Periodontal Treatment - Periodontitis, Cost, Non-surgical, Root Planing

Periodontal disease (gum disease) is a serious dental problem affecting the gums, teeth, and bones. It is characterized by progressive teeth and gum infection, and disruption of their connective tissue. This a common dental problem that affects many people 1. It is also the main reason for tooth loss in adults. That's why it is important to be aware of this condition and how it can develop.

If you want to know more about the treatment options and how to get rid of periodontal disease read the following lines.

Gum disease stages

The first stage is called gingivitis. This is a mild form of gum disease and it oftentimes proceeds without symptoms.

The second stage is periodontitis where plaque and tartar gradually accumulate on the teeth.

The final stage is advanced periodontitis. Bacterial toxins start destroying the bone and fibres that support your teeth and contributing to bad breath, tooth decay, or even tooth loss.  Severe and advanced periodontitis can also lead to much more serious problems, including diabetes 2, heart attack, and stroke.

What causes periodontitis?

The main reason for gum disease is the accumulation of plaque and bacteria that forms regularly on your teeth. These harmful substances invade the spaces between the gums and teeth and begin producing toxins. The toxins may destroy the bone around your teeth.

A healthy mouth contains many different types of bacteria but most of them are non-pathogenic. These that cause gum disease are called periodontal bacteria. This type of bacteria does not usually cause problems, but under certain circumstances, it can become dangerous. This happens when the layer of plaque is not removed by brushing your teeth regularly.

When plaque is left on the teeth, it creates conditions for the growth of periodontal bacteria. This leads to the release of harmful by-products that activate the body's natural inflammatory response, leading to swelling and inflammation of the gums. If left untreated, gum disease can worsen with plaque hardening and turning into tartar - a hard deposit that can't be removed by brushing your teeth alone.

The accumulation of tartar helps the plaque to develop towards the root of the tooth and the inflammation can become chronic. The bacteria colonize in the pockets and continue to grow, the infection spreads, damaging the jaw bone and structures around the teeth. This can lead to acute apical periodontitis or acute apical abscess and eventually to tooth loss.

Acute apical periodontitis vs. acute apical abscess

Periodontitis and apical periodontitis have a common bacterial character and aetiology. Bacteria, which are usually found in the oral cavity, create a pathological micro-environment in the periodontal pocket or root canal, which leads to an inflammatory reaction. The inflammatory process is more often localized around the tip of the tooth root.

In acute apical periodontitis, the patient complains of a constant, spontaneous, localized toothache, and the pain intensifies at night.

If left untreated, acute periodontitis can lead to unpleasant complications - abscess (acute apical abscess) and phlegmon of the maxillofacial area.

What is the relationship between diabetes and periodontal disease?

The results of a number of studies show that people with diabetes are at higher risk of gingivitis and periodontal disease. This is especially true for diabetics who do not control their blood sugar levels. Over time, glucose is excreted in saliva and creates a favourable breeding ground for the development of anaerobic microflora in the oral cavity, which is extremely harmful. In diabetics, periodontitis not only has significantly more severe symptoms, but there is also an alarming tendency to "rejuvenate" the disease.

Symptoms of periodontitis

One of the initial signs of a problem is bleeding gums when brushing and flossing. Other common symptoms are bad breath, inflamed and swollen gums, ulcers on the lining of the oral cavity, the formation of deep pockets between the teeth and gums, shaking of the teeth, and in many cases lost teeth.

It is possible to have no noticeable symptoms. Most people who have gum disease aren't even aware of it. That is why it is important to go to your dentist for regular check-ups.

Gum disease is not easy to treat, mainly because it is slow, painless and patients seek help when it is in a very advanced stage. If you have any of the inflamed periodontal ligament symptoms described above, do not delay your consultation with a specialist.

Can periodontitis be cured?

The successful treatment of gum disease is entirely in the hands of periodontal specialists. For effective and successful treatment of periodontitis, you need to find a good and reliable specialist. However, this does not relieve you of responsibility for the whole process. You must strictly follow the advice given to you by the doctor. This is the only way to ensure the desired results of the treatment process.

What does periodontal disease treatment involve?

There are several methods of periodontics treatment. These include an examination and professional clean of the root surface, removal of the damaged tissue with a laser or periodontal surgery, and regenerative procedure 3 that restore the lost tissue.

Detailed examination

Firstly, you need to have a detailed examination of the condition of each tooth. Periodontal pockets are measured with a dental instrument called a periodontal probe. The doctor may also take X-rays to make the final diagnosis 4. As a result of this examination, it is determined what stage of development periodontitis has reached and which method of periodontal disease treatment would be the most appropriate in your specific situation. New diagnosis methods are being developed, including such that involve deep learning to automatically diagnose periodontal bone loss and the stage of the disease based on analysis of dental panoramic radiographs 5.

