Gum inflammation and periodontitis are chronic conditions that are normally not preceded by pain or any other considerable symptom. The bacteria most commonly associated with gum inflammation and periodontitis are predominantly gram-negative anaerobic bacteria that constantly form “plaque” on the teeth and gums. These bacteria damage the soft tissue and the bone that supports the teeth.

If dental plaque is not removed by the patient or the periodontist in a timely manner it builds up and leads to severe gum inflammation and bone loss (periodontitis). The anaerobic bacteria that makes up dental plaque is often resistant to antibiotics and mechanical plaque control is the only existing way to remove it completely. As the plaque continues to accumulate and mineralise, it eventually transforms into tartar that has to be periodically removed by a dental practitioner, usually every 3 to 4 months, twice a year or annually, depending on the patient’s condition. Tartar retains more plaque that attaches to the teeth enamel, as well as below the gum line.

A major symptom of gums inflammation is bleeding, especially the gingival bleeding noticed by the dentists upon gentle gum probing (a procedure performed with a special instrument, called periodontal probe). The presence of bleeding indicates a problem that requires professional treatment. Several clinical and laboratory tests are performed to diagnose the affected site, as well as the efficacy of your personal dental hygiene. The treatment of periodontitis requires the full engagement of the patient and is done in three stages.

1. Phase I (Initial, i.e. cause-related therapy) includes:

• Eliminating the causes of the condition (dental plaque, tartar, extraction of hopeless teeth and provisional replacement if needed, flawed dental sealants, crowns and other dental reconstructions), including by the means of surgical procedures.
• Patient education and motivation to take oral hygiene measures using all available means, such as tooth brushes, dental floss, interdental brushes and etc. tools used to maintain high level of hygiene that promotes dental health.
• Prescription of mouthwash and special gels designed to chemically suppress the growth of plaque bacteria.
• Prescription of antibiotics that should be taken post mechanical removal of plaque and tartar. Antibiotics are typically prescribed in cases of severe periodontal or common disease symptoms or conditions.
• Third party consulting – should you or your periodontist requires consultations with other specialists (i.e.orthodontist, endodontist) , such will be arranged for.

The number of visits and the intervals between them are defined individually, based on the severity and speed of development of the underlying conditions and the level of cooperation by the patient. Following a post-therapy re-evaluation and provided that there is considerable improvement of the condition, it is safe to continue the treatment with Phase Three (the so called Restorative Therapy). If gums inflammation persists despite your improved oral hygiene, the treatment must continue to Phase II (Surgical Therapy).

2. Phase II aims at:

• Pocket management in specific situations. The most popular traditional indication is the presence of pockets of ≥3mm that remained present after Phase I. Pockets are treated by tissue removal or by the use of recovery and reconstructive therapies, as defined by your periodontist.

You should be aware that active periodontal treatment, similar to all surgical procedures, may lead to:

• gingival recession (exposure in the roots of the teeth caused by a loss of gum tissue and/or retraction),
• thermal sensitivity of teeth,
• visible change in the proportion of soft tissue and teeth.

3. Phase III (Maintenance Phase).

Preservation of the periodontal health of the treated patient is as important as the elimination of periodontal disease. In the maintenance phase, patients are placed on a schedule of periodic recall visits for maintenance care to prevent recurrence of the disease. The intervals between recall appointments are varied according to the patient condition. The long-term success of periodontal treatment depends on the patient’s effort to maintain the results achieved in the other phases of the periodontal treatment plan. Negligence to follow all recommended practices and recall visits may result in deterioration of the conditions and further complications. In such cases, the responsibility lies within the patient. This mandates a lifelong relation between the patient and the treating dentist or periodontist.