How Is Gum Disease Treated?

Non-surgical Treatment of Gum Disease

  •       Periodontal Scaling. During periodontal scaling, your dentist or dental hygienist will remove the plaque (bacteria) and tartar (calculus) from all the teeth, above the gum line. If there are signs of gum disease (bleeding gums, redness, tenderness), your dentist may recommend periodontal scaling more than twice-a-year. 
  •       Periodontal Scaling and Root Planing. This is a cleaning of the roots above as well as below the gum line typically performed under a local anesthetic, and commonly referred to as a “deep cleaning”.  Plaque (bacteria) and tartar(calculus) above and below the gum line are scraped away (scaling) and rough spots on the root are made smooth (planing). Smoothing the rough spots removes bacteria and provides a clean surface for the gums to reattach to the teeth. Scaling and root planing is done if your periodontist determines that you have infected gum pockets with plaque (bacteria) and tarter under the gums that need to be removed.

Surgical Treatment of Gum Disease

  •       Pocket Reduction or Flap Surgery. During this procedure, small gum line incisions are made and the gums are pushed back to allow visualization of the roots to better remove the bacteria and tartar under the gum line. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can re-colonize. The gums are then repositioned and secured with stiches.  This procedure reduces the depth of the gum pockets improving oral hygiene.  This procedure also minimizes the areas where harmful bacteria can grow reducing the risk for serious health problems such as diabetes and heart disease. 
  •       Bone Grafts. This procedure allows for repair of bone damaged by gum disease.  Bone graft materials may be derived from your own jaw, donated from human source, bioengineered or synthetic.  Bone grafts serve as a scaffold for the regrowth of bone, which can increase tooth stability and decrease “deep pockets”. 
  •       Soft Tissue Grafts. This procedure treats thin gums or fills in places where gums have receded away from tooth roots.  Soft Tissue Grafts can be obtained from your own mouth, donated from human or procured from animals.  Soft tissue grafts are inserted beneath or on top of the existing gum tissue and stitched in place, increasing the quantity as well as thickness of the existing gum which promotes better long term health of the gums. 
  •       Guided Tissue Regeneration. If the bone supporting your teeth has been lost due to gum disease, this procedure can sometimes be used to stimulate bone repair. Performed in combination with flap surgery, a small thin sheet of material referred to as a “membrane” is inserted between the bone and gum tissue, creating a wall around the bone defect. This membrane protected wall keeps the gum tissue from growing into the area allowing the bone to repair. 
  •       Osseous Surgery.  During flap surgery, the bone around the tooth is reshaped to decrease the irregularities created from gum disease.   This allows for better adaptation of your gums to the tooth roots and underlying bone which reduces the depth of the gum pockets.  Reducing pocket depths makes it harder for bacteria to collect and grow..

Drugs Used to Treat Gum Disease

  •       Various antibiotic and antimicrobial agents can be used to reduce or temporarily eliminate the bacteria associated with gum disease.  Some of these agents can also suppress the destruction of the bone’s attachment to the tooth. Antibiotics or antimicrobials can be used in combination with non-surgical, surgical and other therapies.
  •       Chlorhexidine Gluconate is an antimicrobial used to control plaque (bacteria) in the mouth or within periodontal pockets. The medication can be used as a mouth rinse or found in a gelatin-filled chip that slowly releases the Chlorhexidine within the pockets after root planing. Antibiotics used in low dosages, including doxycycline and minocycline, are also be used to treat gum disease.

  Lasers Used to Treat Gum Disease

What is a laser?

  •       A laser is an instrument that emits light by stimulating emissions of electromagnetic radiation through the process of optical amplification.  The word LASER is actually an acronym for Light Amplification by Stimulated Emissions of Radiation.  Today, lasers are used across a broad spectrum of industries and are commonplace in both medicine and dentistry.  Certain types of lasers are now used to treat gum disease around teeth as well as around dental implants.

Is there more than one kind of laser?

  •       There are many types of lasers used in dentistry and in the specialty of periodontics.  Every laser device works within a specific range of wavelength.  Since there are so many different laser wavelengths, there are many different types of laser device.  In addition, the energy power and time of laser application plays a role.   Therefore, all lasers are not the same and can’t be used to treat the same things.  In 2015 there were approximately four different laser devices approved by the FDA for the treatment of periodontal disease in the United States.

How are lasers used for periodontal disease treatment?

  •       Only certain laser devices have been approved for the treatment of periodontitis.  None of these devices however has been approved as stand-alone therapy.  Laser therapy is used as an adjunct to classical treatment procedures such as scaling and root planing (deep cleaning).  The laser is carefully applied below the gum line usually under a local anesthetic.  The energy emitted from the laser is selectively absorbed and reflected by the various structures beneath the gum including the bacteria.  The use of the laser in conjunction with classical treatment leads to improved gum health. 

How effective is laser treatment?

  •       Studies have shown that one specific laser device and treatment protocol in particular can actually regenerate lost gum and bone tissue due to periodontal disease. Other studies have shown that lasers can reduce inflammation and kill bacteria.   Laser periodontal treatment appears very promising but additional long term studies are needed.

Can lasers cause any harm to my gums?

  •       Different laser wavelengths interact differently with all the different structures in the mouth. If a laser that is FDA approved to treat cavities is used to treat gum disease, it will likely be ineffective and possibly damage the gum tissues and supporting bone.  Other variables such as power settings and time of application are also very important and if not used appropriately can cause harm.  Laser periodontal therapy requires a trained practitioner to properly use the device in order to achieve a favorable outcome and avoid tissue damage. 
  •       Feel free to contact a member of the California Society of Periodontists for more information on the use of lasers and if it’s right for you.