Periodontal Disease and Its Treatment

What is meant by non-surgical periodontal treatment?

Conventional treatment of gum disease – periodontal disease – has been changing rapidly in some ways over the past several years. In general, if damage from periodontal disease has been more than minimal to moderate (and there are ways to actually measure it), then it was considered necessary to reshape the gum and bone tissues surrounding the teeth so affected by a wide range of surgical procedures.

There has gradually been an evolution in treatment toward more conservative approaches in the sense that surgery can often be avoided. Obviously, avoiding surgery is seen as a benefit in that it saves money and avoids the discomfort of a surgical procedure…sometimes of several surgical procedures.

Is there a choice between surgical or non-surgical treatment?

Unfortunately, there has been a lot of press given to ideas suggesting that there was a choice. Some dentists capitalized on the idea. In fairness, perhaps for a period of time, there may have been realistic choices in the sense that some dentists only did the conventional approach, while others were attempting to avoid surgery.

At this point in time, however, progressive dentists should all be aware of increased potential for treating without surgery. But just what does that mean?

Why do or don’t do surgery?

When periodontal disease damages your gums, the general pattern of damage is that the gums separate or split away from the surface of the teeth. In health, the gum surrounds each tooth and forms a collar of gum tissue with a depth of about 1/8 inch. If you could slide a probe down between a healthy tooth and its gum, therefore, the probe would slide under the visible edge of the gum and about 1/8 of an inch of the tip of the probe would disappear under the gum, at which time the probe would “hit bottom” and could go no further without actually piercing the gum.

In disease, that crevice under the gum gets progressively deeper. When it gets to about 3/16 inch, we generally speak of “moderate” disease, and when it gets to the neighborhood of ¼ inch to 3/8 inch or more, we speak in terms of “advanced” periodontal disease. When we check your gums for disease, we use a special probe to actually measure the depth of the pocket around your teeth.

The significance of these depths is simply that normal brushing and flossing is only effective up to a depth of about 1/8 inch. As the gum depths increase beyond 1/8 inch, the bacteria collecting under the gums are able to multiply more and more, and your ability to do anything about it becomes less and less. The deeper it gets, the worse it gets, and the quicker it gets even worse and even deeper! It sort of “snowballs” further out of control.

The initial treatment for gum disease is not surgical. It consists of deep “cleanings” possibly also with various medications. The goal of this initial treatment is to reduce the depth of the gum crevice to as close to 1/8 inch as possible. This is the goal because at that depth, as stated earlier, you have the possibility of being able to maintain it in a clean enough state that it will hopefully remain healthy.

If the end result is not enough reduction in the depth of the gum crevice, some more complicated techniques might be recommended to help you help yourself at home in trying to keep the deeper-than-normal gum crevices healthy. You need to know it’s not an easy task, so the results will depend largely on how hard you are willing to work on it at home. Your immune system will give you more or less help, depending on systemic health factors.

If you are able to maintain a healthy state, we would just have you return for regular periodic maintenance cleaning and monitoring. If a healthy state cannot be maintained at this stage, however, we would most likely recommend surgical treatment. Surgical treatment is usually aimed at re-shaping the gum and bone around the teeth, to create reduced depths that will allow you to clean it more easily, with a reasonable effort.

So how is this different from earlier approaches?

While the sequencing of treatment is similar to earlier approaches…i.e.: if initial treatment is inadequate, the next step is surgery…, much more is possible now to make the initial treatment more likely to succeed. And even if the initial treatment is not quite successful enough, more is available now to help you help yourself at home even in the face of greater than ideal gum crevice depths.

So, while I don’t see non-surgical treatment as an alternate choice to surgical treatment, I do see it as an alternative possibility to regaining health. Surgery still has its place…but its place now is often later in the sequence of treatment than it used to be and in many instances, is not needed at all!

What is the initial phase of treatment?

Once it has been determined that you might have a periodontal problem, an appointment will be recommended to gather detailed information that will be used to confirm whether or not a problem exists, and if so, to what extent. If there is a problem, treatment recommendations will be suggested. Clinical examination would include careful measurements by probing the gum crevices and examination of a full set of oral x-rays. X-rays more than six months old – certainly any older than twelve months old – would be of little relevance in evaluation the current status of active periodontal disease.

Deep cleaning of areas of active disease would usually be planned next. Most often one half of the mouth is treated during one appointment. Usually, the area is numbed and the teeth and gums are treated using instruments similar to those used in a normal “cleaning”, except it is much more extensive. Antibiotics and other medications may be used, depending on your specific situation.

Optimally, all areas will have been completed in one month, or two months at most. You will be coached in techniques to be used at home to help the healing process. An appointment will be set to re-evaluate in about one month. At the re-evaluation appointment, recommendations will be made regarding increased or different home care techniques to try for awhile. Often, more evaluations of gum health will be recommended, for a period of up to one year.

If a surgical procedure is recommended, you can rest assured that this recommendation would come only after trying home care as the first line of treatment.

This handout was written in the hope that it will increase understanding about a topic that is important to dental health. Obviously, it is only part of the whole story. If you have questions after reading this, please don’t hesitate to ask us your questions, or to call our office.