Treatment of Gum Disease
The goal of periodontal treatment is to control any infection that exists and to halt progression of the disease. Treatment options involve home care that includes healthy eating and proper brushing and flossing, non-surgical therapy that controls the growth of harmful bacteria and, in more advanced cases of disease, surgery to restore supportive tissues.
Although brushing and flossing are equally important, brushing eliminates only the plaque from the surfaces of the teeth that the brush can reach. Flossing, on the other hand, removes plaque from in between the teeth and under the gum line. Both should be used as part of a regular at-home, self-care treatment plan. Some dentists also recommend specialized toothbrushes, such as those that are motorized and have smaller heads, which may be a more effective method of removing plaque than a standard toothbrush.
John J. Golski, D.D.S., a Frederick, Md., periodontist, says that the rationale behind flossing is not "just to get the food out." From the periodontal standpoint, Golski says, "You're flossing to remove plaque which is the real culprit behind gum disease," adding that proper brushing and flossing techniques are critical.
During a typical checkup your dentist or dental hygienist will remove the plaque and tartar from above and below the gum line. of all your teeth. If you have some signs of gingivitis, your dentist may recommend that you return for future cleanings more often than twice a year. Your dentist may also recommend that you use a toothpaste or mouth rinse that is FDA-approved for fighting gingivitis.
In addition to containing fluoride to fight cavities, Colgate Total is the only toothpaste approved by the FDA for helping to prevent gingivitis -- also contains triclosan, a mild anti microbial that has been clinically proven to reduce plaque and gingivitis if used regularly. A chlorhexidine-containing rinse, also approved to fight plaque and gingivitis, is available only with a prescription.
If your dentist determines that you have some bone loss or that the gums have receded from the teeth, the standard treatment is an intensive deep-cleaning, non-surgical method called scaling and root planing (SRP). Scaling scrapes the plaque and tartar from above and below the gum line. Root planing smooths rough spots on the tooth root where germs collect and helps remove bacteria that can contribute to the disease. This smooth, clean surface helps allow the gums to reattach to the teeth.
A relatively new drug in the arsenal against serious gum disease called Periostat (doxycycline hyclate) was approved by the FDA in 1998 to be used in combination with SRP. While SRP primarily eliminates bacteria, Periostat, which is taken orally, suppresses the action of collagenase, an enzyme that causes destruction of the teeth and gums.
Periodontal procedures such as SRP, and even surgery, are most often done in the office. The time spent, the degree of discomfort, and healing times vary. All depend on the type and extent of the procedure and the person's overall health. Local anesthesia to numb the treatment area usually is given before some treatments. If necessary, medication is given to help you relax. Incisions may be closed with stitches designed to dissolve and may be covered with a protective dressing.
Susan Runner, D.D.S., chief of the Dental Devices Branch in the FDA's Center for Devices and Radiological Health, says that devices have been approved both for diagnosing gum diseases and promoting regeneration of periodontal tissue.
"Periodontal membranes, along with bone-filling material, are used in treatment of the condition to help repair damage resulting from periodontal disease," Runner says. "Tissue engineering devices mimic the biological characteristics of the wound-healing process, and may help stimulate bone cells to grow."
Opinions about which treatment methods to use vary in the periodontal field. For some people, certain procedures may be safer, more effective, and more comfortable than others may be. Which treatment your dentist or periodontist chooses will most likely depend on how far your disease has progressed, how you may have responded to earlier treatments, or your overall health.
"Generally, we all have the same goals, but the methods for getting to them may be different," says Golski. "One size doesn't fit all." Professional treatment can promote reattachment of healthy gums to teeth, reduce swelling, the depth of pockets, and the risk of infection, and stop further damage.
"But in the end," Golski says, "nothing will work without a compliant patient."
Antibiotic treatments can be used either in combination with surgery and other therapies, or alone, to reduce or temporarily eliminate the bacteria associated with periodontal disease.
However, doctors, dentists and public health officials are becoming more concerned that overuse of these antibiotics can increase the risk of bacterial resistance to these drugs. When germs become resistant to antibiotics, the drugs lose the ability to fight infection.
"The resistance we're worried about," explains Robert Genco, D.D.S., Ph.D., chairman of the oral biology department at The State University of New York at Buffalo, "is in association with antibiotics in the traditional use; those at higher levels in the blood that kill bacteria."
Jerry Gordon, D.M.D., of Bensalem, Pa., shares Genco's concerns. "There is a role for antibiotics in periodontal disease," Gordon says, "but you have to be very selective in your use."
Each time a person takes penicillin or another antibiotic for a bacterial infection, the drug may kill most of the bacteria. But a few germs may survive by mutating or acquiring resistance genes from other bacteria. These surviving genes can multiply quickly, creating drug-resistant strains. The presence of these strains may mean that the person's next infection will not respond to another dose of the same antibiotic. And this overuse would be detrimental to people if they develop a life-threatening illness for which antibiotics would no longer be helpful.
John V. Kelsey, D.D.S., dental team leader in the FDA's dermatologic and dental drug products division, says, "The widespread use of systemic antibiotics is generating resistant organisms, and that's a problem." And that fact, he says, "has prompted the industry to develop new strategies that would reduce the risk of resistance developing."
For example, three relatively new drugs, Atridox (doxycycline hyclate), PerioChip (chlorhexidine gluconate), and Arestin (minocycline) are antibiotics that were approved in sustained-release doses to be applied into the periodontal pocket. Local application of antibiotics to the gum surface may not affect the entire body, as do oral antibiotics.
Oral Health and Overall Health
According to the Centers for Disease Control and Prevention (CDC), researchers have uncovered potential links between periodontal disease and other serious health conditions. In people with healthy immune systems, the influx of oral bacteria into the bloodstream is usually harmless. But under certain circumstances, the CDC says, the microorganisms that live in the human mouth can cause problems elsewhere in the body "if normal protective barriers in the mouth are breached."
If you have diabetes, for example, you are at higher risk of developing infections such as periodontal disease. These infections can impair the body's ability to process or use insulin, which may cause your diabetes to be more difficult to manage. Diabetes is not only a risk factor for periodontal disease, but periodontal disease may make diabetes worse.
However, the CDC cautions that there is not enough evidence to conclude that oral infections actually cause or contribute to cardiovascular disease, diabetes and other serious health problems. More research is underway to determine whether the associations are causal or coincidental.
Other Common Measures for Treating Gum Disease
- Curettage -- a scraping away of the diseased gum tissue in the infected pocket, which permits the infected area to heal.
- Flap surgery -- involves lifting back the gums and removing the tartar. The gums are then sewn back in place so that the tissue fits snugly around the tooth. This method also reduces the pocket and areas where bacteria grow.
- Bone grafts -- used to replace bone destroyed by periodontitis. Tiny fragments of your own bone, synthetic bone, or donated bone are placed where bone was lost. These grafts serve as a platform for the regrowth of bone, which restores stability to teeth.
- Soft tissue grafts -- reinforce thin gums or fill in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place over the affected area.
- Guided tissue regeneration -- stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.
- Bone (osseous) surgery -- smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.
- Medications -- in pill form are used to help kill the germs that cause periodontitis or suppress the destruction of the tooth's attachment to the bone. There are also antibiotic gels, fibers or chips applied directly to the infected pocket. In some cases, a dentist will prescribe a special anti-germ mouth rinse containing a chemical called chlorhexidine to help control plaque and gingivitis. These are the only mouth rinses approved for treating periodontal disease.