To determine whether you have periodontitis and how severe it is, your dentist may:
- Review your medical history to identify any factors that could be contributing to your symptoms, such as smoking or taking certain medications that cause dry mouth.
- Examine your mouth to look for plaque and tartar buildup and check for easy bleeding.
- Measure the pocket depth of the groove between your gums and teeth by placing a dental probe beside your tooth beneath your gumline, usually at several sites throughout your mouth. In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters (mm). Pockets deeper than 4 mm may indicate periodontitis. Pockets deeper than 5 mm cannot be cleaned well.
- Take dental X-rays to check for bone loss in areas where your dentist observes deeper pocket depths.
Your dentist may assign a stage and a grade to periodontitis based on the severity of the disease, the complexity of treatment, your risk factors and your health.
Treatment may be performed by a periodontist, a dentist or a dental hygienist. The goal of periodontitis treatment is to thoroughly clean the pockets around teeth and prevent damage to surrounding bone. You have the best chance for successful treatment when you also adopt a daily routine of good oral care, manage health conditions that may impact dental health and stop tobacco use.
If periodontitis isn’t advanced, treatment may involve less invasive procedures, including:
- Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments, a laser or an ultrasonic device.
- Root planing. Root planing smooths the root surfaces, discouraging further buildup of tartar and bacteria, and removes bacterial byproducts that contribute to inflammation and delay healing or reattachment of the gum to the tooth surfaces.
- Antibiotics. Topical or oral antibiotics can help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of 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.
If you have advanced periodontitis, treatment may require dental surgery, such as:
- Flap surgery (pocket reduction surgery). 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 root planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. After you heal, it’s easier to clean these areas and maintain healthy gum tissue.
- Soft tissue grafts. When you lose gum tissue, your gumline recedes. You may need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or using tissue from another donor source and attaching it to the affected site. This can help reduce further gum recession, cover exposed roots and give your teeth a more 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.
- 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.
- Tissue-stimulating proteins. Another technique involves applying a special 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.