The treatment of periodontitis aims at freeing the whole of the teeth and the gums from the inflammation and at preventing a new degradation. If periodontitis is discovered early, a basic treatment of the inflammation is often sufficient. However, if this does not work or if the periodontitis has progressed further, additional surgical interventions are necessary. In both cases, patients with periodontal disease need constant follow-up by the dentist.
Periodontics, the basic treatment:
Good oral hygiene is a prerequisite for successful treatment of periodontal disease. In a comprehensive consultation, the dentist (or a specially trained professional) should explain to the patient how to use a conventional or electric toothbrush, dental floss and interdental brushes. As a demonstration, plaque is often made visible with tooth staining tablets before the dentist removes them.
Sub-gingival cleaning is also very important, i.e. the removal of bacterial plaque and tartar from under the gums, on the dental necks and exposed dental roots. This is called "closed" periodontal treatment because the gums are not opened. The dentist cleans the gum pockets under local anesthesia, usually with fine instruments (curettes or scalers), an ultrasound device or rotary instruments. Alternatively, subgingival instrumentation with a laser may be considered.
The dentist also smoothes the accessible areas of the tooth roots to prevent bacteria from reattaching. The edges of crowns and protruding obscurations are also smoothed.
As part of the basic periodontal treatment, the patient can also opt for a professional dental cleaning: the teeth are cleaned, polished and (especially) fluoridated.
- Antibiotics for more severe forms:
Basic treatment is often sufficient to stop the inflammation underlying periodontal disease. In severe cases, however, additional antibiotic therapy may be necessary. Patients are usually prescribed antibiotic tablets for this. Sometimes antibiotics are also applied locally by applying them directly into a gum pocket in the form of a gel or ointment. In order to select an appropriate antibiotic, it may be helpful to first determine what bacteria are in the patient's gum pockets using laboratory tests.
Periodontics, surgical procedures:
Surgical periodontal treatment (previously called open periodontal treatment) includes cleaning of deep gum pockets, regeneration of periodontal structures, and plastic surgery to restore the gums, if needed.
It begins with the cleaning of the deep pockets of the gums. To do this, the dentist opens the pockets through a small incision under local anesthesia. This makes it easier to access areas that are infected with bacteria. Next, the dentist cleans the exposed root areas and removes the diseased tissue. Finally, he or she sutures the cut so that the gums are once again pressed against the tooth. With this procedure, the gums are supposed to adhere better and the pockets are eliminated (gum pocket removal).
Regeneration of the tooth support system becomes necessary when long-term or aggressive periodontitis has already destroyed so much connective tissue and bone that the teeth lose their anchorage.
Be aware that bone tissue degraded by periodontitis can be partially rebuilt with a bone graft. Bone tissue from the body is usually used as a graft (autologous bone graft). The dentist removes it from the back of the patient's jaw in a small operation and transplants it into the defective area (bone pocket).
Alternatively, demineralized and freeze-dried bone tissue from another person can be transplanted: the dentist obtains such allogenic bone grafts from tissue banks.
The grafts can only improve the existing bone structure - complete regeneration has not yet been possible with them.
Periodontics, the dentist's follow-up:
Because periodontitis is a chronic disease, good follow-up care must be implemented over the long term, especially if the gums are already receding. Because then the necks and roots of the teeth are exposed and are therefore much more prone to cavities, because they are not protected by a layer of enamel like the teeth.
The follow-up consists of :
- Consistent oral hygiene;
- Regular visits to the dentist;
- Regular professional cleaning of the teeth (possibly several times a year).
Dentists often recommend a structured follow-up for their periodontitis patients - called "periodontitis support therapy". This includes visits to the dentist every three months up to a maximum of 12 months (depending on the degree of periodontitis). At these appointments, the dentist checks the success of the periodontal treatment so far, checks the oral hygiene and cleans the teeth.
Controlling risk factors, including smoking and diabetes, is important for successful periodontal treatment. Periodontitis patients should refrain from smoking and control their diabetes with medical help.