The "Scaling" is typically done using local anesthesia, with very small ultrasonically powered probes ("micro ultrasonics"). This cleaning technique thoroughly cleans diseased roots and pockets with micro ultrasonic vibrations of the instrument and highly energized flushing of water irrigation. (Patients who are anxious about treatment can elect to be orally sedated before the local anesthesia and during the treatment.)
Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, antibiotics may be placed in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.
After the initial procedure, patients typically have little or no discomfort, and a re-evaluation is performed after 4-6 weeks to check the initial response to treatment.
When deep pockets between teeth and gums are present, it is difficult to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.
Even in most severe cases of periodontal disease, non-surgical periodontal therapy most often precedes surgical therapy. This is done so that the overall tissue quality is improved prior to surgery and also limits the areas of required surgery.
Surgical Periodontal Therapy
After a comprehensive examination and initial non-surgical treatments, pockets may remain that are too deep to clean with daily at-home oral hygiene and routine professional care.
After the areas have been meticulously cleaned, defects in the jaw bone surrounding the teeth are corrected in one of two ways to decrease the depth of the pre-existing pockets:
- Osseous Surgery
- Periodontal Regeneration
In cases where surgery is not, or cannot, be performed, or in very advanced cases, there are often residual pockets after treatment. The deeper these pockets, the more guarded the long-term results will be. We try to reduce pockets as much as we can. With a shallower pocket, the hygienist is able to clean more thoroughly at recall appointments, and the patient is able to remove a greater percentage of the plaque that forms.
Periodontal disease may be considered a chronic disease, and for that reason a complete "cure" is usually not possible. Patient susceptibility may continue to be high, and the cause of infection, plaque, is always present in the mouth. Daily vigilance is needed to control the disease and keep the gums in good health. Even with the best care, certain areas may lose ground, although the vast percentage of patients who follow good maintenance can expect to have their teeth for their lifetime.
In summary, the treatment of periodontal disease focuses on removing bacterial plaque and calculus that forms under the gums. In more severe cases, surgery is used to provide access for scaling, and to reduce pocket depth so the patient can more effectively access and remove plaque from their teeth at home. Good oral hygiene along with regular periodontal maintenance appointments (recalls) will help preserve the teeth for a lifetime.