your own bone, artificial material, or donated bone in areas where bone has eroded to hold your tooth in place. In time, your own bone will regrow in that area.
Guided tissue regeneration (GTR). This procedure is often done together with a bone graft. The periodontist puts a special type of fabric between your gums and the bone graft. The fabric holds the space open so that new bone can grow.
Platelet-rich fibrin (PRF) and platelet-rich plasma (PRP). PRP and PRF speed healing and reduce pain after gum surgery. Your doctor gets PRF and PRP by spinning a small amount of your blood through a machine called a centrifuge. The machine separates out and condenses a protein called fibrin or a liquid called plasma from your blood. The PRF or PRP then goes onto the surgical site to promote healing.
Not all surgical procedures are carried out by all periodontists and there may be variations in preferred methods from country to country. The success rates vary as the procedures involve various layers of complexity with various factors influencing success. Not everyone is suitable for them all. Your periodontist will talk you through viable options in your case. Surgical periodontal therapies are invasive and carry greater risk of complications and greater failure rates than non-surgical therapies.
Guided Biofilm Therapy is an effective non-surgical periodontal therapy treatment option. It uses AIRFLOW and PERIOFLOW technology to deliver the combination of warm water and soft erythritol powder under the gum where the bacteria lives. The Erythritol powders works against the dental biofilm helping to break it down, while the warm water airflow flushes away the debris to effectively decontaminate the area. The no pain piezon ultrasonic is then used where there are hard calcified deposits to complete the cleaning process.
Most non-surgical periodontal therapy carried out with GBT does not require the use of local anaesthetic and can be performed in fewer visits. The advantages of minimal invasive techniques like GBT include less post operative sensitivity, less recession, less use of local anaesthetic and a reduced cost of periodontal treatment. There is good evidence to support Guided Biofilm Therapy as an effective non-surgical therapy option and as a treatment approach for long term supportive care after the disease is stabilised.
Prevention is key and early detection is key to successful periodontal management. Regular dental visits for biofilm disruption and a review of homecare techniques are pivotal in stopping the onset and/or progression of periodontal disease. If you have any of the symptoms listed above and you suspect you have periodontal disease, make an appointment to see your dentist to have the health of your gums assessed.
