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Periodontal treatment involves deep cleaning of the diseased tooth root surfaces. This can be uncomfortable and often local anaesthetic is required to make the treatment comfortable for you. The effects of the anaesthetic last 2 hours on average, however each individual will metabolise and process the anaesthetic at a different rate (some patients have felt numb for up to 8 hours). We advise you to be sensible during this time ie. if you would like to eat or drink something hot, let it cool for 5 minutes first, try and chew the food on the side of your mouth that is not numb or don’t eat at all, don’t plan an important meeting or phone call for immediately after your appointment. This usually only applies to the first phase of treatment and maintenance does not usually require anaesthesia.
While things won’t feel completely normal for 2-3 days; most people do not experience significant pain. If you do require pain control, whatever you would normally take for a headache is adequate or else we recommend Nurofen as it is also anti-inflammatory (please check with your pharmacist before taking). Should you have pain which lasts for more than 3 days, please let us know.
It is normal to experience tooth sensitivity following treatment. For 98% of patients, this will resolve within one week and the best way to control these symptoms is with excellent oral hygiene at home. You may also find that toothpastes specifically for sensitive teeth may be of use. You can use them as a toothpaste, but do not rinse out the paste; or you can apply the paste to one particular tooth and leave it on. If sensitivity becomes a long-term problem we can recommend professional grade products to alleviate these symptoms. It may also be necessary to review your dietary intake of acidic foods and beverages (particularly wine, soft drinks, sports drinks and fruits or fruit juices). Occasionally there is an underlying endodontic (or root canal) problem which requires further management by your dentist.
The gingival tissues are inflamed and ulcerated as part of periodontal disease due to the bacterial infection on the root surface. Gum bleeding will persist for up to 2 weeks after periodontal treatment has been completed. Bleeding may come back, however it usually signifies areas you have been missing with your cleaning. Hint: Clean these areas more, don’t leave them to “heal”.
When you have periodontal disease, the gum is swollen and ulcerated (against the tooth where you cannot see). When the bacteria are removed from the tooth, and the gum begins to heal, the swelling will gradually subside. Patients often feel there are increased gaps between the teeth and sometimes the teeth appear longer. These are unavoidable side effects of gum disease and the amount of recession that occurs is often unpredictable. Most patients become accustomed to the recession and are not concerned. Excellent oral hygiene at home will minimise recession which may occur in the future.
The exposed root surfaces may be at increased risk of caries (decay), particularly if you have a dry mouth. It may be necessary to consider application of stronger fluoride mouthwashes or gels. It is also imperative that you continue regular check ups with your general dentist to check for new areas of decay as well as monitor your other fillings and dental requirements.
Often we will retain teeth if they are functional and comfortable, despite advanced gum disease. These teeth are considered “survivors”. It is not unusual to develop abscesses at these teeth, however should the same tooth be affected more than twice in 4 months, then the tooth requires extraction. Should you develop any pain or swelling, please advise us and we shall arrange an emergency appointment for you.
Regular “maintenance” or cleaning is necessary to stabilise and manage the gum disease. If this is not done regularly the bacteria can be allowed to build up below the gum line, and the disease will progress. Management requires a team effort; what you do at home on a daily basis combined with professional maintenance. Without professional maintenance the gum disease will become unstable and progress from an already compromised position. This is the single greatest factor in determining the success of periodontal treatment.
Periodontal disease is “multi-factorial”. The better you are at controlling the aggravating factors, particularly smoking and diabetes, the more likely it will be that your gum disease will stabilise. Whilst these factors are uncontrolled, there will be progression of the gum disease and extraction of teeth over time. Other factors may also develop over time and impact on disease progression, however these will be reviewed as they occur. Local factors which increase plaque retention (dentures, fillings, crowded teeth etc) may also compromise the ability to control your periodontal disease. It may be necessary to involve your general dentist in addressing these factors and you will be responsible for arranging the suitable appointments. Be aware that on average, 10% of teeth require extraction, however a small percentage of patients will lose a large number of teeth despite the best possible treatment.