During this examination we will need to know your medical history as this will identify any underlying factors such as smoking or diabetes that may contribute towards gum disease. We will also gently probe your gums to measure any pockets or gaps that are developing in between your teeth and gums.
Healthy gums usually have a pocket depth of between one and 3 mm and anything beyond this can indicate gum disease. In addition, we may take x-rays to assess any bone loss and to more clearly visualize the extent of the infection. The main aim of treatment is to control the infection through removing as much bacteria as possible.
Every type of periodontal therapy will require a good oral care at home to help maintain the results and to improve treatment outcome. We may also suggest you make other changes to your lifestyle, for example quitting smoking.
Non-surgical Periodontal Therapy
Scaling and Root Planing
Scaling and root planing is similar to a conventional cleaning but it goes deeper to more thoroughly clean the teeth and gums. During this treatment plaque and tartar are scaled or removed from above and just below the gum line from any tooth surfaces that may be exposed. Root planing smooths any rough spots on the tooth roots, making it harder for plaque bacteria to stick to the smooth surfaces.
Afterwards, your gums will be much cleaner and more able to heal. Scaling and root planing may need to be carried out at regular intervals to help bring the infection under control.
We may prescribe various medications to help control bacterial levels. These medications might include a prescription antimicrobial mouth rinse containing a substance called chlorhexidine which is used just like a regular mouthwash. Sometimes medications are placed topically into the pockets after root planing.
These medications help control bacteria and reduce the size of the periodontal pockets and may be in the form an antibiotic gel or tiny microspheres containing antibiotics. In addition, you may need to take oral antibiotics.
Surgical Periodontal Therapy
Surgical therapy may be used to help clear up more extensive infection that may have developed in the periodontal pockets. It may help regenerate any bone or gum tissue destroyed by periodontitis.
Flap surgery is carried out if you have deep pockets that are inflamed even after scaling and root planing and medications. Flap surgery is used to help remove tartar deposits and can reduce the overall size of the periodontal pocket making it easier to keep this area clean. This type of surgery is quite common and involves lifting back the gums and removing the tartar and any diseased tissue.
Often, bone reduction or augmentation will also be done in order to prevent recurrence of the periodontal pockets. Afterwards the gums can be sutured back into place so they fit more snugly around the teeth. As the gums begin to heal, the periodontal pockets will shrink and the gum tissue will fit more tightly around the teeth. Sometimes this type of surgery can result in teeth appearing longer.
Bone and Tissue Grafts
Nowadays there are sophisticated procedures that can help regenerate bone or gum tissue that has been destroyed by periodontal disease. Bone grafting can use natural or synthetic bone to help promote the growth of your own bone. One particular technique is called guided tissue regeneration and involves the use of mesh like material that is inserted in between the gum tissue and bone. This prevents the gum tissue from growing into the area where the bone used to be and allows the bone and connective tissues to gradually regenerate.
If you have lost gum tissue then you may need a tissue graft. Sometimes gum tissue is taken from another area in your mouth while other times a synthetic material will be used to cover up exposed to tooth roots.
For more information about periodontal disease or Periodontal Disease Treatment in NYC talk to top periodontists, best specialists Dr. Daniel Royzman and Dr. Daria Royzman or contact our Manhattan, NYC center: 212-759-7763