Patient Information on Periodontal Disease

Periodontal disease is an inflammatory disease involving not only the gum around teeth, but also the ligament attaching the teeth in the socket and the bone socket itself. In more advanced disease, the gum will pull away from the tooth and the bone foundation will be destroyed, leading to loose teeth and eventual loss of teeth. Periodontal disease is often symptomless to the patient. Some patients may be aware of redness and bleeding or sore gums, bad taste in the mouth, bad breath (halitosis) or loose teeth.

What Causes Periodontal Disease?

Chronic periodontitis, the most advanced form of the disease, progresses relatively slowly in most people and is typically more evident in adulthood. Although inflammation as a result of a bacterial infection is behind all forms of periodontal disease, a variety of factors can influence the severity of the disease. Important risk factors include inherited or genetic susceptibility, smoking, lack of adequate home care, lack of regular professional cleaning, age, diet, health history, and medications.

Why Some People Are More Susceptible

If your mouth contains aggressive bacteria and your body’s response to this bacteria is not ideal, you will be susceptible to periodontal disease. We can’t change either of these things, but we can help you to control how much bacteria is directly attached to your teeth and roots next to the gum.

Assessing the Health of Your Gums

If you have been diagnosed with a form of periodontal disease, it is important that the severity and distribution of the disease is assessed by recording how much the gum has pulled away from each part of each tooth. We do this by recording pocket depths with a gentle blunt probe. In healthy teeth, there will not be any pockets more than 3mm depth under the gum (an analogy would be to think about the space under a healthy cut fingernail) and there will be minimal or no bleeding as we record this. You can clean up to 3mm under your gum at home using good oral hygiene techniques including the use of interdental brushes and floss.

Understanding Periodontal Pockets

In periodontal disease there will be pockets or spaces between the gum and tooth root from 4mm to 10+mm which will be full of bacterial plaque and tartar (an analogy would be to imagine your fingernail had separated from the underlying nail bed and was full of dirt). It is not possible to see these pockets without using a periodontal probe.

X-Rays & Bone Assessment

It is important to have up to date X-rays of the full mouth to assess the bone foundation around the teeth and also the presence of any hidden hard deposits under the gum.

Preparing for Periodontal Treatment

Treatment of Periodontal disease involves initially ensuring that your oral hygiene techniques are excellent at eliminating bacterial plaque throughout the whole mouth and also 3mm under the gum in all areas. Failure to achieve this will cause more bacterial plaque to fill the pockets under the gum very soon after we remove it from the areas you can’t access, and the work we do will be far less effective.

Professional Cleaning Below the Gumline

Subsequent treatment involves thorough cleaning of the teeth and especially areas more than 3mm under the gum that you can’t access. You may require local anaesthetic for these procedures to make if comfortable for you.

Healing After Treatment

In non-smokers with excellent oral hygiene, your home care regime will prevent plaque formation under the gum during the 2-3 months it takes for the gum to re-attach to the clean tooth root. If you are not thorough enough with your home care, the gum will not re-attach to the contaminated root surface. You may notice some recession of the gums as the inflammation is resolved. You may also notice increased sensitivity in areas of the teeth where the roots are more exposed. Sensitive toothpastes are great at controlling this, but please let us know if symptoms are not manageable.

Reviewing Your Response to Treatment

It is important to review the gums with a new full mouth pocket chart after 2-3 months to assess response to treatment and to find out what further treatment is required. It is not unusual for isolated areas to need further deeper cleaning at this stage to get them back to a position of health. All the healthy areas require thorough cleaning again to ensure that health is maintained. Failure to do this soon after initial treatment will often undo a lot of the hard work that has been completed.

Long-Term Periodontal Maintenance

Unfortunately, if you have had periodontal disease, you will always be at risk of periodontal disease in the future. For this reason, you should ensure that you maintain the excellent standard of oral hygiene lifelong and also have regular professional cleans and assessment at 3-6 monthly intervals. Initially a 3-4 month interval is indicated, with only the most stable patients reverting to maximum 6 monthly recalls. We often find that these patients may regress back to a diseased state due to the longer time between professional cleans, and many of these patients may need to revert back to 4 monthly maintenance cleans lifelong. If your response to treatment is poor without a clear reason, we will usually refer you to a periodontal specialist for further assessment and treatment.

Periodontal Treatment Fees

Fees for periodontal treatment will be based upon the length and number of visits needed for your treatment, and also the complexity of your treatment. On the whole, treatment with a dental hygienist is the cheapest, followed by treatment with a dentist. Treatment with a periodontal specialist will be the most expensive. We will endeavour to give you an estimate of costs at the start of treatment, but please understand it is difficult to know exactly what is required until we have completed a detailed assessment. It is also possible in some cases that thorough treatment may require more or less visits than anticipated due to increased or decreased difficulty, and your fees will be adjusted accordingly. Reasons for this might be stubborn build up that is hard to remove or difficult to access and vice versa.

Health Fund Rebates & Clinical Guidelines

The treatment each individual needs is based upon evidence based practice guidelines as set out by our profession. Reassessment intervals and follow up treatment follow these same guidelines. Unfortunately, it is not always the case that Health Insurance rebates will cover as well as hoped, the costs of treatment that is required. You may not be insured for all of the treatment that you require to return your mouth to a healthy state. Whilst we will do all we can to maximise the benefits you can legitimately claim from your health fund for the treatment you need, our main focus is on ensuring that you receive the best treatment possible based upon well evidenced clinical guidelines rather that Health Fund rebate policies.