Periodontal Therapy

Periodontal disease is the loss of jaw bone around your teeth caused by bacteria in your mouth. Bone loss is an irreversible process. If too much bone is lost around your teeth, your teeth will become loose and lost. Persons with periodontal disease have too many bacteria (that cause inflammation) around their teeth to cope with their immune system. These bacteria cover your teeth’ roots in a “biofilm” layer. They are above and below the gum margin in the gum pocket around your teeth. Usually, rough deposits of calculus (tartar) make complete removal of these bacteria from your teeth impossible without professional help (scaling and debridement).

Periodontal disease progresses through two main stages: gingivitis and periodontitis. Recognising the stage helps determine the right treatment approach.

Gingivitis

Gingivitis is the early, milder form of gum disease. It typically presents as swollen, red, and bleeding gums. At this stage, the teeth are still firmly positioned in their sockets and bone tissue damage has not yet occurred. Gingivitis can often be reversed with improved oral hygiene and professional dental cleaning by a dental hygienist.

Periodontitis

When gingivitis is left untreated, it can progress to periodontitis. At this more advanced stage, the bone supporting the teeth in the jaw may be lost, which can lead to loose teeth and eventually tooth loss. Unlike gingivitis, the bone loss caused by chronic periodontitis cannot be reversed — but progression can be slowed or halted with appropriate periodontal therapy.

Healthy gums are firm, pink (or a darker shade of pink), and do not bleed during brushing or flossing. If you notice any of the following symptoms, it may indicate gum disease at some stage:

• Swollen or puffy gums
• Red or darkened gums
• Gums that bleed when brushing or flossing
• Persistent bad breath or an unpleasant taste in the mouth
• Tooth sensitivity, particularly to hot or cold
• Pus between the teeth and gums
• Teeth that feel loose or have shifted position
• Receding gums (gums pulling away from the teeth)
• Dentures or bite that no longer fits properly

If you notice any of these signs, scheduling a dental assessment promptly can help prevent the condition from progressing. Call Pure Dentistry on 07 3343 4869 to arrange an appointment.

The primary cause of periodontal disease is the buildup of dental plaque — a sticky film of bacteria that forms constantly on the surface of your teeth. When plaque is not removed through regular brushing and flossing, it can harden into a calcified deposit called tartar (or calculus).

Tartar forms both above and below the gum line and cannot be removed with regular brushing at home. It requires professional removal during a dental cleaning appointment. Left in place, tartar irritates the gums and creates an environment where harmful bacteria can multiply, leading to inflammation and eventually bone loss around the teeth.

While periodontal disease is relatively common, certain factors may increase your risk:

• Poor oral hygiene — inadequate brushing and flossing allows plaque to accumulate
• Smoking or tobacco use — one of the most significant risk factors, and a common cause of treatment being less effective
• Genetics — a family history of gum disease can increase susceptibility
• Diabetes — people with diabetes may have a higher risk of developing infections, including gum disease
• Certain medications — some drugs, including certain cancer therapy medications and steroids, can affect gum health
• Hormonal changes — such as during pregnancy or when taking oral contraceptives
• Stress — can affect the body’s ability to manage infection
• Vitamin C deficiency

If you have a family history of gum disease or any of the risk factors above, regular dental check-ups are particularly important for early detection.

The treatment aims to make all your teeth as smooth as possible by removing any calculus (tartar) from the roots of the teeth and any rough edges from old fillings. Areas where food catches or jams/lodges also need to be attended to.

Once your teeth are as smooth as possible, it is your job to keep everything clean with a toothbrush, dental floss and Pikster/IP brushes (interproximal brushes) every day. We will show you how to do this.

Under local anesthetic, the teeth are cleaned of calculus (tartar) using ultrasonic instruments and hand scalers. Rough edges on old fillings are removed using polishing burs. Old fillings that are catching food may need to be replaced or modified.

Antibiotics may be prescribed

For patients with severe problems or who are in a high-risk category. These antibiotics are started 1 hour before treatment. Some antibiotics react badly with alcohol, so it may be that you cannot drink alcohol for five days while you are taking the antibiotic course. Painkillers (Panadol, Nurofen or Codeine) may be recommended, before and after treatment, to make the surgery and recovery more comfortable.

If you are apprehensive about treatment, you can be prescribed a mild sedative (Oral Valium/ Diazepam) to be taken an hour pre-operatively. However, you will not be able to drive nor operate machinery for the remainder of the day. You will need to be accompanied to and from your appointment by a responsible adult.

During Treatment

Once the teeth are fully anaesthetized, no pain should be felt at all during treatment. You will NOT be expected to feel any pain, and all necessary measures will be taken to ensure your comfort. Sometimes dissolving sutures (stitches) may be placed to ensure better healing.

