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Periodontal Diseases and their Possible Treatments

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What is periodontal disease?

Periodontal disease is defined as the inflammatory disease that affects the gums, the dentine of the tooth, surrounding alveolar bone as well as the PDL (periodontal ligaments). The early diagnosis of this disease is crucial because at an advanced stage, periodontal disease becomes irreversible thus resulting in the loss of natural tissue and structures. One of the most prominent features of periodontal disease is the formation of pockets of varying depth (depending upon the stage of the disease).

There is also marked recession of the gums, resulting in abnormal exposure of the root portion of the tooth. This recession eventually causes the mobility of the affected tooth and may result in tooth loss. One of the main causes of periodontal disease is gingivitis when it is left untreated for a prolonged duration of time. One can thus state that periodontal disease is one of the leading complications of gingivitis.

Types of periodontal disease:

Some of the most common periodontal diseases include simple gingivitis (the inflammation of gums), periodontitis (inflammation of gums, and surrounding structures of the teeth), and a condition known as acute necrotizing ulcerative gingivitis.

Gingivitis and periodontal disease are both caused mainly due to the accumulation of bacteria that is capable of destroying mineralized structures. These bacteria produce initiate reactions that can cause the inflammation of the gingiva, thus resulting in the formation of pockets, attachment loss, recession of the gums and ultimately, tooth loss. It is important to note however, that gingival and periodontal diseases are not always associated with the presence of bacteria, but can also result from various changes in the hormones of the body, or due to several systemic disorders and diseases.

Treatment options for periodontal disease:

Dentists all over the world plan the treatment of periodontal diseases based on the stage of the disease that the patient presents in. If diagnosed in the early stages, patients are strongly advised to improve their oral health and hygiene regime. This includes the correct technique of tooth brushing, flossing of teeth (in order to release plaque accumulations from inter-dental spaces, avoiding sugary diet or establishing a proper frequency of the intake of sugar containing food substances, and quitting habits that can promote periodontal diseases, for instance smoking. Once a patient follows these instructions, it is possible to prevent the progression of the disease and the gums may return to their natural, healthy form once again.

In more progressed stages, dentists recommend treatment options such as root planning and scaling. Scaling and root planning are done in case of excessive build up of calculus (calcified matter) on and around the teeth. Scaling effectively removes calculus from areas that cannot otherwise be cleaned by tooth brushing. Root planning is frequently done in patients that present with progressed stages of periodontal disease because it is the most effective treatment for the elimination of calcified matter from the root portion of the teeth. Timely treatment of periodontal diseases can aid in the prevention of tooth mobility or loss.

Periodontal Diseases and side effects

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When we smile, the most visible structures of our face are our teeth. Many factors can adversely affect the beauty of our smile and shatter our confidence, one major factor being unhealthy and unsightly teeth and gums. These not only appear unpleasant, they also lead to bad breath or odor from the mouth, known as halitosis, infections in the oral cavity or mouth and may lead to other, more serious consequences such as tooth decay and even tooth loss.

Inflamed and gums, also known as gingivitis, is directly related to periodontitis, which is a disease of the gums in addition to the other supporting tissues of the teeth. Both these inflammatory conditions are detrimental to oral health and the teeth, and can lead to tooth loss. Periodontitis is a progression of gingivitis, but in either case, they are both considered periodontal diseases.

Oral complications or periodontal disease

Gingivitis is caused by accumulation of plaque and hardened calculus between the teeth and gums due to lack of adequate oral hygiene maintenance. The inflamed gums pull away from the teeth as they are swollen, and allow easy access for bacteria within the plaque to accumulate and grow beneath them, leading to further destruction of the periodontal tissues. The bacteria not only damage the periodontium, but also cause tooth decay and infection within the periodontal tissues. These can eventually lead to destruction of the teeth themselves and eventual tooth loss. The toxins and acidic by-products of the bacterial destruction of periodontal tissues severely damage the underlying bone and periodontal ligaments, in periodontitis, leading to tooth loss.

