Treatment of Gum Diseases

The ultimate goal of gum treatment is to get the gum tissue and underlying bone back to a healthy state, and then to keep it that way. There are many different types and forms of treatment that are used in combination with each other to help achieve the goal.

Treatment of gum disease should be planned in phases: the sanitive phase, the corrective phase, and the maintenance phase.

The sanitive phase strives to help to reduce or eliminate the active infection and inflammation from the gums.

The corrective phase serves to reform, reshape, and rebuild the gums and bone to make them more resistant to future disease, and to make home care easier to perform.

The maintenance phase helps to keep the tissues healthy and inflammation low - this is the "for-a-lifetime" phase.

Progression through the first two phases of therapy may take many months, as initial healing and response to therapy can be quite variable from person to person, and optimal waiting times to move from the first phase to the second phase are therefore also varied.

Some forms of therapy may be described and non-surgical, while others are surgical. The full scope of treatments used in each phase must be personalized to suit the patient’s needs and desires.

Scaling and Root Planing:The mechanical removal of plaque and tartar from the surfaces of the teeth above and below the gumline, may be done using directly using sharp scaling hand instruments, or with scaler tips that vibrate ultrasonically. The surfaces of the roots are planed to make them as smooth as possible to reduce bacterial attachment and promote reattachment of gum tissue. For more severe cases, local anesthetic may be necessary to ensure patient comfort during the process, and treatments may be spread out over a number of appointments such that one quarter or one half of the mouth is focused on at a time. Systemic antibiotics: For patients with weaker immune systems or very aggressive bacterial infection, taking antibiotics for a few weeks or longer while working through the sanitive phase may be helpful to help reduce the number of bacteria that can survive and repopulate the gum pockets. Systemic anti-collagenase: There is an antibiotic called Doxycycline that has been shown to reduce the action of a special enzyme that is created within the patient’s own gums (by the immune system) that serves to destroy the natural integrity of the gums even further. This antibiotic is taken is very small doses such that it has no anti-bacterial capability, only anti-enzymatic, and is routinely taken for a period of 6 to 9 months. This is a controversial adjunctive treatment, but there have been some credible scientific studies in humans that point to a definite usefulness. Anti-bacterial mouthrinses: Medicated mouthrinses made of chlorhexidine help to reduce the growth of bacterial colonies in the mouth, specifically in and around the gums. Again, this is useful during the sanitive phase or after surgical treatments, but is not meant to be a permanent practice. Occlusal Equilibration (bite adjustment): This refers to the slight adjustment of the biting surfaces of certain teeth to relieve them of heavy bite spots and distribute the forces of chewing and clenching/grinding more evenly across many teeth. Splinting: Teeth that have reduced support due to bone loss become less able to cope with the stresses of chewing and clenching/grinding, so further gum and bone breakdown my occur. Splinting a group of teeth together allows teeth with weakened support to gain support from neighboring ones, and therefore reduce trauma to one single tooth. Bruxism Appliances (bite guards): These are appliances that are worn at night and/or day, and help to protect the teeth from heavy forces that are created in people who have strong clenching or grinding habits. The heavy bite forces are absorbed and distributed by the acrylic appliance, so that the teeth and supporting gum and bone structures are not overloaded.

No one really looks forward to the prospect of having “surgery “ to their gums and jawbone, but very often it is necessary to help re-establish and create a form that allows for reduced inflammation, and actually prevents further destruction.

Some surgical procedures may be done in the sanitive phase, while others must be done once the main level of infection and inflammation is reduced greatly. This is because actively infected gum and bone tissue do not heal well or predictably.

To keep things simple, the description of surgical treatments can be classified and those that reduce the level of gum and/or bone around the teeth, and those that add volume and gum and/or bone back to the area.

Pocket-Reduction Therapy : During this form of treatment, the gums are lifted back, and the root surfaces can be carefully cleaned of all tartar buildup that could previously not be seen. In some cases, irregular surfaces of the damaged bone are smoothed in order to limit the areas where disease-causing bacteria can hide. The gums are then placed back so that they fit more snugly around the teeth and in a slightly higher position compared to before. Once healing has occurred, the teeth may look longer and there may be larger spaces between the teeth, but personal oral hygiene will by much easier to perform and maintain. In the long term, the chance of inflammation and infection returning will be greatly reduced.

Bone Regeneration Therapy (Bone Grafting): There are certain types of bony defects under the gums that have been created by the progression of disease around teeth that are treatable with techniques that promote and stimulate bone to grow and fill in. These techniques use either artificial bone-like materials or bone harvested from the patient (localized scrapings), harevested from other humans (cadavers), or from other animal species (i.e. bovine). Rest assured that any bone sources other than your own are completely safe and have been treated numerous ways to kill any forms of bacteria or viruses. There are also very specially refined blood elements mixed in with the graft material that serve to turn on the bone-making cells of the individual.

placing bone graft material	gums closed over the graft	patient’s natural bone regenerates into graft material

Gum Regeneration With Gum Grafting: Gum recession that has occurred with or without the presence of infection can generally be treated with gum grafts. Sometimes the exposed area of tooth can be re-covered with the graft, and other times the graft will simply strengthen the gum and prevent further recession. Prior to the procedure, contributing factors must be identified and controlled. As part of this form of treatment, a small piece of donor grafting tissue is taken from the palate (roof of mouth) where the tissue is firm and plentiful, and transplanted into the recipient area. Because this technique uses the body’s own tissue, there is really no chance of rejection. Therefore, this type of therapy creates two surgical sites at once, but these generally are kept small and heal uneventfully.