Periodontal Disease - Prevention

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Antibiotics. At the time of scaling and root planning, your dentist may recommend the use of antibiotic medications. Because of the risk of developing antibiotic-resistant infections, antibiotics are recommended only when necessary (for example, in cases of severe active infection). Antibiotics for periodontal disease come in various forms. They may be taken as a prescription mouthwash rinse, or placed topically as dissolving gels, threads, or microchips into the periodontal pockets. In some cases, the dentist may prescribe a short course of systemic antibiotics in a low-dose of doxycyline taken in pill form.

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Surgical Treatment

Flap Surgery (Periodontal Pocket Reduction). Surgery allows access for deep cleaning of the root surface, removal of diseased tissue, and repositioning and shaping of the bones, gum, and tissues supporting the teeth. The basic procedure is known as flap surgery: It is performed under local anesthesia and involves:

• The periodontist makes an incision and folds back the gum surface away from the tooth and surrounding bone.
• The diseased root surfaces are cleaned and curetted (scraped) to remove deposits.
• Gum tissue is sewn back into a position to minimize pocket depth. The gum is covered with gauze to soak up any blood.
• The periodontist may also contour the remaining bone or attempt to regenerate lost bone and gingival attachment through bone grafts or guided tissue regeneration.

For several days following surgery, patients should rinse their mouths with warm salt water to help reduce swelling. Gauze pads should be changed. Post-surgical discomfort is usually treated with over-the-counter medications such as ibuprofen or the application of ice packs.

Gum Graft. In cases of excessive gingival recession, the periodontist may perform a gum (gingival) graft to cover the area of exposed root. There are various ways to perform the tissue graft. With a free gingival graft, a thin layer of tissue is removed from the palate of the mouth and sutured onto the exposed root surface. However, many patients find the healing of the donor site on the roof of the mouth to be more painful than the actual surgical procedure. An alternative method, called a subepithelial connective tissue graft, removes tissue from inside the palate (as opposed to the outside, as with the free gingival graft). Recovery is less painful with this method. A synthetic graft has been developed, but it is not yet clear if results are as successful as with the other graft methods.