Periodontal Disease Treatment

What is Periodontal Disease?

Periodontal treatment is necessary when the gums and bone that hold teeth in place become compromised. Some causes of periodontal disease include improper dental hygiene and maintenance, various medical conditions, and smoking. Healthy gums enhance the appearance of your teeth, like a frame around a beautiful painting. When the gums are not healthy, they can recede or become swollen and red. In later stages of periodontal disease, the supporting bone in the jaw is destroyed and the teeth can shift, loosen, or fall out. These changes not only affect your ability to chew and speak, they also affect your smile and can have a negative impact on your sense of self.

Periodontal diseases are ongoing infections of the gums that gradually destroy the support of the natural teeth. Periodontal disease can affect one or more of the periodontal tissues—alveolar bone, periodontal ligaments, cementum, or gingiva. While there are many diseases that affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues. These inflammatory lesions are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the two diseases, may never progress into periodontitis, it always precedes periodontitis.

Dental plaque is the primary cause of gingivitis. Plaque is a sticky, colorless film composed primarily of food particles and various types of bacteria that adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. The bacteria found in plaque produce toxins or poisons that irritate the gums. The gums may become inflamed, red, and swollen, and may bleed easily. If this irritation is prolonged, the gums will begin to separate from the teeth causing pockets, or spaces, to form. If daily brushing and flossing is neglected, plaque can harden into a rough, porous substance known as calculus, or tartar. Calculus can occur both above and below the gum line.

If gingivitis progresses into periodontitis, the supporting gum tissue and bone that holds teeth in place deteriorates. The progressive loss of this alveolar bone can lead to loosening and subsequent loss of teeth. Periodontitis is affected by bacteria that adhere to the tooth’s surface, along with an overly aggressive immune response to the bacteria.

Periodontal disease is dangerous in that it is often painless and symptomless. Eighty percent of Americans will be afflicted with periodontal disease by age 45, and four out of five patients with the disease are unaware they have it. It is important to maintain proper oral care at home and schedule regular dental visits to reduce the risk of developing periodontal disease.

Preventing Gum Disease

Clean your teeth thoroughly once a day (preferably last thing before going to bed). The usual advice is to brush twice a day because sometimes people skip a brushing or not do it thoroughly, because they’re in a rush or because they are too exhausted at the end of a long day.

Use a specific direction for cleaning and stick to it. Always start in the same place and always finish in the same place, with the direction in between the same each time. Any route that reaches every surface of every tooth is fine. The important thing is that whatever route you choose, stick to it. If the brush always goes in the same direction then you’re less likely to miss some areas while doing others twice.

Especially difficult or awkward areas need extra attention, as with those areas more prone to problems. These are different for each individual, so talk about it with a dentist or hygienist.

When to see a Periodontist

Gum disease is a condition that can easily creep up on you before you realize there’s even a problem. It’s not like a tooth abscess, which causes pain you can’t ignore. Instead, the warning signs of periodontal disease are more subtle. Most people experience little or no pain until the later stages of periodontitis. This means you need to be especially vigilant in monitoring gum health. Here are some common gum disease symptoms that indicate you may need a consultation with a periodontist:

Gum Redness, Swelling and Bleeding

Your gums should be an even pink tone that doesn’t vary much in color across your gum line. If you see areas that are bright red or purplish in color, this is an indication of inflammation. Check all your teeth including those in the back of your mouth (a small dental mirror can help). You may find areas of redness around your molars where it is more difficult to brush effectively. Plaque or tartar along your gum line is causing this inflammatory reaction by irritating the sensitive tissues of the gum. The tartar can actually act like a splinter, constantly rubbing on your gums.

The gums may puff out away from the surface of your teeth due to inflammation. The surface of your gums may take on a very smooth, shiny appearance as the tissue swells up. You may find that your gums bleed easily when you brush and floss your teeth. Finally, you may notice that your breath tends to smell bad—regardless of what you eat or drink. Sometimes, these are simply symptoms of early gingivitis (inflammation that occurs before serious bacterial infection sets in). In that case, they should go away within a couple of weeks once you begin brushing and flossing correctly. If these symptoms of gum disease persist, you may need to see a periodontist to check for more advanced gum problems.

Gum Recession

As periodontitis progresses, you are likely to see changes in the contours of your gum line. One or more teeth may look longer than usual. This is due to the gums pulling away from the teeth and gradually deteriorating. The waste products created by bacteria (and by the white blood cells your body sends to fight the bacteria) can erode your gum tissue severely. Your gums may or may not hurt or be sensitive to the touch.

