Periodontitis

Diagnosis

The diagnosis of periodontitis involves asking the symptoms, examining one’s medical history for any elements that might be connected to the symptoms, and looking for plaque and tartar accumulation in the mouth, as well as any signs of easy bleeding.

The stage of periodontitis is determined based on the severity of the condition, the difficulty of the required care, one’s own risk factors, and general health. To confirm the diagnosis, other tests may be required, such as:

• Dental X-rays: This imaging test can identify oral health problems like cavities and gum disease before they get worse. This is often requested to look for bone loss when the healthcare provider notices wider pockets.
• Measurement of pockets between the gums and teeth: The pocket depth in a healthy mouth typically ranges between 1 and 3 millimeters. Greater than 4 mm-deep pockets might be a sign of periodontitis. With ordinary treatment, pockets that are 5 mm or deeper cannot be effectively cleaned. This procedure requires inserting a small ruler known as a dental probe between the teeth and gumline to determine the depth of the pockets between the gums and the teeth.

Treatment

Treatment for periodontitis depends on the extent of the gum disease. The objective of treatment is to fully resolve the pockets around the teeth and protect the surrounding bone and gum tissue from harm. Consistent daily oral hygiene routines, addressing any medical conditions that may impact dental health, and quitting smoking can be beneficial in managing the condition. Typically, treatment for periodontitis encompasses a combination of surgical and non-surgical approaches.

• Nonsurgical treatments: For mild to moderate cases of periodontitis:
  • Antibiotics: Oral antibiotics may be prescribed to combat infection. Topical antibiotics may be applied under the patient’s gums to target the affected area. It might also take the form of antibiotic mouthwashes.
  • Scaling: During the procedure, a vibrating tool called an ultrasonic scaler is used. The scaler’s vibrating metal tip removes tartar above the gums, a water spray washes it away, and any remaining bits of tartar are scraped off with a manual tool called a curette.
  • Root planning: This procedure is like a deep cleaning for the teeth. The healthcare provider carefully cleans the roots of the teeth under the gums, making them smooth. In some cases, an antibiotic medication is applied directly into the gum pockets to help with any infection. This helps in re-attaching the gums to the teeth.
• Surgical treatments: For moderate to severe periodontitis:
  • Flap surgery: In flap surgery, the gum tissue is momentarily lifted away from the teeth by creating an incision along the gum line. This allows for more efficient scaling and root planning by exposing the tooth roots. If bone loss has occurred due to infection, the healthcare provider may perform a procedure to reshape the underlying bone ridge. This alteration makes it significantly easier to maintain proper cleaning and hygiene in the treated areas once they have healed.  This procedure is also known as pocket reduction surgery.
  • Soft tissue grafts: This procedure can prevent additional gum loss, cover exposed roots, and improve the appearance of the teeth. It involves taking a small amount of tissue from the roof of the mouth or obtaining it from another donor source and attaching it to the affected area. When gum tissue is lost, it can cause the gumline to recede, revealing parts of the tooth roots. Some of the tissue that has been injured may need to be reinforced through soft tissue grafts.
  • Bone grafting: Graft serves as a support structure for new bone growth with the goal of reducing the person’s risk of future infections and tooth loss. In this process, bone-grafting material is placed in the areas where bone tissue has been lost, which can be the person’s own bone, donated bone, or synthetic material. Bone grafting is often recommended when periodontitis destroys the bone surrounding the tooth root.
  • Guided tissue regeneration: In this procedure, a special membrane between the existing bone and the tooth is placed. This membrane stops unwanted tissue from growing and enables bone that was damaged by bacteria to regenerate instead.
  • Tissue-stimulating proteins: A gel that encourages the formation of healthy bone and tissue and contains the same proteins that are present in forming tooth enamel may be applied directly to the affected tooth root.
  • Platelet-rich plasma (PRP): During the procedure, the healthcare provider collects a blood sample from the individual and uses a centrifuge to separate the platelet-rich plasma from the red and white blood cells. The platelet-rich plasma is then placed in the deficient areas to stimulate the growth of new bone tissue. PRP can aid in the regeneration process among people who experienced bone or gum tissue loss.