The Four Stages of Periodontal Disease Treatment

Stage One
The first stage of periodontal therapy begins with a thorough exam and consultation. The nature of the disease will be explained and how it is normally treated. A full mouth series of dental X-rays is taken in order to help in the diagnosis. A detailed mapping of the gum pockets is performed and study of the "bite" is done, in order to collect the necessary information for an accurate diagnosis. Once all the information is collected a treatment plan is presented and discussed. Alternatives are presented and recommendations are made so that the patient can understand the overall prognosis of the teeth and gums.

Stage Two
Stage two is called initial therapy. During this time the patient learns various techniques to aid them in cleaning the "gum pockets" and a deep cleaning is performed below the gingival or "gum line". This is scaling and curettage in which calculus or tartar is removed from the teeth and gums, as well as the inflamed "gum tissue" or pocket lining. The gums then usually shrink and reattach to the teeth within a very short time. A reevaluation or reprobing of the gum pockets is then performed to evaluate the amount of healing that has been achieved. A "bite adjustment" maybe performed to eliminate excessive forces on the teeth and gums which may have contributed to the bone loss. Essentially the bite is balanced so that the teeth can equally share the biting forces. The healing period is used to evaluate how well the individual is cleaning the gums. Often the cleaning technique needs refining to enable the individual to clean effectively. No patient can proceed to the next stage if unable to perform effective home care.

Stage Three
For those patients who successfully finish stage two and have good healing and pockets which they are able to clean no further therapy is necessary. They are put on a recall programs explained in Stage Four. Some individuals whose pockets are too deep and still infected for them to effectively clean often need some minor gum trimmings. The extent of the procedures are usually determined by the prior amount of bone destruction. The gums are numbed and the excess gum trimmed away, the bone exposed, cleaned, and gums replaced with sutures. The night of surgery there is minor discomfort which is easily controlled with medication. Most people return to work the following day. A week later the sutures are removed. Once all the gums have healed therapy is complete and the individual is placed on a recall program.

Stage Four
The recall and maintenance program is essential. A daily home regimen of brushing, flossing or using other cleaning devices is essential for continued health. Plaque builds up daily and must be removed or the disease will return. The periodontal procedures performed have been done to facilitate cleaning. Gum surgery is not a cure but will enable the patient to clean the shallow residual pockets. A professional cleaning every three or four months is recommended to maintain continued health.

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