Scaling and Root Planing

Scaling and root planing, otherwise known as conventional periodontal therapy, non-surgical periodontal therapy, or deep cleaning, is the process of removing or eliminating dental plaque and calculus, which cause inflammation, leaving the periodontium free of disease.

Periodontal scaling procedures include the removal of plaque, calculus and stain from the crown and root surfaces of teeth. Root planing is a specialized skill involving scaling of the root of the tooth, made up of cementum. Because cementum is softer than enamel, it is affected more by ongoing build-up and inflammatory byproducts. A smooth cementum provides less opportunity for bacteria to accumulate and form calculus. So root planing is an important part of stopping the progression of periodontal disease, especially once deeper pockets have formed in the gums, which is really in the bone. Thus root planing is a specific treatment that removes the roughened cementum and surface dentin that is impregnated with calculus, microorganisms and their toxins. Scaling and root planing is one of the most effective periodontal methods of treating gum disease before it becomes severe.

Osseous Surgery

Osseous surgery is a procedure done when you have a pocket around a tooth (or teeth) that has not responded to other treatments. It is done in an effort to help you retain the tooth and create an environment that is easier for you to keep clean.

The surgical procedure is used to smooth and reshape the affected bone and create a shallow pocket that makes it more difficult for the more aggressive bacteria to survive. The surgery includes a thorough cleaning of the root surface. These steps make it harder for the bacteria to grow and multiply and to make it easier for the body to work toward self-repair.

The first step is to identify which teeth need surgery. The primary characteristic is that the pocket around the tooth, when measured by the periodontal probe, is 4mm deep or more. The gum around the tooth may also be red, inflamed, swollen, and bleed easily.

Surgery is generally done after most other treatments have been tried, but the pocket depth remains or has worsened over time.

When the surgical area is feeling numb from the local anesthesia, Dr. Manesh will make an incision in the gum tissue around the area to be treated, and lift the gum away from the tooth and underlying bone. This will allow the hygienist access and direct vision of the bone and tooth root surface. She will then use an instrument, either a hand instrument or a powered handpiece, to make sure the root surface is thoroughly cleaned.

When the roots have been cleaned (debrided) and the bone reshaped, the gum tissue is trimmed to match the new underlying structure and stitched in place. The stitches will hold the gum tissue in place while it heals.

Tissue Grafting

Three different types of gum tissue grafts are typically performed, depending on your specific needs. Graft procedures include:

Connective-tissue grafts

This is the most common method used to treat root exposure. During the procedure, a flap of skin is cut at the roof of your mouth (palate) and tissue from under the flap, called subepithelial connective tissue, is removed and then stitched to the gum tissue surrounding the exposed root. After the connective tissue—the graft—has been removed from under the palatal flap, the flap is stitched back down.

Free gingival grafts

Similar to a connective-tissue graft, free gingival grafts involve the use of tissue from the roof of the mouth. But instead of making a flap and removing tissue under the top layer of flesh, a small amount of tissue is removed directly from the roof of the mouth and then attached to the gum area being treated. This method is used most often in people who have thin gums to begin with and need additional tissue to enlarge the gums.

Pedicle grafts

In this procedure, instead of taking tissue from the palate, it is grafted from gum around or near the tooth needing repair. The flap, called a pedicle, is only partially cut away so that one edge remains attached. The gum is then pulled over or down to cover the exposed root and sewn into place. This procedure can only be done in people who have plenty of gum tissue near the tooth.

Crown Lengthening

Crown lengthening is a surgical procedure performed by Dr. Manesh to expose a greater amount of tooth structure for the purpose of subsequently restoring the tooth prosthetically. This is done by incising the gingival tissue around a tooth and, after temporarily displacing the soft tissue, predictably removing a given height of alveolar bone from the circumference of the tooth or teeth being operated on. While some general dentists perform this procedure, others frequently refer such cases to our office.


A frenectomy (also known as a frenulectomy, frenulotomy or frenotomy) is the removal of a frenulum, a small fold of tissue that prevents an organ in the body from moving too far. It can refer to frenula in several places on the human body. It is related to frenuloplasty, a surgical alteration in a frenulum. Done mostly for orthodontic purposes, a frenectomy is either performed inside the middle of upper lip, which is called labial frenectomy, or under the tongue, called lingual frenectomy. Frenectomy is a very common dental procedure in the dental world and is performed both on children and adults.