If you’ve been diagnosed with periodontal (gum) disease, the good news is that it often can be treated successfully.

The first nonsurgical step usually involves a special cleaning, called “scaling and root planing”, to remove plaque and tartar deposits on the tooth and root surfaces. This procedure helps gum tissue to heal and periodontal pockets to shrink. This is sometimes referred to as “periodontal cleaning” or “deep cleaning.”

Your dentist also may recommend medications to help control infection and pain, or to aid in healing. These medications could include a pill, a mouthrinse or a substance that the dentist places directly in the periodontal pocket after scaling and root planing.

At the next visit, the dentist checks the pocket depth to determine the effect of the scaling and root planing. At this point, many patients do not require any further active treatment, only preventive care. If the periodontal pockets are deep and the supporting bone is lost, surgery may be necessary to help prevent tooth loss. You may be referred to a periodontist, a dentist who specializes in the treatment of diseases that affect the supporting structures of the teeth-the gum and bone tissue-for treatment.

When periodontal pockets do not heal after scaling and root planing, surgery may be needed to better remove inflamed tissues and reduce the damage to the bone that has formed around the teeth. As the pockets enlarge, they provide a greater place for bacteria to live and attack the bone and tissue.

Surgery allows the dentist to access hard-to-reach areas under the gum and along the roots where tartar and plaque have accumulated. Eliminating this bacterial stronghold and regenerating bone and tissue help to reduce pockets and repair damage caused by the progressing disease.

Your dentist may recommend additional procedures. bone surgery, including bone grafts, is used to rebuild or reshape bone destroyed by periodontal disease. Membranes (filters), bone grafts or tissue-stimulating proteins may be used to encourage your body’s natural ability to regenerate bone and tissue.

Splints, bite guards or other appliances may be used to stabilize loose teeth and to aid in the regeneration of tissue during healing. If excessive gum tissue has been lost, a soft-tissue graft (gum graft) may be performed. A soft-tissue graft can reduce further gum recession and bone loss.

Soft-tissue grafts can be used to cover roots or develop gum tissue where excessive gingival recession has occurred. During this procedure, gum tissue is taken from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

Once your periodontal treatment is completed, your dentist will want to see you at regular intervals. Your appointments may alternate between your general dentist and a periodontist. Daily cleaning helps keep the plaque biofilm under control and reduces tartar formation, but it won’t completely prevent it. More frequent checkups and cleanings may be needed to keep your gums free of disease.

If you use tobacco, ask your dentist or physician for information about how to successfully stop the habit. Tobacco contains chemicals that can slow the healing process.

You don’t have to lose teeth to periodontal diseases. Brush, clean between your teeth, eat a balanced diet, avoid tobacco and schedule regular dental visits for a lifetime of healthy smiles.

-JADA, Vol. 136, January 2005