The main goal of treatment of periodontal disease is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. Additionally, modifying certain behaviors, such as quitting tobacco use, might also be suggested as a way to improve treatment outcome.

Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease.

Medications

Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on the severity of gum disease, the dentist or periodontist may still suggest surgical treatment. Long-term studies will be needed to determine whether using medications reduces the need for surgery and whether they are effective over a long period of time. Here are some medications that are currently used:

Prescription antimicrobial mouthrinse: a prescription mouthrinse containing an antimicrobial called chlorhexidine use to control bacteria when treating gingivitis and after gum surgery. It's used like a regular mouthwash.

Antiseptic "chip": a tiny piece of gelatin filled with the medicine chlorhexidine used to control bacteria and reduce the size of periodontal pockets. After root planing, it's placed in the pockets where the medicine is slowly released over time.

Antibiotic gel: a gel that contains the antibiotic doxycycline used to control bacteria and reduce the size of periodontal pockets. The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.

Antibiotic micro-spheres: tiny, round particles that contain the antibiotic minocycline used To control bacteria and reduce the size of periodontal pockets. The periodontist puts the micro-spheres into the pockets after scaling and root planing. The particles release minocycline slowly over time.

Enzyme suppressant: a low dose of the medication doxycycline that keeps destructive enzymes in check used to hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue. This medication is in pill form. It is used in combination with scaling and root planing.

Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again.

Bone and Tissue Grafts. In addition to flap surgery, your periodontist may suggest bone or tissue grafts. Grafting is a way to replace or encourage new growth of bone or gum tissue destroyed by periodontitis. A technique that can be used with bone grafting is called guided tissue regeneration, in which a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.

Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including severity of the disease, ability to maintain oral hygiene at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.

Getting a Second Opinion About Treatment

When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.