Non Surgical Periodontal Treatment

What is periodontitis and how does it develop?

Periodontitis is an infectious disease that destroys the tissues supporting the tooth in the jaw bone. It begins as gingivitis and left untreated, develops into gradual loosening and severance of support for the teeth in the jawbone. Its development is fast, penetrating the tissues and manifesting as loose teeth that are likely, in advanced stages, to fall out.

Three of every four adults aged 35 years and up show some level of periodontitis. It is caused by bacteria found beneath the gums and around each tooth. Toxins released by these bacteria cause the inflammation that disconnects the gum tissue meant to support the tooth. As a result, infected pockets form around the tooth. Over time, a layer of bacteria and plaque accumulates in the pocket, destroying the gums further and enlarging the pocket. The bacteria are now able to penetrate into the blood supply, flow through the body, and continue to release toxins. The body’s immune system will then react as it does to any infection and try to eradicate it.

Conventional treatment of periodontitis initially removes the factor causing the disease – the layer of bacteria and plaque. The process is conducted in stages. Initial treatment involves cleaning the plaque, root scaling (deep cleaning around the roots) and receiving instruction on correct maintenance. Some weeks later, the post-cleaning status can be evaluated and decisions made on whether complementary surgical intervention is required.

The purpose of surgical intervention is to reach the deeper pockets, remove the disease-causing factor and heal damaged teeth-supporting tissue (the jawbone and connecting tissue). In most cases treatment integrates bone substitutes, growth proteins and membranes.

For many patients, there is a direct link between periodontitis and gum surgery.

In many instances, periodontal treatment encompasses surgery. In some cases, however, surgery is unsuitable and alternatives can be applied, such as when:

  1. 1. The disease and the pockets appear in aesthetic areas (front teeth); or around crowns, reconstruction, and new rehabilitative solutions, all of which make surgery very difficult to perform.
  2. 2. The depth of the pocket is borderline and it is worth trying non invasive treatment first.
  3. 3. Patients suffer from systemic illnesses and significant medical problems that do not allow surgical intervention.
  4. 4. Cases are so extreme that surgery cannot help.
  5. 5. Patients have already undergone surgical treatment and the disease has reappeared. In such cases we suggest complementary periodontal care of a non invasive, conventional kind.

What alternatives are available?

1. Introduction of a Periochip

The Periochip is one of several preparations for localized treatment and is well established in the international market. The Periochip is the size of a baby’s fingernail and is penetrated direct into the periodontal pocket after cleaning and root scaling. The Periochip is inserted at a depth of 5 millimeters or more. Insertion takes less than a minute, and does not require anesthesia. The Periochip remains in place, releasing an antiseptic substance called chlorhexidine into the pocket for some 7 to 10 days. The Periochip completely disintegrates, making it unnecessary for the patient to return and have it removed. It does not stain the teeth or damage the sense of taste. The patient does not have to avoid any foods or beverages, but is only required to maintain good oral hygiene.

For optimal results, the Periochip should be inserted every 3 months over a 9 to 12 month period, if the pockets remain at a depth of 5 millimeters or more. The Periochip can also be integrated into the periodontal maintenance program (and post-surgery), together with cleaning and instruction on maintaining healthy oral hygiene.

2. Introduction of ARESTIN (Minocycline Hcl 1-mg)

Arestin is an antibiotic penetrated locally to treat periodontal pockets. It is a powder containing more than 100,000 microcells that release Minocycline, an antibiotic substance. In just one appointment, the dentist will conduct thorough cleaning and root scaling, then penetrate the Arestin into the pocket between tooth and gum. The procedure does not cause pain, and the combination of cleaning and antibiotic can greatly improve results by neutralizing and killing off the bacteria deep in the pocket. The penetrated antibiotic remains active for a long time.

Research shows that use of Arestin in conjunction with root scaling triples the scope of the treatment’s success, compared to root scaling alone.

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