Non-surgical periodontal treatment is the first step or phase in treating periodontal disease. It consists of oral hygiene instruction with scaling and root planing. It is sometimes called "deep cleaning" and often performed using local anesthetic ("Novacaine") by the general dentist or their hygienist. In more severe cases, the general dentist will refer to the periodontist for this procedure. In all cases, it consists of carefully removing contaminants from the root surfaces under the gums using special instruments. The analogy of removing a splinter to get rid of the source of the infection is a good one. This usually resolves swelling of the gums and the majority of the inflammation pending the initial severity.
Antibiotics can be used either locally in the deep pockets or in severe cases, systemically using pills.
The post-operative discomfort is generally minimal consisting of an awareness that is controlled by warm salt water and over the counter analgesics or non steroidal anti-inflammatory drugs such as Tylanol or Advil.
In severe cases of periodontal disease where the roots are not covered by the gums, the roots may become sensitive to cold. If they are sensitive, toothpastes such as Sensodyne or prescription toothpaste such as Prevident-5000 can be used to correct this symptom. When using these agents, it is best to not rinse the mouth afterwards, instead, leave a residual film on the teeth to allow time for the agents to soak into the roots of the teeth.
Typically 4 to 6 weeks are allowed for the effects of excellent oral hygiene and healing to take place before evaluating the amount of disease resolution. Pending the results, either more homecare, more root planning or surgical treatment will be considered.
If there are isolated areas of inflammation with minimal bone loss, the use of an endoscope to aid in the removal of diseased root surface accretions can be used. This is an instrument that allows us to look under the gums and magnify up to 48x to visualize possible residual problems causing the disease. If these problems can be corrected, then we are often able to see dramatic results.
If there is extensive bone loss, then periodontal flap surgery is indicated. This is a procedure that allows for grafting of bone to regenerate lost tissue. We are lucky now to have available techniques and materials such as platelet derived growth factor that increase the healing capacity of our tissue to regenerate what was lost.
| Back |
| Home |