Dr Tank talks treatment of periodontal disease
In the final part of a 3-part blog our Specialist Periodontist, Dr Manoj Tank, talks about how to go about ensuring the successful treatment of periodontitis.
In my first blog on gum disease prevention, I mentioned two simple preventive things you can do to keep your teeth clean and ensure your gums are screened on a regular basis by your dentist.
In my second blog on bacteria and the causes of gum disease, I went into a bit of geeky science about bacteria and how their accumulation upon our teeth leads to the breakdown of the periodontal ligament and surrounding bone, leading to gum pockets. Understanding this is important if we are to now consider how we treat periodontitis.
Understanding the extent of the problem
The first step after your initial screening test for the gums is for your dental professional to act upon the findings. I mentioned in the first blog that if any area of the mouth achieves (for want of a better word perhaps) a score of 3 or 4, this will require further assessment. Initially, an x-ray of that area will inform the dentist whether you have lost any bone from around your teeth. This is important to rule out a ‘false positive’ screening result. You may then require a full and detailed assessment of each tooth in order to accurately measure the gum pockets around your teeth to understand the extent and severity of your gum disease. If there are any complicating factors, your dental professional may advise you to see a specialist periodontist (expert in gum disease, like myself) for this assessment and any subsequent treatment.
Stage 1: Hygiene Phase
Treatment of periodontitis is typically carried out in stages. I like to call the first stage the hygiene phase. This would involve a good general clean up of your teeth in order to remove the superficial plaque and calculus (‘tartar’, which is the hardened plaque). This then allows you to access all the sides of your teeth to keep clean at home. This phase also involves showing you all the right oral hygiene tools to use and exactly how to use them in order to control the plaque at an exceptional level, which is very important if you want to treat and control the disease. It may also be necessary to arrange a quick review to ensure that you have kept up your plaque control levels. This is vital if we want to move on to the next stage.
Stage 2: Active Treatment Phase
The second stage is the active treatment phase. Initially, this would involve cleaning any further plaque and calculus deeper down on the root surfaces within your gum pockets. Cleaning all this thoroughly using specially designed instruments allows the inflammation to subside and the gums to start healing. You will notice yourself that the gums feel more comfortable, bleeding is minimised and the mouth feels fresher. You will also notice that the gaps between your teeth will increase (these gaps are actually already there but hidden by the inflamed and enlarged gums between the teeth), and therefore your teeth will appear longer and your teeth may be sensitive at first (but this should be controlled using toothpaste for sensitive teeth).
Stage 3: Reassessment
After a period of healing, we carry out a full reassessment in order to analyse the healing that has occurred and remeasure all the gum pockets accurately. If there are still some deep gum pockets, these will require further corrective treatment as we know that any pockets of 6mm+ are highly likely to deepen over time and therefore risk future loss of the tooth. Further treatment may involve minor surgical procedures designed to reduce the pocket or even regenerate the lost bone and ligament tissue around your teeth where possible.
Stage 4: Maintenance Phase
Once all your pockets have healed, you would enter the maintenance phase. This involves regular monitoring of your gum condition, as you will always be susceptible to the disease recurring, combined with professional cleaning of your teeth and any shallow gum pockets that may remain. This would typically be carried out on a 3-monthly basis because many scientific studies have shown that to be the most appropriate interval in order to maintain periodontally-compromised teeth long-term. If any deterioration is detected in the gum health then it may become necessary to carry out further active periodontal therapy again.
What does successful treatment of periodontitis look like?
In the below example, you can clearly see the improvement in gum health with the reduction of gum inflammation, but the side effect of gum recession.
So you can see that there are a lot of aspects to periodontal disease and once you have it, unfortunately you will be susceptible to it for life.
The key to treatment success is excellent plaque control at home, limiting risk factors like smoking and diabetes, treatment of the gum inflammation to allow good healing to occur and reduction of all pockets to reduce the environment where the bad bacteria can live under the gum line which we are unable to clean on a daily basis.
If you would like to understand more about periodontal disease and it’s treatment, I would direct you to the website of the British Society of Periodontology (www.bsperio.org.uk). Alternatively, please contact the patient care team on firstname.lastname@example.org or 0333 0162 230 and the team will be happy to help point you in the right direction.
Thanks for reading!
BDS (Brist) MJDF RCS (Eng) MClinDent (Perio) MPerio RCS (Eng)
Manoj is our Specialist in Periodontics, which means he has carried out further intensive training after his initial dental degree to master the clinical understanding and treatment approaches to periodontal conditions and diseases that can occur in the mouth. He has been working at our Camberley practice in Surrey since 2013 and provides all aspects of non-surgical and surgical periodontal treatment including dental implant treatment. He is also trained in “drill-free dentistry” techniques such as laser treatments and air polishing.
He accepts referrals from other dentists in the region and has been involved in the teaching of dental students and qualified dentists. He is a Faculty member of the British Society of Periodontology, in recognition of his involvement in teaching and education, and in 2018 he will be on its Executive Council. Manoj is also a member of the European Association for Osseointegration and has presented clinical cases and research both nationally and internationally, winning the Ron Wilson Research Prize awarded by Kings College London.
Manoj adopts a gentle, caring and understanding approach and works with his patients to gain the very best treatment outcomes. You will always feel safe in his hands and he will always be open to answer any questions you may have.