Systemic complications of periodontal disease

Apart from tooth loss being a major side effect of periodontal disease, there can potentially be some dangerous effects as well that result from the disease, even with systemic complications. A study shows that clinically, patients that undergo joint replacement for treating arthritis are at a higher risk of infection in newly placed prosthetic joint if they suffer even a mild form of periodontal disease. This is due to the fact that the causative bacteria present beneath the gums can easily be displaced from their area of accumulation and be transported elsewhere by simple stimulation of the gums, such as during normal tooth brushing and flossing. It is for reasons such as this that all periodontal diseases must be treated completely before a patient undergoes any major surgical procedure.

Another dangerous side effect of periodontal disease is the fact that bacteria residing beneath the gums can easily enter the blood stream after a tooth extraction and reach the heart of a patient with a prosthetic heart valve, leading to a dangerous and life threatening inflammation of the heart known as endocarditis. Bacteria can also accumulate in the heart’s coronary artery, leading to their inflammation as well, which can lead to a stroke.

Gingivitis is characterized by persistently bleeding gums which is bad for those on anti-coagulant therapy for blood disorders. The bleeding is difficult to stop, the gums remain sore, swollen, easily ulcerate and heal extremely slowly, causing a constant unhealthy state of the oral cavity and affecting the entire system as whole. Eating normal food becomes difficult due to the pain of inflamed gums, mobile teeth and burning.

Only a strict oral hygiene regime, awareness of the health status of oneself and regular check-ups and cleanings with the dentist are the best way to deal with periodontal disease to prevent any systemic complications from occurring.

The Costs of Periodontal Disease

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What are the treatment options for periodontal disease?
There are a number of treatments that can be offered to patients suffering from periodontal diseases, depending upon the stage and severity of the disease. Some of the most common treatments for periodontal diseases include antibiotic therapy, scaling, root planning, gingival curettage, open flap curettage surgery, guided tissue generation, bone grafting, enamel matrix protein derivative procedure, gingival grafting, dental implants and various cosmetic procedures that can restore the esthetics and/or functionality of the teeth.

Costs of periodontal disease treatment procedures

Emphasis must be placed on the fact that the cost of periodontal disease treatment procedures vary from region to region and may be different with different dental surgeons. However, the average costs of the procedures around the world have been discussed below.


The teeth are divided into four quadrants. Generally, dental surgeons charge $200-$300 for conventional root planning procedures for each quadrant. This may or may not include the cost of extractions if they are required. Simple scaling may cost much less than that and the cost varies greatly across the globe. It is believed and understood that the cost of the treatment procedure increases with the degree of the invasive of the procedure. Periodontal surgeons may also recommend a perioscopy, a procedure which can cost from $300 to $800 for each quadrant. The regenerative periodontal endoscopy is comparatively more expensive and can cost up to $800 per quadrant.

Conventional laser periodontal therapies are still rather expensive. They generally comprise of about 6-8 sittings, whereby each sitting can cost up to $400. In case of extreme severity of the disease, the bone is generally involved in which case bone grafting or osseous periodontal surgeries are recommended. The Osseous periodontal surgery ranges between $1000 to $2000 for each quadrant and the cost may or may not include extractions, if required.

By far the most expensive procedure used for the treatment periodontal diseases is dental implants. Dental implants are considered to be the ideal replacement of the natural tooth in terms of strength and durability. The average cost of a single implant in the United State of America is about $3000 to $4000. This cost includes extraction, placement of the implant, provisional temporary crown, placement of the abutment and finally the placement of the porcelain crown. The most expensive components of a dental implant procedure are the implant and the porcelain crown, which cost about $1000 and $1500 respectively.

Signs of Periodontal Disease

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Periodontal disease is an inflammatory condition of the gums (gingiva), periodontal ligaments that support the teeth and the surrounding alveolar bone. Both gingivitis and periodontitis are included in the category of periodontal disease, which is simply a term used to describe an inflammation of the supporting tissues of the teeth.

How does periodontal disease begin?

Periodontal disease begins with an inflammation of the gingiva, known as gingivitis, which gives external support to the teeth and underlying alveolar bone that supports the teeth. This is caused by local irritating factors such as accumulation of plaque and calculus. As periodontal disease progresses however, the underlying bone begins to destruct as the swollen gingiva moves away from the teeth and allows bacteria to reach beneath. The periodontal ligaments which attach the teeth to the alveolar bone within the tooth socket begin to break down as well, due to acid release by the bacteria. This results in loss of bony attachment of the teeth, making them mobile.

