Key Topics in Restorative Dentistry

• Can gum / periodontal disease be treated?

Periodontal disease can be treated successfully but cannot be cured. By controlling the disease, we aim to prevent further damage and tooth loss.  Failure to treat and stabilise the disease can lead to its progression including continued bone loss, gum recession, loose teeth and eventually tooth loss. 

• Why have I been referred?

Dentists or hygienists in general practice may consider referral to the hospital if your periodontal disease is advanced and beyond the scope of their care. If you are not accepted for treatment, the consultant or specialist may have felt that treatment could be provided by your dentist or hygienist. In this case they will usually provide a detailed treatment plan.

• What’s the usual waiting time for appointments?

The waiting time in hospital can be much longer when compared to your local practice. This depends on the current workload but can vary from a few weeks to several months.

• How long are the appointments and how many visits will I need?

Appointment times can vary from 15 minutes to 3 hours, depending on the treatment required. Usually a course of periodontal treatment involves 3 to 7 appointments depending on what is required. Treatment at the hospital often takes longer than in practice, particularly if you are being treated by a student or trainee as they may have to wait to get things checked by a supervisor.

• Who will be treating me?

Depending on the complexity of your care you may be seen by one or more of the following: dental undergraduate students, trainee hygienists or therapists, staff hygienists, qualified dentists undergoing further training, specialists or consultants. If you are seen by students or trainees, they will be closely supervised by an appropriately qualified member of staff.

• What type of treatment will be carried out?

Initial treatment will include instructions on how to look after your teeth and gums, as well as non-surgical periodontal therapy which is a procedure to remove bacterial build up on the teeth above and below the gum. The aim is to reduce the depth of your gum pockets. To do this, machine operated tools which spray water and hand instruments may be used. Scaling teeth can be sensitive and often a dental anaesthetic injection is given to help make the treatment more comfortable for you. On some occasions gum surgery is required and this will be discussed with you in more detail if it is appropriate.

• What are the aims and benefits of treatment?

The aim is to reduce the depths of your gum pockets, increase your ability to maintain good oral hygiene and ultimately increase the lifespan of your teeth. Your role in maintaining lifelong optimal oral hygiene is essential for this to occur, which is why we spend a lot of time educating and supporting you to achieve this important skill.

• What are the common side effects or risks of treatment?
• Pain – can occur after treatment and may require common pain relief medications such as paracetamol. Persistent pain is not common and may be a sign of a nerve problem with a tooth.
• Sensitivity – this is normal after treatment and can vary between individuals. This may occur for a few days or persist for several months. There are treatments that can help, including changing your toothpaste, fluoride mouthwashes and avoiding acidic foods and drinks.
• Bleeding – may occur during treatment or after. Please inform us if you know you have a bleeding disorder or are taking any medications.
• Swelling/abscess –a localised swelling with a discharge of pus can sometimes occur after scaling an area that is inflamed. Please avoid taking antibiotics unless there is a clear reason for you to take them.
• Numbness – temporary and usually lasts for 1- 4 hours depending on the local anaesthetic given.
• Black triangles/spaces/receding gums – this is a normal response to treatment as your gums shrink back to health. 
• Mobility/loosening of teeth – you may notice your teeth feel slightly looser after treatment, even if they did not feel loose to start with. This is usually temporary but may last several weeks. A tooth that remains very loose may have lost too much bone and may not be able to be maintained.

• Will the treatment always work?

It will work for the majority of people but periodontal treatment does not guarantee the condition will stabilise. Despite controlling the risk factors for periodontal disease, it can sometimes be challenging to treat and you may require additional treatment including further non-surgical therapy, drug therapy or sometimes gum surgery. 

• What will be my role in the treatment?

Your role in the management and control of the disease is crucial. Now that you have this condition, you will need to make changes to your lifestyle and daily routine if you wish to keep your teeth. Our initial aim is to reduce and eliminate your individual risk factors, for example by stopping smoking. Treatment is only successful in the long term if an optimal level of oral hygiene is maintained at home. Following treatment and stabilisation of the disease you will require lifelong continuing care and support to prevent and detect any relapse. This will mean attending your general dentist or hygienist for regular supportive periodontal therapy appointments.

• What will happen once my course of treatment has been completed?

Once your treatment is complete, you will be discharged. We do not have the capacity to offer long term care so this needs to be provided by your general dentist, sometimes with the help of a hygienist.

• What if I don’t have treatment?

If the bone loss around the teeth is not controlled then teeth may become loose, the gums may shrink further and in some cases teeth may become infected or even fall out. There is also evidence that untreated periodontal disease can have a negative impact on general health. 

• What is the discharge policy?

If you do not turn up to appointments, cancel regularly at short notice, or are consistently late you will be discharged back to the care of your dentist. We may also need to discharge you if you don’t follow the instruction on tooth brushing and cleaning between your teeth, as treatment will not be successful without your commitment to a thorough cleaning routine. If you are having difficulty maintaining your oral hygiene please discuss this with the clinician who is treating you.