From the Guidelines
The recommended treatment for periodontal disease involves a comprehensive approach starting with professional dental cleaning called scaling and root planing, which removes plaque and tartar from below the gumline and smooths rough spots on tooth roots. This initial therapy is crucial for reducing bacterial load and inflammation, and it should be followed by meticulous oral hygiene at home, including twice-daily brushing with fluoride toothpaste, daily flossing, and antimicrobial mouth rinses containing chlorhexidine (0.12%, used twice daily for 30 seconds) or essential oils 1.
For moderate to severe cases, adjunctive treatments may include localized antibiotics such as minocycline microspheres (Arestin) or systemic antibiotics like amoxicillin (500mg) with metronidazole (250mg) three times daily for 7-14 days, as studies have shown significant reduction in probing depth and clinical attachment level gain with these treatments 1. However, the use of systemic antibiotics should be based on individual patient needs and medical history, as some guidelines recommend against the use of antimicrobials for chronic periodontitis or peri-implantitis 1.
Advanced cases might require surgical interventions including flap surgery, bone and tissue grafts, or guided tissue regeneration. Regular maintenance visits every 3-4 months are crucial for long-term success, as they help to prevent further bone and tissue loss that characterizes periodontal disease progression. The American Dental Association recommends the use of systemic sub-antimicrobial dose doxycycline (20 mg twice daily for 3-9 months) as an adjunct to scaling and root planning for chronic periodontitis 1.
Key points to consider in the treatment of periodontal disease include:
- Professional dental cleaning and scaling and root planing as initial therapy
- Meticulous oral hygiene at home, including brushing, flossing, and antimicrobial mouth rinses
- Adjunctive treatments with localized or systemic antibiotics for moderate to severe cases
- Surgical interventions for advanced cases
- Regular maintenance visits for long-term success
- Consideration of individual patient needs and medical history in treatment planning.
From the Research
Treatment Options for Periodontal Disease
The recommended treatment for periodontal disease involves a combination of non-surgical and surgical therapies.
- Initial non-surgical periodontal therapy primarily consists of home care review and scaling and root planing 2.
- For residual sites with active periodontitis at periodontal re-evaluation, a contemporary regenerative or traditional resective surgical therapy can be utilized 2.
- Periodontal maintenance therapy at a regular interval and long-term follow-ups are also crucial to the success of the treatment and long-term retention of teeth 2.
Non-Surgical Therapies
Non-surgical therapies include:
- Mechanical plaque removal, which remains the bedrock of successful periodontal disease management 3.
- Professionally administered plaque control, which significantly improves gingival inflammation and lowers plaque scores 3.
- Use of re-chargeable power toothbrushes, which provide small but statistically significant additional reductions in gingival inflammation and plaque levels 3.
- Inter-dental cleaning devices, such as inter-dental brushes (IDBs), which are the device of choice for interproximal plaque removal 3.
Surgical Therapies
Surgical therapies include:
- Scaling and root planing (SRP) alone or in combination with systemic metronidazole and/or repeated professional removal of supragingival plaque 4.
- Use of local drug delivery systems, such as chlorhexidine gel, metronidazole gel, and tetracycline fibers, which can provide improved results when used adjunctively with mechanical cleansing 5.
Antibiotic Therapies
Antibiotic therapies include:
- Systemic metronidazole, which can be used in combination with SRP and professional plaque removal to treat chronic periodontitis 4.
- Local adjunctive antibiotics/antimicrobials, which can be used in the management of periodontal diseases, but should be used judiciously and based on an evidence-based approach 6.