Periodontitis (gum disease) and Treatment

In health the gums are firm, fibrotic, pink and do not bleed. Usually the space between the tooth and the gum (pocket or collar) is less than 1/8 inch (3mm) in depth. On x-rays the bone is usually within a millimeter of the crown of the tooth.

In gingivitis bacteria and plaque get around the teeth slightly under the gums. This results in an increase in bleeding and inflammation of the gums. This is a reversible situation. It can usually be treated by professional cleaning and home care alone.

In Periodontitis the bacteria gets more varied and more complex. The bacteria puts out poisons which get into the gums. Eventually the bone sees the poisons and your body dissolves its own bone as a defense mechanism. As the bone is lost, the gum has lost the support and it unseals from the tooth. This deepens the cuff or collar of gum tissue around the tooth. The cuff or pocket depth now gets to ¼ inch (6mm) or more. As the pocket gets deeper it is easier for harmful bacteria to build up.

Usually gum disease (periodontitis) is painless until late stages.

Treatment Planning
The first thing that Dr. Gager will do is a detailed examination measuring the depth of the gums in millimeters. Usually a standard full set of x-rays less than three years old is needed.

Depending on your situation we may be able to outline treatment at your first visit. If we need to take x-rays, usually it takes time to process x-rays and develop a plan. The plan is then outlined at a subsequent visit. Please feel free to have a friend or relative come with you if it would be helpful.

Non-Surgical Treatment
Classic treatment begins with a series of visits to clean the teeth and to establish good home care. This is done by our hygienists. It usually takes about six visits over several months. Each visit begins with additional home care instruction followed by cleaning a given area above and below the edge of the gums. If needed, the hygienist will use local anesthetic to make treatment more comfortable.

Gum Surgery
After the hygienist has completed the cleaning, Dr. Gager will re-examine. If the gums are healthy, then active treatment is complete and you can proceed to the maintenance phase.

If the pockets are still deep; if there is bleeding on probing; or if the teeth are loose Dr. Gager may recommend advanced procedures. These are usually surgical. The objective of these procedures is to clean the teeth further and leave the pocket shallower. We also have laser surgery available. (link to section 7 laser surgery)

Treatment does not cure periodontitis. Treatment gets it under control and improves the success of maintenance. The bacteria and plaque will try to return and do further damage.

The most important part of maintenance is what you do at home. That is why your first treatment visit begins there.

In addition, your professional cleaning frequency will be every three to four months. Experience shows that professional cleaning every three to four months gets to the difficult areas and greatly reduces recurrence. Often the regular cleaning visits will alternate between your general dentist and Maine Periodontics.

The most important part of treatment is mechanically removing plaque and calculus from the teeth. However, we do use oral medications for pain control. We use antibiotics to control infection. On occasion we use long-term low dose medication to modify your body’s response to inflammation.

There are numerous mouthwashes which are occasionally prescribed for short term use such as Peridex. Usually your general dentist will manage any fluoride rinses needed to prevent decay.

On very rare occasions we may use topical antimicrobials inserted around the gums.

Treatment Variations
The approach listed above is the most common. Some individuals have more severe situations which require loss of some teeth and replacement.

Second Opinions

We are more than happy to offer second opinions on your need for periodontal treatment and your options. Simply call to schedule an exam. Please consider that your time is much better spent if you bring x-rays or copies of them.

Crown Lengthening

Often your restorative dentist needs to place a crown in order to protect and retain a tooth. If there is not enough healthy tooth available then a procedure called crown lengthening can be done. This procedure is much like the classic osseous surgery done in periodontitis. The result is that more tooth is exposed so that a crown lasts longer.


If there is gum recession, there are multiple techniques available to graft soft gum tissue to the area around the tooth. On occasion, this is done for cosmetics. The majority of the time, it is done in order to keep the tooth healthy.

The common techniques involve removing gum from the roof of the mouth as a skin graft. We also have other methods whereby we do not have to take donor tissue from the roof of the mouth.


Sometimes we are unsure exactly why gum tissue is not healthy. If this is the question, we can remove a small amount of tissue and send it to a lab for analysis much like a biopsy is done anywhere on the body. Dr. Gager only does biopsies on the soft gum tissue. Biopsies on the tongue or bone are usually done by an oral surgeon.


Our role is to help you maintain your oral health. For some individuals dealing with stress associated with dental care is the most difficult part.

Let us know what it is that makes dental treatment particular difficult for you. For most, it is the fear of pain. For some people it’s the sounds. For some people it is the gag reflex. For other people it is the fear of the unknown.

The first thing we can do is see that dental treatment is not painful. Either the doctor or specially trained hygienist can use topical anesthetics and local anesthetic so there is no pain for any procedures.

For some people, local anesthetic is not enough. We have two additional approaches. The first approach is use of oral premedication. This does not put you to sleep. However, it makes the visit easier.

The final step is intravenous sedation. In this technique we start an IV and use sedative medications much like used in the hospital for endoscopy procedures. This is not general anesthesia as would be done for major surgery.

Please let us know if you would like to consider steps beyond local anesthetic.

Medical implications

Recently, the connection between oral health and overall systemic health has become a hot topic in the profession and in the popular press. Lets take a look at known situations.

First, we have known for quit some time that medications taken for varies medical conditions can greatly affect the mouth. Blood pressure medications can cause enlargement and bleeding of the gums. They can also cause a decrease in salivary flow. A decrease in salivary flow can cause an increase in the rate of decay.

Second, we have known that bacteria can get into the blood stream from the mouth during treatment causing problems for certain individuals susceptible to heart problems and to problems with prosthetic joints.

Third, we know that individuals who are diabetic tend to have more gum disease. Conversely, treatment of gum disease can affect insulin dose for a diabetic.

These situations demonstrate that the relationship between oral health and systemic health is a two way street. Disease in the gums can affect the body and disease or treatment of systemic problems can affect the teeth and gums. This only makes sense.

Additional questions have come up. How does periodontal disease relate to preterm birth weights? How does periodontal disease may to heart disease? The final answers on these questions are not in. However, we already know that disease in the mouth can adversely affect the body overall. Your oral health is an important part of your overall health. It only makes sense.

The biologic reality is self-evident. Unfortunately, this rarely results in coverage under medical insurance.

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