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Treatments and drugs

By Mayo Clinic staff

There are several ways to treat periodontitis, depending on its severity. The goal of periodontitis treatment is to thoroughly clean the pockets of bacteria and to prevent more damage. Treatment may be performed by a periodontist, a dentist or a dental hygienist. Treatment is most successful when you adopt a daily routine of good oral care.

Nonsurgical treatments
If your periodontitis isn't advanced, treatment can include less invasive procedures, including:

• Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments or an ultrasonic device.
• Root planing. Root planing smoothes the root surfaces, discouraging further buildup of tartar.
• Antibiotics. The use of antibiotics to treat periodontitis remains open to debate. Your periodontist or dentist may recommend using topical or oral antibiotics to help control bacterial infection. Topical antibiotics are generally the treatment of choice. They can include antibiotic mouth rinses or insertion of threads and gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.

Surgical treatments
If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, your periodontitis treatment may require dental surgery, such as:

• Flap surgery (pocket reduction surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.
• Soft tissue grafts. When you lose gum tissue to periodontal disease, your gumline recedes, making your teeth appear longer than normal. You may need to have damaged tissue replaced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.
• Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone. Bone grafting may be performed during a technique called guided tissue regeneration.
• Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
• Enamel matrix derivative application. Another technique involves applying a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.

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