Treating periodontitis

If the dentist finds periodontitis, the patient has to go through various phases of treatment. The treatment is adapted to the severity of the disease and the patient’s individual circumstances.

Measuring periodontal pockets

Periodontal examination

Periodontal therapy consists of a number of phases. If not before, the dentist assesses the patient’s periodontal status when he/she complains of bleeding gums or gum recession. This involves measuring the depth of the periodontal pockets and noting whether minor bleeding occurs while the measurement is being carried out. The examination is usually painless. The dentist may take X-ray images to enable him/her to see and assess existing damage to the jaw.

Improving dental care

If the dentist establishes that periodontitis is present, the first thing he/she will do is try to improve the patient’s dental care. Besides regular professional tooth cleaning, this will also include giving the patient precise instructions on how to look after his/her teeth and gums properly at home. Tooth brushing alone is not enough, however, as looking after the spaces between the teeth is extremely important. If a check-up does not show the desired improvement despite good dental care, the next steps in the periodontitis treatment are planned. There may also be a need for microbiological or genetic testing.

A dentist shows the patient a denture

Periodontal therapy

In the next phase of treatment, the periodontal pockets are cleaned thoroughly. This is usually done under local anesthesia. The dentist uses special instruments to get beneath the gingival margin and remove the bacteria that have colonized the deepest zone of the periodontal pocket. While doing this, he/she also scrapes off deposits such as calculus and uses antibacterial solutions for rinsing. This makes the surface of the teeth smooth again, which makes bacterial recolonization difficult. This treatment usually takes place over two appointments, one shortly after the other. If an antibiotic is required, the patient is started on the tablets in parallel to the cleaning. The tablets must be taken diligently and exactly as prescribed by the dentist in order to maximize medication efficacy.

In some cases, antibiotics are also required

If antibiotic therapy is needed, it is important for the dentist to know what types of bacteria are present in the periodontal pockets. Only then will he/she be able to decide whether an antibiotic will actually be helpful, and if so which will be most effective. The relevant information can be obtained by means of a microbiological analysis of the periodontal pocket contents. This prevents antibiotics from being prescribed when they are not actually therapeutically necessary. The dentist thus spares the patient unnecessary side effects and reduces the risk of antibiotic resistance development and spread. Because multidrug-resistant pathogens resulting from excessive and inappropriate antibiotic use are becoming increasingly widespread, responsible and careful use of antibiotics is very important. However, analysis of the microbial spectrum also prevents antibiotic therapy from being overlooked when there is an urgent need for it because of a high bacterial load. Even such undertreatment can have a negative impact on the outcome of treatment.

The patient also has a responsibility

After the treatment, regular check-ups are performed in the dental practice to ascertain whether it has been effective and whether the patient is following a proper dental care routine at home. Because one thing is certain: If the patient does not clean his/her teeth thoroughly, the bacteria will be back inside the periodontal pockets in no time and it will be back to square one. There is nothing much even the best dentist can do if the patient is lazy about looking after his/her teeth. It is therefore the patient’s responsibility to maintain the “clean” conditions that the dentist has created with the periodontal treatment. With professional support from the dentist and his/her team, of course.