Immediately after treatment

Your will be VERY numb and should not attempt to eat until the anesthetic wears off, in case you bite your cheek, lip or tongue. For some people, the anesthetic may last several hours after treatment.

The rest of that day

Strenuous exercise should be avoided on the day as this will increase pain and may start bleeding. Soft but nutritious food is recommended. Hot, cold and acidic foods should be avoided for the first few days

That night

Use the recommended mouthwash (es) and take the painkillers (if appropriate) but do not clean the teeth treated. They will be too sore.

The next day

Use the recommended rinses in the morning and evening and the antibiotics as prescribed. Start GENTLE but thorough cleaning, especially with dental floss and Pikster brushes. THIS IS VERY IMPORTANT. Often an electric toothbrush will be too sore from using at first, so a soft-bristled brush is recommended.

Post-Operative Complications

It is common for your teeth to be sensitive to hot AND ESPECIALLY TO COLD drinks and foods for the first few days or even weeks. This sensitivity will gradually subside. PROVIDED YOU CLEAN YOUR TEETH AS INSTRUCTED and that you use the fluoride mouthwash that we have recommended. There will be gum shrinkage in deep pocketing areas where the bone loss was most significant, which may lead to GAPS appearing between your teeth. Unfortunately, this gum shrinkage is inevitable and permanent. The bone lost due to the disease will not return, but treatment will help to prevent its progression.

First Review of healing

After three months, we perform a light cleaning of all your teeth to remove any new accumulated plaque and check that the gums are healthy. This is usually a 45-60-minute appointment with the dentist or dental hygienist. Any areas that are still inflamed can be identified and remedied.

Long Term Periodontal maintenance

It is essential that regular professional cleaning is performed on a regular and long-term basis. This maintenance might be three-monthly, four monthly or six-monthly, depending on the severity of your disease and the standard of your cleaning at home. The better you clean and floss, the less professional maintenance you will need.

Maintenance cleans are usually undertaken by a dental hygienist to reduce your costs. All the research worldwide shows that the most common cause of periodontal treatment being unsuccessful in the long-term is that patients fail to have regular maintenance cleaning.

Continuing to smoke is also a prevalent cause of failure.

Surgical Treatment Options

If nonsurgical treatments such as scaling and root planing cannot adequately reduce the depth of periodontal pockets, surgical options may be considered. These procedures are typically reserved for moderate to advanced cases.

Flap Surgery

Flap surgery (also called pocket reduction surgery) involves creating a small incision in the gum to lift a section of tissue, allowing your dentist to clean the tooth roots and repair underlying bone damage more thoroughly. Once the tartar and damaged tissue are removed, the gum flap is repositioned and sutured.

Gum Grafting

Soft tissue grafts can address gum recession, where the gums have pulled back to expose tooth roots. A small amount of tissue is taken from the palate or another donor source and attached to the affected area to cover the exposed root and reduce further recession.

Bone Grafting

When periodontal disease has caused significant bone loss around the teeth, a bone graft may be needed to help regenerate lost bone structure. This can also be necessary to prepare for dental implant placement if teeth have already been lost.

Guided Tissue Regeneration (GTR)

This procedure uses a biocompatible membrane placed between the gum tissue and bone to prevent soft tissue from growing into areas where bone regeneration is needed, encouraging new bone growth in the affected area.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Smoking and Periodontal Treatment

It is very well documented that most smokers DO NOT HEAL as well as non-smokers or reformed smokers. Periodontal treatment for smokers often leads to far more post-operative sensitivity and discomfort than others, and healing will be less predictable. Patients who cannot quit smoking are best advised to cut down as much as possible before any treatment and that their treatment may not be successful. Some studies suggest that low-level smoking (less than five cigarettes a day) has only a small effect on healing, but these patients must be almost perfect with their cleaning. Our advice is to stop smoking altogether, if possible for at least one month before treatment, to allow the immune system in your mouth to recover and to enable your gums to heal properly.

Periodontal Disease and Your General Health

There is definite medical evidence that “advanced” periodontal disease is an additional risk factor in Heart Disease in the same way that smoking, being overweight, and high cholesterol is risk factors. Bacteria from the mouth have been found in heart tissue in patients who have had heart attacks. This happens because, in ” Advanced” and “Very Advanced” diseases, there are so many bacteria around the teeth that they get into the general bloodstream, causing bacteremia or infection of the blood.

Whilst this does NOT mean that you will die from periodontal disease, you must be aware that severe periodontal disease is NOT suitable for your general health.

Other Health Connections

Beyond heart disease, research suggests that advanced gum disease may also be associated with an increased risk of other health conditions, including diabetes complications, pregnancy complications (such as premature birth or low birth weight), and stroke. While periodontal disease alone does not cause these conditions, managing gum health is an important part of supporting your overall wellbeing.