Treatment of periodontitis

The main goal of periodontal therapy is to contain the inflammatory processes and to ensure healing. In addition, the risk of recurrence of periodontal disease must be minimized. For this reason, extensive screening is usually carried out before treatment.

First of all, the treating dentist has to get an exact picture of the severity and extent of the disease. It is also important to analyze the cleaning behavior and the thoroughness of oral hygiene. The dentist can do this with quite simple means.

In the beginning, the condition of the gums (gingiva) is observed with the naked eye. Inflammatory processes in the area of the gums influence the appearance of the gingiva quite quickly and cause visible discoloration. Once rosy, light-colored gums with normal blood supply become increasingly darker and appear damaged even with the naked eye.

The extent and depth of the gingival pockets are also assessed. For this reason, a narrow, scaled probe is inserted into the pockets along the tooth, between the tooth substance and the gingiva. The so-called PSI (Periodontal Screening Index) forms the average value of the pocket depths of each quadrant of the dentition, i.e. it is only measured on one tooth (representing all teeth of the quadrant).

A much more accurate method is the detection of all gingival pockets. Six values are recorded for each tooth. If the periodontitis is extensive, it also makes sense to make a so-called X-ray overview image (OPG).

This image allows an exact assessment of the bone condition and thus an evaluation of the further course of treatment. The treatment of periodontitis is divided into three phases, which are followed by regular prophylaxis.The exact course and intensity of the therapy (i.e. the choice between closed or open tooth cleaning) depends, as with most dental treatment measures, to a large extent on the initial state and the aggressiveness of the disease. The already described diagnosis and assessment phase is continued by the hygiene phase.

It serves to evaluate the individual cleaning behavior of the patient. In addition, the entire dentition is professionally cleaned with the help of so-called curettes (professional tooth cleaning, PZR, curettage). These are sterilizable hand instruments which are ground at a specific angle at the ends.

This special grinding allows the curettes to be guided closely along the tooth substance. The result is an effective removal of hard (tartar) and soft (plaque) plaque. All plaque that lies above the gum line (supragingival) is thoroughly removed.

Furthermore, the patient is introduced to a suitable type of oral hygiene and the handling of dental floss and/or interdental space brushes (tooth space brush) is explained. The condition of the periodontium can already be significantly improved by performing a professional tooth cleaning and learning a suitable tooth brushing technique. In most cases, no further treatment measures need to be added to the acute containment and therapy of periodontitis.

However, if the periodontitis is more advanced, the closed treatment phase follows. In this phase, all deposits under the gumline (subgingivally) are removed. In addition to the curettes used in the hygiene phase, sonic and/or ultrasonic hand instruments are also used.

In this way, even particularly fixed plaque and tartar can be removed. After the teeth have been cleaned, the gums are given a one-week healing period during which the pocket depths are usually already significantly reduced. The progress of the therapy is evaluated in a separate control appointment by measuring the pocket depths again.

In the case of small reductions or particularly deep initial pockets (from a depth of approximately 7mm), it is often necessary to initiate an open treatment method. In the course of this procedure, the gums are surgically opened with a scalpel, and the dentist can then remove the (subgingival) plaque under the gums under visual control. In addition, bone defects that have already occurred can be filled with bone replacement material in the same session.

In addition to the advantage of better visibility, this method also has a number of disadvantages. For example, the healing time is significantly longer compared to the closed procedure. This is due to the fact that the surgical incisions always cause trauma to the penetrated tissue.

The chances of success of periodontal treatment can be increased many times over by using a suitable antibiotic, because ultimately the causative plaque consists of waste products of bacteria. It is therefore very useful in the course of prevention (prophylaxis) of an immediate reinfection to reduce the bacterial colonization within the oral cavity. Furthermore, the patients concerned are encouraged to use an antibacterial mouth rinse (so-called full-mouth disinfection) after brushing their teeth.

This also reduces the number of bacteria. A novel treatment option consists of an antimicrobial photodynamic laser therapy. Here, a special substance (photosensitizer) is introduced into the gum pockets.

This substance is activated by a laser. The oxygen is released from the bacteria that absorb this substance and the oxygen-sensitive bacteria die. Due to the almost complete destruction of the bacteria by the laser, antibiotic treatment is not necessary.

The laser does not damage surrounding tissue, which prevents bleeding and accelerates the healing process. However, if you decide on laser therapy, you have to finance it yourself. A complete laser treatment of the entire dentition amounts to approx.

250 – 300 Euro and must be paid privately. In order to achieve the most efficient effect of the antibiotic, it is best to administer it directly after the dentist has removed the hard and soft plaque.Every periodontitis patient has a different occurrence of the typical periodontopathogenic (pathological) bacteria that are found in periodontitis. In order to select the antibiotic suitable for each individual patient, an analysis of the existing bacteria in the oral cavity should be carried out.

In this way it is possible to take targeted action against the increased number of bacteria. Depending on the presence of the bacterial species, the following active ingredients are used, among others: amoxycillin, ciprofloxacin, metronidazole, doxycycline, tetracycline, clindamycin. Very effective are often also applied combinations of metronidazole and amoxycillin or of metronidazole and ciprofloxacin.

In many cases the time of antibiotic intake is 2-3 times a day for 7 days. This may vary depending on the active ingredient. It is important to follow the doctor’s instructions.

There are some home remedies that are used in the own treatment of periodontitis. These include hydrogen peroxide, for example. It is considered a strong antibacterial agent, which can be used as a mouthwash in a dilution with water (1:2) in the morning and evening.

It is very important not to swallow the rinse and then rinse the mouth with water. Furthermore, baking powder is a well-known household remedy for fighting bacteria under the gums. The baking powder is mixed with water to a paste and applied to the gums with a finger.

After 10 minutes the mouth can be rinsed out. Other well-known household remedies that are said to have already led to success are green tea, aloe vera gel or an oil cure, in which a tablespoon of cold-pressed sunflower oil is rinsed in the mouth for about 15 minutes before the first meal and then spat out. In general, however, it is also very important to know that home remedies have already had success in the complementary therapy of periodontitis, but that they represent a treatment alternative of their own.

The actual treatment takes place at the dentist. To reduce germs in the oral cavity some home remedies are often used. These include the use of tea tree oil as a mouthwash.

To do this, mix 1 teaspoon of tea tree oil in a glass of lukewarm water. The mouthrinse should be used several times a day. Furthermore, an oil cure with tea tree oil can be carried out.

The so-called oil extraction has already proven to be successful in the prevention of periodontitis and the fight against unwanted germs in the oral cavity. In addition in the morning after getting up on an empty stomach a tablespoon of tea tree oil is rinsed in the mouth. The oil is pulled through the teeth for about 10-15 minutes until it emulsifies from a yellowish to a white liquid.

Then the oil can be spat into a paper towel and disposed of. Home remedies should, however, if at all, only be used as a support to the actual therapy in the dental practice. Homeopathy can be a supplement to conventional periodontitis therapy.

However, it is very important to know that homeopathic treatment is not an alternative to dental treatment. If the periodontitis is already advanced, an antibiotic must also be administered. There is no other way to fight the aggressive bacteria.

Nevertheless, a homeopathic treatment is a possible supplement, especially in the aftercare. Suitable remedies include Arnica, Aqua silicata complex Nestmann, rinsing solutions or Schüssler salts (especially nos. 2, 3, 11). You should consult a homeopath about the exact complementary treatment options for periodontitis.