A periodontal treatment is a specific treatment to treat periodontitis (pyorrhea). Periodontitis is an infection that affects the supporting tissues of the tooth. Once the patient is diagnosed with periodontitis, the treatment phases are organized as follows:
Phase 0: Periodontal study
- Clinical examination: Measurements are taken in 6 locations per tooth (periodontogram), evaluating the bone loss per tooth and also the amount of gingival recession. This gives us an objective assessment of the state of the tissues surrounding the tooth before starting treatment. Plaque index (PI) and indentation index (SI) are also performed. The PI shows us the areas where the brushing technique is not correct and the IS shows us the areas where there is more inflammation.
- Radiological examination: A serial radiographic examination is performed consisting of 16 periapical radiographs (small radiographs). These radiographs allow us to assess in greater detail the bone loss and type of bone loss, as well as other possible scenarios such as caries or infections.
- Microbiological examination: In advanced cases, this test allows us to know what type of bacterial flora exists in order to administer a more effective antibiotic during treatment.
Phase 1: Scaling and root planing
This consists of the removal of calculus (tartar) under the gums by means of a combined treatment with curettes and ultrasound. This phase is performed under local anesthesia, therefore, it should never be uncomfortable for patients. Normally, this phase is performed in two sessions with a week’s interval. In advanced cases it is combined with antibiotic treatment.
Phase 2: Re-evaluation
After 6-8 weeks of phase 1, we will again perform the periodontogram (measurements in 6 locations per tooth), to evaluate the patient’s response to the phase 1 treatment. If we have already reduced the pockets we will consider the periodontal treatment phase to be concluded (75% of cases). However, if we still have pockets (25% of cases) we will move on to phase 3.
Phase 3: Periodontal surgery
In advanced cases, where phase 1 does not manage to remove all the tartar, we perform a small intervention where we slightly lift the gum, allowing us to access the tartar adhered in the deep areas of the root and allows us to regenerate the lost tissues in the indicated cases. In this phase we will also treat by means of microsurgical techniques: gum recession, short tooth syndrome (gummy smile), dental implants in case of absence of any dental piece.
Phase 4: Maintenance
Periodontal disease is a chronic pathology, therefore, in order to control it we need the patients to have exquisite hygiene techniques and to come to the monitoring (maintenance) check-ups. In these visits we will control tooth by tooth the possible advance of the periodontitis. We will control hygiene techniques by means of the Plaque Index, inflammation by means of the Bleeding Index and we will insist on hygiene instructions.
These visits are not uncomfortable or painful because we have the latest technology that improves the patient’s experience.
What are the causes of periodontal disease (periodontitis)?
Periodontitis is a multifactorial inflammatory disease. There are different factors that cause the development and progression of the disease. The main factor is the bacterial plaque that is deposited on the enamel or roots of the teeth by a bad toothbrush, the second factor may be genetic susceptibility causing a greater progression or development of the disease. There are other aggravating factors such as smoking or systemic diseases that can promote the development of the pathology.
What are the signs of periodontal disease?
The most obvious symptoms of periodontal disease are:
- Bad odor or taste in the mouth: due to the metabolism of bacterial plaque.
- Displacement of teeth or tooth mobility: due to the loss of supporting tissues.
- Longer teeth: caused by gum recession.
What are the risks of this type of disease?
The disease has consequences on the health, function and esthetics of the teeth. On many occasions, the loss of the supporting structures of the teeth is irreversible, therefore the prognosis will always be better the sooner it is treated and prevention will be our best way to combat it.