Periodontal (gum) disease can be a very aggressive infection: Left untreated, it can destroy the vital periodontal structures that protect teeth and maintain their attachment to the jaw. The end result—tooth loss—harms both your health and appearance.
Controlling gum disease and ultimately restoring health and appearance to damaged gums and tooth-supporting bone requires aggressive treatment—sometimes even surgical measures. Periodontal (gum) surgery treats moderate to advanced disease.
Gum disease is primarily caused by bacterial plaque, a thin film of food remnants and bacteria that builds up on tooth surfaces when oral hygiene is inadequate or inefficient. As the gums become infected by the bacteria, the body responds with inflammation, a defensive mechanism aimed at isolating the bacteria and destroying it.
But as the war between body and infection rages, the inflammation becomes chronic and damages the surrounding gum and bone tissues. This causes gum attachment and supporting bone to be lost from the teeth, creating spaces between the gums and teeth known as periodontal pockets. The progression of periodontal disease becomes a vicious cycle: As the pockets deepen, dental hygiene becomes less effective.
The only way to stop gum disease is to remove bacterial plaque and calculus (hardened plaque deposits) from all tooth surfaces—including from the roots that lie beneath the gum line. Dentists use special hand instruments (or ultrasonic equipment) called scalers to manually remove calculus. If you need a deeper cleaning of the root surfaces, your general dentist may refer you to a periodontist (gum specialist) for a manual plaque-removal technique known as root planing or debridement. If the tissues don’t appear to be responding as desired, then antibiotic treatment to reduce bacterial levels might be introduced. Splinting teeth together, or bite adjustment—where a tiny bit of tooth enamel is removed to reduce forces received by a particular tooth—may also be included to help stabilize loose teeth.
Of equal importance is a necessary change in behavior and lifestyle on the part of the patient. The disease develops and advances primarily because of a lack of effective hygiene, so the patient must therefore renew and maintain a daily habit of brushing and flossing, and a routine of regular dental visits for cleanings and checkups (at least twice a year and maybe more with advanced gum disease). He or she should also consider stopping tobacco use and other habits that harm oral health.
If the infection has caused deep periodontal pockets (5 mm or more) or has settled beyond the reach of manual scalers, then gum surgery may be needed to access, clean and repair the diseased areas.
Flap surgery is one type of procedure used to access the deeper pockets of infection and clean them. The surgeon, usually a periodontist, creates a three-sided flap in the gum tissue, with one side still attached to the blood supply. The resulting opening resembles the flap of an envelope. Opening the flap, the surgeon can then access deep periodontal pockets to perform plaque removal, as well as repair receded gum tissue or lost bone. When finished, the surgeon then sutures the flap closed with self-dissolving stitches.
Regenerative techniques may also be needed to re-grow lost tissue and bone. These involve the use of various grafting procedures to obtain tissue from the roof of the patient’s mouth or another source and attach it where needed. Once in place, the graft acts as a scaffold for new gum tissue to grow upon and develop. These micro-surgical techniques require meticulous skill (and some level of art) not only to place the grafting material so it is most conducive to growth, but also to fashion it cosmetically to achieve the most attractive result.
These and similar procedures are usually performed with local anesthesia, sometimes supplemented with other sedation methods. Special cleaning instructions will be given to protect the site from further infection, and any minor discomfort after the procedure can usually be managed with anti-inflammatory medication (like ibuprofen) for a few days.
Gum disease treatment, including surgery, isn’t a cure—the prospect for re-occurrence is always there. Proper hygiene and maintenance by both you and your dentist is essential for preventing this. Gum surgery is performed to regenerate lost bone and to help create an environment around the teeth and gums that makes it easier to clean and maintain them. Gum surgery, then, should be considered as part of an overall strategy to stop periodontal (gum) disease’s unchecked advance so that healing can take place. This will allow you to keep your natural teeth for as long as possible—maybe even for life.