Risk Factors, Treatment and Research

• Smoking -- Smoking is one of the most significant risk factors associated with gum disease. It also can lower the chances for successful treatment.
• Hormonal changes in girls/women -- These changes can make gums more sensitive and make it easier for gingivitis to develop.
• Diabetes -- People with diabetes are at higher risk of infection, including gum disease.
• Illnesses -- Treatments for cancer, HIV/AIDS, and other diseases can negatively affect the health of gums.
• Medications -- Hundreds of prescription and over-the-counter medicines can reduce the flow of saliva, which protects the mouth. Without enough saliva, the mouth is vulnerable to gum disease and other infections. Some medications also can cause abnormal overgrowth of gum tissue, making it difficult to keep gums clean.

How is gum disease treated?
The main goal of treatment is to control the infection. Depending on the extent of the gum disease, treatment varies. But all treatment requires the patient to maintain good daily care. The doctor may also suggest changing certain behaviors, such as quitting smoking as a way to improve treatment outcome.

Deep Cleaning (Scaling and Root Planing)
The dentist, periodontist, or dental hygienist scrapes off the tartar from above and below the gum line, and gets rid of rough spots on the tooth root, where the germs gather. This helps remove disease-causing bacteria. In some cases, lasers are used to remove plaque and tartar. This can result in less bleeding, swelling, and discomfort than traditional deep cleaning methods.

Medications
Medications may be used with scaling and root planing, but they cannot always take the place of surgery. Long-term studies are needed to determine whether medication reduces the need for surgery and is effective over a long period.

Surgical Treatments

• Flap Surgery. This common technique involves lifting back the gums, removing the tartar, and suturing the gums back in place so that the tissue will shrink to fit more tightly around the tooth. This sometimes makes the teeth appear longer.
• Bone and Tissue Grafts. Grafting replaces or encourages new growth of bone or gum tissue destroyed by periodontitis. In "guided tissue regeneration" a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.

Because each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with post-operative care, and risk factors, like smoking, which may lower chances of success.

Get a Second Opinion
When considering any extensive dental or medical treatment options, consider getting a second opinion. Call your local dental society for a dentist or periodontist in your area. Additionally, dental schools may sometimes offer second opinions. Call your area dental school to find out whether it offers this service.