Periodontitis diagnosis and treatment

Most people occasionally have some inflammation and bleeding of the gums. This usually isn’t a major problem, at least at first. However, when left untreated, this inflammation, otherwise known as gingivitis, may worsen and cause damage to the soft tissue and bone responsible for keeping our teeth anchored. This more severe form of gum disease is an infection referred to as periodontitis. Over time, periodontitis can cause teeth to loosen or be lost.

Maintaining healthy oral habits and going for regular dental checkups can prevent gingivitis from becoming periodontitis. If you develop periodontitis, treatment performed by a dentist or hygienist can stop or slow down the progression of this serious gum infection. Often, more challenging periodontal care, particularly surgical care, is provided by a periodontist, a dentist with advanced training in the prevention, diagnosis, and treatment of periodontal disease.  Treatment works best when accompanied by good at-home care and control of risk factors for periodontal disease. Let’s take a closer look at how periodontitis is diagnosed and treated.

How is periodontitis diagnosed?¹

During a routine dental checkup, your dentist will be able to detect signs of periodontitis at an early stage. Therefore, it is important to schedule regular dental visits at least once a year. Your dentist can determine whether you have or are at risk for periodontitis and its level of severity using the following method:

• Review of medical history — Your dentist will review your medical history to identify potential risk factors that could contribute to your periodontal symptoms, such as smoking, teeth grinding, poor nutrition, stress, certain diseases like diabetes, and some medications.
• Examination of the mouth — Your dentist will assess your mouth for plaque or tartar buildup and check for gums that bleed easily.
• Measurement of gum pocket depth — Your dentist may place a dental probe at sites around your teeth to check the attachment of the gums to the teeth. Pockets deeper than 4 millimeters may be an indicator of periodontitis.
• Dental X-ray evaluation — If your dentist observes pocket depths that are deeper than normal, they will usually take dental X-rays to check for potential bone loss.

What are the treatment options for periodontitis?²

Periodontitis treatment aims first to thoroughly clean plaque and tartar from the pockets around teeth and prevents further damage to the surrounding bone and gum tissues. Successful treatment is only possible when you adopt a daily routine of good oral care and manage health conditions and habits that may impact your dental health. There are two types of treatments depending on the severity:

Nonsurgical treatments for early stages

If periodontitis isn’t advanced, treatment may involve minimally invasive procedures, including:

• Scaling — Typically performed using instruments or ultrasonic devices. Scaling removes tartar and plaque bacteria from the tooth and root surfaces above and beneath gums.
• Root planning — Smooths the root surfaces to discourage further tartar and bacteria buildup. In addition, this technique removes bacterial byproducts that cause inflammation and delay healing.
• Scaling and root planning — Sometimes referred to as a “deep cleaning.” It is typically only done when you already have a diagnosis of periodontitis with some bone loss present.
• Topical or oral antibiotics — May be given to help control bacterial infection.

Surgical treatments for advanced stages

If periodontitis is advanced, surgical treatments may be required, such as:

• Gingival flap surgery (pocket reduction surgery) — During flap surgery, tiny excisions are made in your gum. In doing so, a section of gum tissue can be lifted back, exposing the roots for more successful scaling and root planing. This procedure may help reduce the depth of pockets around your teeth, making it easier to keep them clean and prevent further disease.
• Bone grafting — Bone grafting is performed when periodontal disease has destroyed some of the bone surrounding your tooth root. The bone graft helps prevent tooth loss by providing additional support and serving as a platform for natural bone regrowth.
• Soft tissue grafts — If you start to lose gum tissue and your gum line recedes, then  graft surgery can help cover the exposed root, protect the remaining gum tissue, and prevent further recession and bone loss. This is done by removing a small amount of tissue from the roof of your mouth or other donor site and attaching it to the affected site. Grafts can also protect previously exposed roots from decay and sensitivity and make for a more esthetic smile.
• Regenerative procedures — These more advanced procedures can sometimes help your body regrow some of the bone and gum tissue lost as a result of periodontitis.

Final thoughts

Periodontitis can be prevented if early gum problems like gingivitis are detected and treated early enough. But if you have periodontitis, then routine dental checkups with your dentist are crucial to ensure that your periodontal disease doesn’t progress. To avoid the problem getting worse, you may need more frequent dental visits. For successful treatment, it is important to maintain excellent oral hygiene habits, control risk factors like smoking or bruxing, and closely follow your dentist’s instructions.

Additional resources

Looking for more information? Learn more about periodontitis:

• Gum disease overview
• Periodontitis overview
• Common causes of periodontitis

Sources

Mayo Foundation for Medical Education and Research. (2020, February 14). Periodontitis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/periodontitis/diagnosis-treatment/drc-20354479.