There are 2 types of periodontal treatment; non-surgical and surgical. The objective of all periodontal treatment is to try to reduce the gum space that is next to the tooth to 3mm or less wherever that is possible.
Non-surgical Perio Treatment
Initially, a new patient’s mouth receives a cleaning, as the first step in removing tartar and stain. The patient is taught proper hygiene methods including; flossing, brushing, and the use of an inter-dental pick for cleansing between the teeth. Very often an oral irrigation device is recommended.
At the next visit, periodontal pockets are measured and the readings recorded in the chart. If the readings are still over 3mm in depth but less than 5mm, the patient is often given a second visit (sometimes 2 visits) in which the gum tissue is numbed, and the dentist or hygienist performs a procedure called scaling and root planing on the side of the root in the gum space to reduce inflammation and get further shrinkage. At the same time oral hygiene techniques are reviewed.
On the next visit (usually 2 -3 weeks later) the pockets are then re-measured to see if they have shrunk to less than 3 mm. If they are still too deep, surgical periodontics is the next step. Most commonly this is performed by a periodontist who has had 2years or 3 years of additional schooling to permit him to treat deeper regions of the gum and bone.
Surgical Perio Treatment
Surgical perio treatment is done under local anesthesia. It may be done in either a 1/6, 1/4, 1/2 or the entire mouth, depending on the surgeon’s preference and the patient’s desires. The treated periodontal area is often covered with a clay-like or gum-like material called “pack”. This is usually removed 1-2 weeks later. This is ultimately done for all 4 sections of the mouth. When the entire mouth is finished, usually the hygienist takes over and polishes any stain off the teeth and removes any residual tartar that is now visible. Oral hygiene instruction is strongly re-enforced so that the tissue heals correctly. During this phase, other aspects of rebuilding the mouth may also be taking place. This may include root canal treatment, orthodontics (tooth movement) and stabilization of loose teeth.
Soft Tissue Grafts
Soft tissue grafts are indicated where the gum margin lacks an adequate zone of what is called “attached gingiva”. This gingival gum is normally textured or stippled, which means it looks a little bit like the skin of an orange peel in comparison to the smoother shining surface of the mucosal tissue which is below the “attached gingiva”. Why is this important? If the zone is too narrow, it is been observed that the gum recedes away from the enamel and down the root. To avoid this type of recession, a small, thin, superficial layer of gum tissue is removed from the palatal gum near the bicuspid upper teeth. It is transplanted to the area where it is needed after first removing, under anesthesia, the most superficial layer of the gum tissue. The donor tissue or graft is then sutured into position and most commonly covered with a dressing or pack. This is then removed 10 days to 2 weeks later by which time the sutures have dissolved. The teeth are polished so as to remove any stain and the patient is again taught proper oral dental hygiene.
Read more about Gum disease here.