Once a dentist has diagnosed periodontal disease, there may be different treatment options depending on the type and severity of the condition. A good home oral care regimen of brushing twice daily and flossing to remove food and plaque is always a key component of the treatment plan. The dentist or dental hygienist may recommend brushing after every meal, which may require taking a toothbrush to work. Patients with advanced, severe or chronic periodontal disease may be referred to a specialist (periodontist) for surgical treatment.

Examples of treatments for the milder form of periodontal disease (gingivitis) include:

• Scaling. Scraping the teeth to remove all plaque and tartar (similar to the preventive cleanings performed every six months). Scaling is better than brushing and flossing because it gets to debris that may be trapped under the gum line. The hygienist probes and scrapes the tooth. This procedure that can be painful or uncomfortable for some, especially if gums are already sensitive. A topical analgesic, which numbs the nerves and usually eases the pain, can be swabbed onto the gums prior to and during cleaning. For hyper sensitive patients, stronger measures, such as anesthesia, may be used. An ultrasonic device, which sends out sound waves on high frequencies to break down plaque and tartar, may also be used.
  
  
• Polishing.  Buffing the tooth surface. Plaque has more difficulty forming on a smooth surface.
  
  
• Root planing. A deep cleaning of the root (cementum) eliminates crevices, holes or uneven surfaces that can harbor bacteria and plaque.
  
  
• Antibiotics. Mouthwashes and toothpastes containing antibiotics. The dentist may prescribe antibiotic mouth rinses, which kill bacteria on contact when swished in the mouth, or toothpastes that use antimicrobial agents to inhibit bacterial growth.

Some patients may require deep cleaning (debridement) more often than twice yearly (perhaps every three months or sooner) depending on how aggressively the disease progresses. Since deep cleanings take longer than a regular (twice yearly) cleaning, the hygienist typically cleans quadrants of the mouth during one of four appointments.

Those who have had certain procedures or who have some conditions (e.g., total joint replacements, rheumatoid arthritis, certain cardiovascular disorders) should inform their dentist. A dose of antibiotics taken an hour before the dental appointment may be required for these individuals. A periodontal deep cleaning can cause the harmful bacteria being scraped off the teeth and roots to flow into the bloodstream, leading to potentially life-threatening complications.

More aggressive non-surgical treatment options include:

• Local antibiotics. Deliver medications to the infection site to control bacteria. Antiseptic “chips,” antibiotic gels and micro-spheres can be placed into the periodontal pockets after root planing and scaling. These items deliver antibacterial medication in slowly-released doses (one to seven days) directly to the infection site to control bacteria growth.
  
  
• Broad spectrum antibiotics. Periodic doses of antibacterial drugs. For severe infection, some dentists may prescribe broad-spectrum antibiotic pills for 10 to 14 days. However, there is uncertainty over how effective these drugs are in controlling periodontal disease compared to medications that deliver antibiotics directly to the infection site. Of more concern is that the risk that the anaerobic bacteria that causes periodontal disease can build up a resistance to the antibiotic and make the drugs less effective in fighting off other, more harmful bacterial infections.
  
  
• Enzyme suppressors. Drugs to block periodontal issue erosion. There are prescription drugs that suppress the growth of the enzymes that destroy gum and bone tissue when the body’s immune system reacts to periodontal infections.

More severe periodontal cases – where deep pockets of 5 millimeters (mm) or more are present – may not respond to the typical treatment regimen and surgery may be required. There are several possible procedures:

• Flap surgery. Also called gum flap surgery, this procedure involves cutting a flap in the gums and pealing the tissue back to expose the roots to more thorough scaling and planing. The periodontist can also reshape the alveolar bone or put in splints to support weakened areas.
  
  
• Curettage. Scraping bacteria off of gum tissue using a sharp instrument called a curette.
  
  
• Gum grafts. When healthy gums have eroded or died, it may be necessary to cover the exposed roots with tissue taken from the roof of the mouth (palate). The periodontist cuts a piece of palate tissue and sews (sutures) it onto the gum line. Donor tissue may also be used for this procedure.
  
  
• Bone grafts. If the alveolar bones that anchor teeth to the jaw are destroyed by the infection, the periodontist may attempt to repair the damage by attaching a piece of the patient’s own bone or synthetic bone material to the site. This provides a more stable anchor for the teeth and may help prevent tooth loss.
  
  
• Guided tissue regeneration. Periodontists attempt to stimulate new bone growth by placing a mesh of biocompatible material into the area of the bone graft between the bone and gum.

The effectiveness of each of these treatments or surgeries varies depending on oral hygiene and smoking habits of the patient and whether there are other underlying systemic diseases.