Periodontal Disease

What is Periodontal Disease?

Periodontal disease is a low grade chronic inflammatory condition triggered by deposits of bacterial plaque and tartar. Everyone has a different response to the plaque bacteria; some people produce more inflammation than others; similar to an allergy. The bone and gum around the teeth are destroyed by this inflammation, causing red or bleeding gums, gum recession or sensitivity, loose or drifting teeth, gaps between teeth, discharge from the gums or a bad taste or odour and often tooth loss if left untreated.

What treatment is on offer?

Treatment is about management of the inflammation to achieve a stable balance without progressive damage to the tooth support.

First line treatment is a basic work-up to clean your mouth as thoroughly as possible. This involves meticulous cleaning of tartar and plaque from all areas of your mouth. This will probably take 6-8 visits depending on the disease severity. As you go through the programme, considerable advice will be given on better and easier ways of cleaning your mouth; this is absolutely the key to successful treatment; we will ask you to be slightly fanatical about the level of cleaning but without this level of home-care, your treatment will fail.

In some cases it may be necessary to recommend a tooth is removed; this is only ever done to reduce the risk of losing a more useful neighbouring tooth.

What other treatment might be offered?

1. Elyzol/Chlosite; these are antimicrobial gels that are delivered locally into the space between the gum and tooth (pocket) to kill the bacteria.
2. Periostat; this is a low dose tetracycline given for three months to damp down the inflammation and prevent collagen loss.
   
3. Gum Surgery may help to improve access by reshaping the damaged gum.
4. Surgery may also be used to try to regenerate lost bone and/or soft tissue.
   
   
5. Root Resection; a relatively simple way of saving a damaged tooth with several roots is to remove the worst affected root.
6. Photodynamic Therapy; this is a brand new way of dealing with bacteria within the gum tissue. A special dye is introduced into the spaces (pockets) between the gum and tooth. The dye locks onto the disease causing bacteria. A soft diode laser is then used to activate the dye and it destroys the target bacteria.This is a totally painless and effective one-visit treatment used instead of the antibiotic gel treatment.
   
7. Smoking Cessation; smokers with gum problems can lose up to seven times as many teeth as non-smokers. They take 3-4 times as many visits to get the gums stable and still relapse afterwards. We offer a variety of support including hypnotherapy to help you stop.
8. Dentalyse Genetic test; this is a simple mouth swab which will help us to identify anyone who is genetically more susceptible than the average person (about 5% of the population). This is a one-off test which helps us to select the best treatments for your particular problem.

What other implications are there if untreated?

1. Heart disease may be worsened in at risk patients.
2. Diabetic control affected.
3. Premature, low-birthweight babies risk increased.

How can I help treatment to be successful?

1. Good home-care
2. Stop Smoking; smokers lose up to 7 times as many teeth to gum problems as non-smokers. Your local GP practice or Gateshead PCT can give you help and advice in their smoking cessation clinic, or our Hygienist (Gerrie Forrest) can offer hypnosis to help you to stop.
3. Regular recalls; most patients with moderate-severe gum problems who are doing the best they can with their home-care manage to stay fairly stable provided they are seen every 3 months for supplementary cleaning. Longer recalls often allow further relapse to occur.
4. Stress reduction
5. Diabetes; well controlled

What costs are likely?

Initial examination, x rays, consultation / treatment plan with our periodontal specialist; @£96.00

Hygienist treatment time; (usually 1/2 hour appointments) @£120/ hour

Specialist Surgical time @£265 / hour

Chlosite/ Elyzol antibiotic gel (2 applications including hygienist time); £173.54

Periostat (3 month course) £68

Photodynamic Therapy £150

Grafting materials;

Bone substitute (Grafton, BioOss or Fortoss Vital)

Collagen membrane

Emdogain

@£137.50 each; sometimes more than one material may be required to supplement a surgical procedure.

Why have I been referred?

Because there is a large genetic influence on the level and rate of damage to your gum and bone, some patients are less easy to manage in a general practice framework and more specialised measures may be required.

Some patients are managed well in general practice for years and then develop problems that tip the balance in favour of more rapid and unacceptable destruction.

This specialist referral service has been created to cater for the needs of these patients. We work closely with your own dental practice and will keep them informed of your progress.