In most of the entries in this blog in which we approach the field of periodontics, we always do so from a preventive point of view, because, like any other professional in the health sector, we believe that prevention is the best treatment for any disease, oral or otherwise. However, it also makes sense to inform about the steps or processes to follow when this line has already been exceeded and we suffer from advanced periodontitis. This is when I listen:
Doctor, what are my options?
The options differ depending on the stage of the disease, as well as the patient's personal characteristics in terms of bone and other factors that periodontists evaluate, as we discussed in this article. Once the patient and their needs have been classified, we will opt for the least invasive treatment possible, as long as it is effective in their case. Treatments for periodontitis can be surgical or non-surgical, and we will start by looking at the latter.
Scraping and curettage
Commonly referred to as curettage, this is one of the most basic periodontal treatments and one of the few that does not involve surgery. To make it easier for patients to understand, we often compare them to regular dental cleanings, although they are actually different dental techniques. In fact, scaling is usually performed by a dentist, not a hygienist. The radical difference between the two, beyond the obvious ones, is that dental hygiene is a preventive treatment, while scaling is a straightforward treatment, i.e. one that is used to combat an existing condition.
The reason for comparing them is that the aim of both is to remove tartar and plaque, except that curettage removes it from the gum and the root of the tooth, once these have already been affected. It is performed under local anaesthesia because it works in depth, which could be painful or uncomfortable for the patient. Thanks to specific dental instruments, the tartar that has accumulated under the gum is 'scraped' (hence the name). Subsequently, root planing is performed, which 'polishes' the root of the tooth to leave the surface completely smooth and decontaminated.
Flap surgery
This is the least invasive surgical technique that can be used to treat periodontitis. In this technique, the dentist, with the patient under anaesthesia, makes a cut in the gum, in the area closest to the root of the tooth, in such a way that the tissue can be 'lifted' and thus access the deepest and most difficult to access periodontal pockets. It requires sutures and, as with any surgery, a postoperative process is associated with it.
Gum grafting
Gum grafting is a solution to one of the specific consequences of periodontitis, rather than to the disease itself. As the disease progresses, it causes the loss of the soft tissue surrounding the tooth, which eventually leads to gum recession.
Grafting - or periodontal plastic surgery - is usually performed with tissue taken from the roof of the mouth or other gum area. It is removed and placed in the area to be relined and sutured.
As with any surgery involving sutures, the postoperative process following surgery requires special care, including the use of specific mouthwashes.
Although there are more options, such as guided tissue regeneration or bone grafting, these treatments also depend on the field of implantology, as they are usually performed with the express and specific intention of placing an implant.
If you suffer from periodontitis and think you may need any of the following treatments
