Diagnosis

To determine whether you have periodontitis and how severe it is, your dentist may:

  • Review your medical history to identify any factors that could be contributing to your symptoms, such as smoking or taking certain medications that cause dry mouth.
  • Examine your mouth to look for plaque and tartar buildup and check for easy bleeding.
  • Measure the pocket depth of the groove between your gums and teeth by placing a dental probe beside your tooth beneath your gumline, usually at several sites throughout your mouth. In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters (mm). Pockets deeper than 4 mm may indicate periodontitis. Pockets deeper than 6 mm cannot be cleaned well.
  • Take dental X-rays to check for bone loss in areas where your dentist observes deeper pocket depths.

Treatment

Treatment may be performed by a periodontist, a dentist or a dental hygienist. The goal of periodontitis treatment is to thoroughly clean the pockets around teeth and prevent damage to surrounding bone. You have the best chance for successful treatment when you also adopt a daily routine of good oral care and stop tobacco use.

Nonsurgical treatments

If periodontitis isn't advanced, treatment may involve less invasive procedures, including:

  • Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments, a laser or an ultrasonic device.
  • Root planing. Root planing smoothes the root surfaces, discouraging further buildup of tartar and bacteria, and removes bacterial byproducts that contribute to inflammation and delay healing or reattachment of the gum to the tooth surfaces.
  • Antibiotics. Topical or oral antibiotics can help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.

Surgical treatments

If you have advanced periodontitis, treatment may require dental surgery, such as:

  • Flap surgery (pocket reduction surgery). Your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. After you heal, it's easier to clean these areas and maintain healthy gum tissue.
  • Soft tissue grafts. When you lose gum tissue, your gumline recedes. You may need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This can help reduce further gum recession, cover exposed roots and give your teeth a more pleasing appearance.
  • Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
  • Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
  • Tissue-stimulating proteins. Another technique involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.

Lifestyle and home remedies

Try these measures to reduce or prevent periodontitis:

  • Brush your teeth twice a day or, better yet, after every meal or snack.
  • Use a soft toothbrush and replace it at least every three to four months.
  • Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.
  • Floss daily.
  • Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist.
  • Supplement brushing and flossing with an interdental cleaner, such as a dental pick, interdental brush or dental stick specially designed to clean between your teeth.
  • Get regular professional dental cleanings, on a schedule recommended by your dentist.
  • Don't smoke or chew tobacco.

Preparing for your appointment

You may start by seeing your dentist. Depending on the extent of your periodontitis, your dentist may refer you to a specialist in the treatment of periodontal disease (periodontist).

Here's some information to help you get ready for your appointment and what you can do to prepare.

What you can do

To get ready for your appointment, make a list of:

  • Any symptoms you're experiencing, including any that may seem unrelated to the reason for your appointment.
  • Key personal information, such as any medical conditions you may have.
  • All medications you take, including vitamins, herbs or other supplements, and the dosages.
  • Questions to ask your dentist to make the most of your time together.

Some questions to ask your dentist may include:

  • What's likely causing my symptoms?
  • What kinds of tests, if any, do I need?
  • What's the best course of action?
  • Will my dental insurance cover the treatments you're recommending?
  • What are the alternatives to the approach you're suggesting?
  • Are there any restrictions that I need to follow?
  • What steps can I take at home to keep my gums and teeth healthy?
  • Are there any brochures or other printed material that I can have?
  • What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your dentist

Your dentist may ask you questions about your symptoms. Be ready to answer them to reserve time to go over any points you want to focus on. Your dentist may ask:

  • When did you first start experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How often do you brush your teeth?
  • Do you use dental floss? How often?
  • How often do you see a dentist?
  • What medical conditions do you have?
  • What medications do you take?
  • Do you use tobacco products?
April 14, 2017
References
  1. Periodontitis (pyorrhea). Merck Manual Professional Version. http://www.merckmanuals.com/professional/dental-disorders/periodontal-disorders/periodontitis. Accessed Nov. 10, 2016.
  2. Periodontal (gum) disease: Causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research. http://www.nidcr.nih.gov/oralhealth/Topics/GumDiseases/PeriodontalGumDisease.htm#. Accessed Nov. 10, 2016.
  3. Gum disease information. American Academy of Periodontology. https://www.perio.org/consumer/gum-disease.htm. Accessed Nov. 10, 2016.
  4. Wilder RS, et al. Gingivitis and periodontitis in adults: Classification and dental treatment. http://www.uptodate.com/home. Accessed Nov. 11, 2016.
  5. Smiley CJ, et al. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planning with or without adjuncts. Journal of the American Dental Association. 2015;146:525.
  6. Gum disease. American Dental Association. http://www.mouthhealthy.org/en/az-topics/g/gum-disease. Accessed Nov. 11, 2016.
  7. Oral health. American Dental Association. http://www.mouthhealthy.org/en/az-topics/o/oral-health. Accessed Nov. 11, 2016.
  8. Periodontal treatments and procedures. American Academy of Periodontology. https://www.perio.org/consumer/treatments-procedures. Accessed Nov. 11, 2016.
  9. Brushing your teeth. American Dental Association. http://www.mouthhealthy.org/en/az-topics/b/brushing-your-teeth. Accessed Nov. 15, 2016.
  10. Salinas TJ (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 4, 2016.