Once periodontitis is identified, it may be held in check—depending on the severity—using a variety of approaches. In your grandparents’ generation, advanced infections in the mouth would have been treated by removing whole sections of teeth. Today, the goal is to stop the disease from progressing, repair the tissues and keep the tooth, or teeth, for as long as possible.
The first priority is to stabilize the disease by removing its underlying cause: plaque and tartar buildup. If inflammation of your gums is mild, it may just mean stepping up your routine cleanings to every three months, to remove the plaque and tartar and to keep it from recurring.These patients should also be given home oral-care tips, and possibly a prescribed antimicrobial mouthwash. But they may be referred to a periodontist for a four-to six-hour deep cleaning called “root planing,” during which the tooth root is scoured and smoothed. More than one session may be required, depending on the severity. “Root planing is more substantial than normal cleaning,” says Mirbod. “It’s usually done with different instruments than a typical cleaning, and local anesthesia.” A low-dosage antibiotic, Periostat, may also be prescribed to slow the disease.
“For some patients, non-surgical therapy like root planing is adequate,” says Mirbod. But it’s a different story for those with more advanced cases. These may require “pocket reduction” surgery, in which the periodontist lifts a flap of gum tissue, removes tartar from the tooth root, and reattaches the gum in a lower position, reducing the amount of plaque it will trap in the future.
Jawbone that has been damaged by periodontal disease doesn’t grow back on its own. But surgery can be used to smooth out rough or pitted bone, making it harder for bacteria to regrow there, and enabling gum tissue to reattach. There are also many surgical procedures to regenerate the bone and supporting fibres around the teeth—including bone grafting and guided tissue regeneration—that have advanced greatly over the past decade. For instance, a periodontist can apply to the root a gel containing proteins that stimulate healthy growth and act as a sort of fertilizer.
Whatever the approach, once the active phase of treatment is over, frequent dental appointments will likely be needed—typically, a cleaning every three months. “The maintenance should be lifelong so that it doesn’t recur,” says Mirbod.