Once intial therapy has been completed and the follow-up assessment performed a maintenace schedule or additional treatment will be arranged.

If the gums healing nicely a normal maintenance schedule is cleaning at 3 month intervals. Research tells us that this is the ideal interval to keep the gum disease causing bacteria at their lowest level which gives you the best chance for success.

If one or several areas are not healing well additonal surgical treatment may be necessay to better clean or rebuild the area(s). In advanced disease cases this is the time where a decision may also be made to remove bad teeth to prevent them from affecting the teeth around them.

The first stage of treatment for severe gum disease or periodontal disease is a very thorough cleaning above and below the gum line and often the use of disinfecting solutions as well.

The gums at this stage are often very tender and sore so the use of local anesthetic is required. Some patients who find they are nervous at the dentist will also request sedation although it is definitely not a requirement. Most patients do quite well with the "numbing" alone.
Most of time half the mouth is done per visit. In exteme cases only the top or bottom teeth on one side will be completed in a visit.

Once local anesthetic is administered the hygienist will perform the gum cleaning. An analgesic such as Tylenol or Advil is give before hand to minimize post operative discomfort which not not usaually very severe.

Due to the nature of the bacteria that cause gum and periodontal disease the entire mouth should be completed within 1 mo or sooner. Healing is allowed to occur for the next 4-6wks and then all the gums are re-evaluated to monitor improvement or the lack there of.

More severe gum disease and periodontal disease require more aggressive treatments. The concern with severe gum disease and periodontal disease are all the possibilities that can happen without treatment and in advanced cases, even after treatment.

Peridonatl disease means the bone around the teeth is being slowly eaten away by the infection. The more bone that is loss the looser the teeth will become. The front teeth can splay and look unattractive, there can be pain on chewing, abscesses can form and teeth can be lost.

In these case the best success is by quick and aggressive treatment. In severe cases, as mentioned prognosis may not be predictable. In some severe cases the decision is made not to attempt treatment and to remove some or all the teeth to avoid put money into a treatment that may not work.

If a decison is made to proceed with treatment of severe gum or periodontal disease here is what it will look like...