What does one experience during periodontal disease?

Mobility of the teeth brings to mind pain upon chewing or mastication. If a person has a progressed form of periodontal disease, he may have such mobile teeth that he won’t be able to chew at all, due to extreme pain and discomfort caused by the mobile teeth. Periodontal disease can be localized to a single tooth or generalized within the whole dental arch.

Lack of the ability to chew normal food can result in malnutrition due to inadequate dietary intake of solid food. The person may stop chewing or eating altogether, and may neglect his oral hygiene even further to avoid pain and discomfort. This leads to further destruction of the periodontal tissues and eventually, the teeth become so loose within their sockets that they eventually fall out.

Periodontal disease that leads to tooth loss also majorly compromises one’s esthetics, as good teeth are the key to looking and feeling great about oneself. Once teeth are loss, it only looks esthetically unpleasing but greatly affects the individual’s confidence and self-esteem. Furthermore, natural teeth cannot be replaced once they are lost, and prosthetic replacements are then needed which come with their own array of disadvantages.

What are the signs of periodontal disease?

Gingivitis is the initial sign of periodontal disease, which is the inflammation of the gums. It manifests as dark pink to red, swollen gums, followed by easy bleeding which may worsen as periodontitis progresses. Another sign is persistent bad breath, also known as halitosis, due to excessive accumulation of bacteria on and around the gums. Gingival recession results due to the presence of excessive plaque and calculus, which later can lead to tooth mobility and eventual tooth loss.

Adults generally present with a type of periodontitis known as chronic periodontitis.  Progressed stages of periodontitis are irreversible and will ultimately cause tooth loss. Some of the symptoms of periodontitis include swollen, reddish or purplish gums, tenderness and bleeding on pressure, gum recession, recession of the inter-dental gingiva, foul breath and taste in the mouth and tooth mobility. These are the generalized symptoms of a progressed stage of periodontitis which will result in tooth loss.

The most effective way to prevent periodontal diseases is to maintain proper oral hygiene and in case of plaque and calculus accumulation, tooth cleaning and scaling must be considered.

Laser Periodontal Disease treatment – Overview

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What is Laser periodontal treatment?

Laser has been part of a number of dental treatment procedures, and is now being used for the treatment of periodontal disease. Previously it was believed that once periodontal diseases reach a certain stage, they can be considered irreversible and incurable. With the help of laser however, it has become possible to eliminate the periodontal disease and ensuring complete restoration of the affected portion of the gingival.

The main aim of using laser to treat periodontal disease is to induce decontamination in the affected portion. Decontamination kills all the harmful, disease causing bacteria present in the region. These are generally anaerobic bacteria and are found in the gingival lines of the teeth. Laser is being used as an effective means of significantly eliminating periodontal diseases because there are no known types of bacteria that are resistant to laser, hence the procedure is completely reliable and ensures that the disease does not occur again.

What are the advantages of the Laser periodontal treatment?

There are a number of advantages associated with opting for the laser treatment for periodontal diseases. Some of these advantages have been enlisted as follows:

  1. Does not affect or suppress the body’s natural immune system
  2. The procedure is completely painless, in contrast to other periodontal treatment options. The laser does not induce any kind of discomfort or pain in the patient
  3. The procedure is highly efficient and does not require several sessions. Most dentists only recommend two sessions for the laser periodontal disease treatment
  4. Visible progress: With the effective decontamination process and the regular use of antibiotics, it is possible to achieve about 1mm reduction in the size of the periodontal pockets that are formed with the progression of the disease
  5. Studies have shown that laser can reduce the risk of the development of diabetes in a healthy person because it significantly reduces the production of a factor known as glycated hemoglobin
  6. Does not require any invasive procedures such as incisions or sutures. The laser is guided by periodontal probes and this procedure can be accomplished without having to expose inner tissue, or use sutures to heal them
  7. Laser periodontal treatment can be done on patients who possess medical conditions that do not allow them, to opt for conventional surgeries related to the treatment of periodontal diseases

It is the ideal treatment if the patient is prone to recurrent episodes of periodontal disease.