How do you treat periodontal disease?

Treatment of Periodontal Disease

The treatment of periodontal disease requires a combination of professional mechanical plaque removal, antimicrobial therapy, and consistent oral hygiene practices to effectively control bacterial infection and reduce inflammation. 1

Diagnosis and Classification

Before initiating treatment, proper diagnosis is essential:

• Gingivitis: Reversible inflammation of the gums without attachment loss
• Periodontitis: Irreversible disease with destruction of tooth-supporting tissues (gums, periodontal ligaments, cementum, bone) 1

Treatment Approach

Phase I: Initial/Cause-Related Therapy

1. Professional Mechanical Plaque Control

   • Scaling and root planing (detartraj) to remove bacterial plaque and tartar 2
   • Professional brushing to disrupt biofilm formation 2

2. Antimicrobial Therapy

   • Local antimicrobial agents:

     • Hyaluronic acid (Gengigel): Apply twice daily for 2-4 weeks as an adjunct to mechanical plaque control 2
     • Natural product mouthwashes:
       • Aloe vera (10ml twice daily for 21 days)
       • Triphala (10ml twice daily for 2 weeks)
       • Curcumin 20% (twice daily for 21 days) 2

   • Systemic antibiotics (for advanced periodontitis with multiple abscesses):

     • Amoxicillin, tetracycline, doxycycline, minocycline, clindamycin, or combined therapy of amoxicillin with metronidazole 1
     • Note: Use with caution due to growing antibiotic resistance concerns

3. Patient Education and Home Care

   • Detailed instructions on proper plaque control measures 3
   • Regular brushing and flossing
   • Use of antimicrobial mouthwashes

Phase II: Surgical Therapy (If Needed)

For cases that don't respond adequately to non-surgical treatment:

• Surgical elimination of pathologically deepened pockets 3
• Regenerative surgical techniques for vertical bone loss 4

Phase III: Periodontal Reconstruction (If Needed)

• Procedures to restore lost periodontal tissues
• Note: Horizontal bone loss is generally considered irreversible as no techniques are currently available to restore the lost alveolar crest and interdental septa 4

Phase IV: Periodontal Maintenance

• Regular recall appointments every 3-6 months 3
• Ongoing assessment of:
  • Oral hygiene
  • Gingival conditions
  • Probing depths
  • Clinical attachment levels
  • Radiographic evaluation of bone height 3

Special Considerations

Patients with Systemic Conditions

• Diabetes: Periodontal disease adversely affects diabetes outcomes. Intensive periodontal treatment has been associated with better glycemic control (A1C reduction from 8.3% to 7.8%) and reduction in inflammatory markers 5

• Chronic Kidney Disease (CKD): Patients on dialysis have poorer periodontal conditions and require:

  • More frequent dental examinations
  • Careful monitoring for gingival bleeding (due to altered coagulation)
  • Management of gingival enlargement (common side effect of medications like calcium channel blockers) 5

Effectiveness and Prognosis

• Gingivitis is completely reversible when treated properly 1
• Periodontitis is irreversible but can be effectively managed with periods of exacerbations, progressions, and remission 1
• Long-term studies show that proper treatment and maintenance can sustain periodontal health for 14+ years in most patients 3
• However, a small percentage of sites may experience recurrent disease, emphasizing the importance of regular maintenance 3

Emerging Therapies

Research is exploring alternative approaches to combat bacteria responsible for periodontitis, including:

• Bacteriophage therapy
• Predatory bacteria therapies 1

These approaches may offer solutions to address antibiotic resistance concerns but require further research before clinical implementation.