Scaling and root planing

Depending on the stage of the disease your dentist may recommend scaling and root planing to minimize the number of toxins in the mouth and to remove tartar and plaque. This procedure may require local anaesthesia to reduce any discomfort. Your dentist will use a manual or ultrasonic cleaning instrument to remove the plaque and tartar under the gum line. After that, your teeth root surfaces will be planed and smoothed. This allows the gum tissue to properly heal and reattach itself to the tooth. After this procedure, your dentist will recommend a special oral healthcare routine that will help a healing process.

Depending on the results achieved so far in the treatment of periodontitis, a decision is made on how to continue the process. It is possible to switch to maintenance therapy with a visit to the dental office every three months. Another option for continuing the treatment of periodontitis is to perform surgical procedures to reduce the pockets or to restore the lost tissue.

Periodontal surgery

If your gum pockets are deep and scaling and root planing can not remove the infection, your doctor may recommend doing flap surgery. This procedure will help the infected pockets to heal. The surgery is done under anaesthesia. The gums are separated from the tooth which creates a flap and gives access to the bone and root of the tooth. The plaque, tartar, and infected tissue are removed from the area. The bone around the teeth is smoothed to limit the areas where bacteria can hide and help the gums reattach to the tooth. Then the gums are secured with a few stitches.

 Flap surgery is one of the most effective methods for treating advanced periodontitis.

Laser treatment

Laser therapy is a modern high-tech alternative to periodontal surgery. With the help of the laser beam can be achieved sterilization of periodontal pockets. The laser affects the causes of the disease - it directly destroys periodontal pathogens in the soft tissues and above the root surface. Laser treatment can be performed both in the initial forms and in severe cases of periodontitis.

Laser treatment is used to kill the bacteria that live inside the bone and inside the gum. It is done with a local anaesthetic. The laser is used at the top and bottom of the periodontal pocket to remove the diseased tissue. The laser energy targets and eliminate selectively only the diseased tissue and germs leaving the healthy tissue unharmed.

Regenerative procedures

Regenerative procedures are used to restore lost supporting hard and soft tissue and can reverse some of the damage caused by periodontal disease. The procedure involves the reflection of the gum tissue and removal of the majority of disease-causing bacteria from within the pocket.

During this procedure, the doctor removes the harmful bacteria and folds back the gum tissue.  Bone grafts or proteins might be used to stimulate the body's natural capability to regenerate tissue and bone.

How long does a periodontal treatment take?

The treatment is a process that usually lasts between 2 and 4 weeks and includes special therapies to remove harmful microorganisms and regenerate the tissues in the oral cavity. However, in order for the treatment of the disease to be sufficiently successful and effective, the patient must also make the necessary efforts such as excellent oral hygiene and daily brushing at least twice a day. It is also recommended regular monitoring of the condition of the teeth and gums.

Is periodontal disease contagious?

The truth is that periodontitis is a contagious disease that is transmitted through direct contact between people. So it is good during the treatment process to minimize direct contact with your partner including kissing, eating with the same spoons, etc.

How much does it cost to treat periodontal gum disease?

Periodontal treatment cost depends on the type of procedure. For scaling and root planing (deep cleaning), you can expect to pay around $60-$200. The cost of the full periodontal treatment including gum disease surgery may vary between $1500 and $8000. Here's a more detailed breakdown of the costs involved in periodontal treatment:

• Full Periodontal Disease treatment - $1500 - $8500
• Periodontist Consultation - $200 - $300
• Periodontal or peri-implant treatment - $350 - $5500
• Implant Placement - $2000 - $5000 (per implant)
• Staged bone grafting - $1000 - $4000
• Periodontal Surgery - $500 - $3200
• Mucogingival surgery - $500 - $900 per tooth
• Basic teeth cleaning (aka deep cleaning) - $60 - $200
• Pocket reduction - $900 - $3200 (per area)
• X-ray - $20 - $200 per tooth

Those are just the average costs. The exact price for your treatment will vary from clinic to clinic, whether or not you have dental insurance and which city or state you live in. Make sure to ask about all the costs involved in your complete treatment plan when you speak with your dentist.

• 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555006/
• 2. https://pubmed.ncbi.nlm.nih.gov/18336370/
• 3. https://medicalxpress.com/news/2019-05-treatment-periodontitis-gum-regen...
• 4. https://www.mayoclinic.org/diseases-conditions/periodontitis/diagnosis-t...
• 5. https://www.nature.com/articles/s41598-020-64509-z