Treatment for Gum Diseases

Improved oral hygiene
Like many other conditions, the best type of treatment is prevention. It is important to brush and floss regularly. Brushing should be done twice a day using proper technique. Flossing should be performed once a day and again, it is important that the technique be proper. Electric toothbrushes may be of use in some situations, but care must be taken not to brush too hard with one and to select one that has been proven to be effective.

There are other items that might be helpful depending on a person’s particular condition. These include:

• Proxabrushes
• Rubber tip stimulators which can be used when there are large spaces between the teeth.
• Sulca brush
• End tufted brush.

Scaling and Root planing
Scaling and root planing refers to a cleaning of the root surface by a hygienist, dentist or periodontist. Scaling refers to cleaning off larger pieces of tartar (which hold the bacteria and their toxins); root planing involves smoothing out the root surface so it is harder for tartar to attach to it. In addition, root planing allows us to remove diseased and infected parts of the root surface. When the tartar and bacteria are removed, there may be a reduction in the amount of gum inflammation. In these instances there may be some recession of gums and there can be an increase in the spacing between teeth. Teeth may be a bit more sensitive to hot, cold or sweets.

Sometimes it is suggested to have sessions of scaling and root planning more frequently than the average 6-9 month interval. This may be suggested to maintain gum health after treatment, or instead of surgical treatment if there is a lot of inflammation and not much bone loss.

Open flap Curettage
Studies have shown that when the pockets are too deep (over 5 mm) scaling and root planning offers limited benefits. This is because the instruments cannot adequately reach down deep enough to get access to the tartar. Additionally, when the pockets are deep, the person doing the scaling and root planning cannot see where they are cleaning. An example is trying to clean your elbows with long sleeves. Unless the sleeves are rolled up it is very hard to get access to clean. In these situations, it is preferable to gently detach the gums slightly from the teeth. This allows the operator to gain access and vision to all areas of the tooth surface so that they can be well cleaned. It also allows some of the infected gum tissue to be easily removed. The gums are then sutured back against the teeth.

After curettage, the pockets are shallower and so the patient has an easier time cleaning the root surface afterwards. The possible side effects are spaces between the teeth that may also be more sensitive to hot, cold or sweet.

Osseous pocket reduction Surgery
At times, the primary goal of the surgery is to reduce the pocket as well as clean the root surface. This is called pocket reduction surgery. Like curettage, the gums are detached from the teeth. During pocket reduction surgery, however, more of the bone around the teeth has to be reduced so that the gums will fit more intimately. This allows the root surfaces to be cleaned by the patient after the procedure. The side effects (spaces between teeth and sensitivity) are a little more pronounced after pocket reductions and sometimes bone must be removed from adjacent teeth that don’t have gum disease.


Regeneration
In certain situations, we can attempt to grow back bone that has been lost. This procedure is referred to as regeneration. Regeneration involves placing a material: either bone, an artificial substitute of bone or a protein into the area of bone loss (the bone defect). Regeneration cannot even be considered in many areas and even when it is attempted in ideal conditions, the results are not predictable. The most common technique used for regeneration now involves the placement of a protein into the bony defect. This protein is one that is around in humans as we develop in the uterus to form the tissues around the teeth. After it is placed, the gums around the teeth that have been regenerated cannot be cleaned for at least 6 months to a year and it may take at least that long for any evidence of bone growth to occur.



Extraction
Sometimes a tooth has experienced a lot of bone loss and there is a large infection around it. In these situations, we may have to consider removing a tooth or teeth. This is usually done when it is felt that keeping the tooth will cause problems to other teeth around it or to a patients health in general. Often times teeth are removed so that the patient can have dental implants.

Maintenance/ Cleaning appointments
None of the above treatments are cures. There is NO CURE for gum disease. The treatments above serve to clean the root surface and remove the infection. There is always bacteria in the mouth, however, and if we do not brush and clean properly the food we eat will also feed the bacteria and infections will start again.

The best way to maximize the benefits of treatment and prevent the disease from coming back is to:

1. Improve cleaning at home

2. Get a professional cleaning (hygienist, dentist or Periodontist) at the suggested frequency. Often, 3 months between cleanings is suggested because studies have shown that it takes about 3 months for the bacteria to turn into those that can destroy bone and the tissues supporting the teeth. If someone has remained stable over time while having their teeth cleaned every 3 months, then the interval between cleanings can be lengthened.

3. Try to reduce any destructive habits such as smoking.

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