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Aggressive Forms of Gum Disease May Require Invasive Measures


Although aggressive and potentially devastating, periodontal (gum) disease can be brought under control with proven methods. For most patients removing the underlying cause, bacterial plaque built up on tooth surfaces, is enough to restore the gums to good health.

For some patients, though, scaling (manual plaque and calculus (tartar) removal using specialized hand instruments) may not be enough. The disease may have progressed deep below the gum line, to inhabit gaps that have developed between the teeth and gums known as periodontal pockets or in furcations, branching points in teeth with multiple roots. Either of these is difficult if not impossible to reach through scaling — without more invasive techniques these patients’ teeth are at a heightened risk for loss.

The infected areas in these cases may require surgical access to clean and disinfect them. One of the more common procedures is gum flap surgery, where the surgeon creates a small opening on three sides of the gum tissue — resembling the “flap” of a letter envelope — to access the roots for disinfection. The procedure can be performed with local anesthesia and the flap closed with self-absorbing sutures.

Antibacterial therapy may also be appropriate for more aggressive forms of bacteria to inhibit re-infection after removing plaque and calculus (hardened plaque deposits). These antibacterial agents, usually tetracycline, are applied topically during treatment or in follow-up cleanings. They can help stop inflammation and promote healing, and can be more effective in penetrating difficult areas than hand instruments.

But one caveat with antibiotics: they will eventually kill good bacteria, and give rise to resistant strains that can make future antibiotic use ineffective. For these reasons, they’re best used for short, isolated attacks on aggressive bacteria and not long-term unless absolutely necessary.

Whether you will need a surgical or antibiotic approach will depend on your individual case. Regardless, as soon as we’ve diagnosed gum disease you should begin appropriate treatment — the sooner we bring this damaging infection under control, the better your chances of bringing your teeth and gums back to good health.

If you would like more information on the causes and treatment of gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treating Difficult Areas of Periodontal Disease.”

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