Treatment of periodontitis: Cleaning, scaling, care

Photo of patient having a professional tooth-cleaning (PantherMedia / Robert Kneschke) Advanced periodontitis can cause teeth to loosen and fall out. Treating the disease in a systematic way can usually stop periodontitis from getting worse. Good oral hygiene is absolutely essential for treatment success.

Besides caring for teeth and gums, there are several different ways for dentists to prevent or treat periodontitis. Systematic treatment of periodontitis consists of the following steps:

  • Improved oral hygiene and professional teeth-cleaning
  • Removing film and deposits below the gumline (subgingival scaling) and planing the roots of the teeth
  • Confirmation of treatment success
  • Surgery with local anesthetic, if needed
  • Follow-up care

Statutory insurers in Germany will cover some of the costs involved in the systematic treatment of periodontitis, but a special request must be filed in advance. This should include a treatment and cost plan provided by your dentist. Your health insurer can let you know which services will be covered in your specific case.

Improved oral hygiene and professional teeth-cleaning

Good oral hygiene is essential for the success of periodontitis treatment. Even if some teeth have already been lost, good regular dental hygiene and not smoking can help to keep your remaining teeth. This is also important for fitting dentures to teeth that have been kept as healthy as possible.

The proper use of toothbrushes, floss and interdental brushes is explained first. Your dentist or a specially trained dental hygienist will first dye the plaque on your teeth so that you can see it and to help explain proper dental care.

During a professional teeth-cleaning, deposits that cannot be eliminated by brushing alone are usually removed using special instruments and/or ultrasound devices. The teeth can also be polished to remove any remaining plaque, stains or deposits and to smooth the surface of the teeth. The cleaned teeth are usually also treated with a fluoride gel or varnish.

The goal is to remove as much plaque as possible from the edges of the gums without using a local anesthetic. The surfaces of the teeth are polished to lower the chances of new plaque deposits on the teeth.

Subgingival scaling and root planing

Sometimes bacterial film and harder deposits also form below the gumline on the surfaces of the neck of the tooth or the roots. They can be removed under local anesthetic using specially shaped instruments. This procedure is also called “subgingival scaling” or “deep scaling.” Usually the surfaces are also smoothed, to make it more difficult for bacteria and deposits to build up.

Three to six months after this phase of “closed” treatment the teeth and gums are reexamined to check whether it has been successful. If the pockets are still deep or the gums continue to bleed, another phase, called “open” treatment, can be done.

Open surgery

In open surgery the dentist makes small cuts in the gums where they are inflamed so that they can be flapped back. He or she can then access the surface of the root to thoroughly clean and smooth it. Sometimes the bone is also contoured if it too has been affected by periodontitis. Then the gums are sewn together so that they are once again snug against the teeth. Local anesthetic is needed for this procedure.

It usually takes about a week for the wound to heal, and for the stitches to be ready for pulling. The gums can recede after the operation, making the teeth appear to be longer.

In Germany, statutory health insurance funds sometimes pay for this procedure for severe periodontitis if other steps have not brought about sufficient results despite improved dental hygiene.

During open surgery the dentist can also place an additional biodegradable mesh membrane between the tooth and the gums. This is done to help bone mass increase. The mesh can also keep fast-growing gum tissue from filling the space around the tooth before the periodontium has fully recovered. This procedure is also called guided tissue regeneration (GTR). It is not covered by statutory health insurers in Germany.

Another treatment not covered by statutory health insurers are enamel matrix derivatives (EMDs). They are used to help speed up recovery in the periodontium, and are applied to the cleaned surfaces of the roots during surgery.

If periodontitis has destroyed part of the bone surrounding the root of a tooth, bone grafting may be an option. Small parts of a bone from the same person or artificial bone tissue are implanted during open surgery. The implanted material should help keep the tooth in place and promote bone density.

Follow-up care

Follow-up care is an important part of periodontitis treatment. It is done to prevent periodontitis from coming back. At a follow-up appointment the dentist examines your teeth, gums and periodontium and offers advice about improving your oral hygiene. You can only keep periodontitis from returning if you also take good care of your teeth at home. That means brushing your teeth several times a day and cleaning between the teeth with dental floss or an interdental brush.

Routine professional teeth-cleaning can support individual oral hygiene. Research in this area cannot show how often it needs to be done, though. Depending on how well you take care of your teeth and how severe the periodontitis was, up to 4 appointments per year may be recommended. Side effects of professional teeth-cleaning may include damage to the teeth or gums, and more sensitive teeth. One positive side effect is that stains on the teeth can be removed.

As part of what is called supportive periodontitis treatment (SPT), in addition to professional cleaning, the dentist can regularly measure how deep the gum pockets are. Depending on the results of this exam and other pre-existing risk factors, you can discuss with your dentist what types of prevention are best for you and when you should have your next check-up.

Is disinfection a good idea?

Chlorhexidine can be used to reduce the amount of germs in the mouth down to a minimum in addition to brushing your teeth. Chlorhexidine is an antibacterial agent found in some mouthwash products. This additional treatment aims to keep germs from settling in the gum pockets directly after having a professional teeth-cleaning, where they can start attacking gum tissue immediately.

Research results indicate that the depth of the gum pockets could be reduced somewhat when the mouth is disinfected after subgingival scaling. But it is difficult to accurately predict the success of treatment, and it has some disadvantages: Chlorhexidine is a strong disinfectant and can cause stains on the teeth when it is used for a longer period of time.

Using antibacterial mouthwash to keep your mouth mostly free of germs can also be made part of your oral hygiene independent of any professional tooth cleaning.

What helps other people to cope with periodontitis?

Some people who have problems with their gums feel guilty about not doing enough for their oral hygiene or because they continue to smoke even though they know that it is bad for their teeth. Having periodontitis means that losing teeth is also a concern. An understanding dentist can help you and encourage you to stick to your resolutions for improving oral hygiene. Staying well-informed and regularly talking with your dentist about how the treatment is going also seems to be helpful. That includes discussing what works well and how you might be able to improve your oral hygiene.

Good oral hygiene is absolutely essential for managing periodontitis and keeping the periodontium healthy for a long time. Regularly brushing your teeth, always keeping the correct brushing technique in mind and not forgetting floss or interdental brushes can be hard work. That is why it is important to start daily dental care routines – and to stick to them. Many people say that they have an easier time with dental hygiene when they start to notice how it improves the health of their teeth.