Periodontology

How do you treat periodontitis?

There are two methods of treatment for periodontitis: The conservative method and the surgical method.

The conservative methods consist of educating the patient about a new programme of oral hygiene and the elimination of inflammation, through scaling and deep cleaning of the roots. The aim of this method is to remove the calculus from the teeth and to polish the root in order for the detached gingiva to become re-attached.

Often however, because of the severity of the disease, and the specificities of the teeth, the conservative method is not sufficient. For this reason, the problem can only be fully resolved with the help of surgery.

Finally, both methods may be accompanied by various drugs and/or techniques, according to the particular needs of each patient.

TREATMENT  OF PERIODONTITIS

“Perio” means around, “dont” means tooth and “itis” indicates infection. Periodontitis therefore, means infection surrounding the tooth, i.e. the bone, gums and ligament of the tooth. The course of the disease is usually slow and initially painless.

SYMPTOMS OF THE DISEASE:  

The disease initially begins with inflammation of the gingival (gingivitis), which includes:

    Red, swollen gums (vs healthy pink, firm gums)
    Gums that bleed during brushing and flossing (vs healthy gums that do not bleed)
    Bad breath and uneven contours of the gums.
     


Following gingivitis, the bone becomes affected, bone degeneration occurs, and the teeth become unstable. The height of the supporting bone decreases, gums recede to expose sensitive tooth necks, and the teeth loosen. Bone loss my be so severe that tooth extraction is the only recourse.

It is shocking to realize that the main cause of tooth loss in people over the age of 30 is not dental caries, but periodontitis.

The disease can be diagnosed by:

 

Measuring the depth of the sulcus (in periodontitis, pockets are deeper than 3mm)

   

Determining the bone levels with x-rays

   

The presence of bleeding when probing the sulcus.

Treatment depends on pocket depths—related to progression of the disease. Gingivitis is treated by conventional scaling and polishing and improved oral hygiene on the patients end.

As soon as the sulcus becomes deeper than 3mm, conventional brushing and flossing are ineffective, as plaque and calculus accumulate unhindered, leading to chronic infection and bone degeneration.

Initial periodontitis can be treated with root planning and curettage:

     

1. The pocket is deeper than 3mm & impossible to clean conventionally
2. The calculus is removed from the pocket with a scaler under anesthesia, leaving the tooth sooth and clean
3. The affected part of the gum is simultaneously cleaned away, this is called curettage
4. Normal gums will present 2 weeks post-operatively if excellent oral hygiene is maintained.

In cases where the bone has been extensively affected and deep pockets are found, the badly affected soft tissue and bone need to be removed surgically.

     

1. The supportive tissue has been extensively affected and deep pockets are present
2. The badly affected gums and infected bone are surgically removed
3. Once all the infected tissue has been removed, the bone is reshaped and contoured to a normal pattern
4. The gums are repositioned and sutured. After healing the gums should be healthy and easy to clean

 

Advanced periodontitis prior to treatment

 

After treatment – the patient can now practice effective oral hygiene to maintain healthy supportive tissues

Ps. After restoring the normal bone-gum relationship in advanced periodontitis, the point of gum attachment to the tooth will be further away from the tooth neck. As a result, the teeth will appear longer; tooth necks will be exposed and may be sensitive for a while.

Thank you to Dr. A.M Dippenaar for the use of his pictures and information from
– TEETH – An owner’s manual.

 

 

 

 

 

 

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