Tooth decay in its earliest stage—before the development of cavities—may be treatable with newer methods utilizing specialized dental sealants, resins, or gums, or fluoride liquid or gel applied directly to the teeth by a dental practitioner. These treatments may remineralize enamel that has been eroded by bacterial acids or seal off decayed areas from further exposure to erosive acids (Stahl 2007; Borges 2011). Once cavities have formed, a dentist will need to remove the part of the tooth affected by decay and replace it with a filling or crown. If the infection has reached the pulp at the center of the tooth, a root canal, in which the root pulp is removed and replaced with a special filling, may be performed in an attempt to save the tooth; however, severely decayed teeth sometimes cannot be repaired and need to be extracted. The options for replacing extracted teeth include bridges and implants (Mayo Clinic 2014a).
Gingivitis can frequently be managed with diligent home dental hygiene and regular cleanings performed by a dental practitioner (Kawar 2011). The recommended time between cleanings is based on the severity of the gingivitis and other individual factors (ADA 1997). Toothpastes and mouthwashes that contain antimicrobial substances such as xylitol and essential oils are frequently used to help control plaque (UMMC 2013; Sharma 2010; Vlachojannis 2013).
Treatment of periodontitis can involve several strategies, depending on the severity of disease:
- Scaling and root planing. These are considered “deep cleaning” procedures. Scaling uses ultrasonic and manual instruments to remove calculus and plaque from tooth surfaces above and below the gum line. Root planing smoothes the root surface so plaque and calculus are less likely to accumulate. The primary purpose of these procedures is to reduce bacterial load in periodontal pockets. Scaling and root planing are generally sufficient treatment for gingivitis and mild periodontitis (Nardi 2012; Paramashivaiah 2013; Singh 2012; Kawar 2011; UMMC 2013).
- Antibiotics. Antibiotics are sometimes used topically at the site of infection in milder cases, or orally (systemically) in more advanced cases (Kawar 2011). Prescription mouthwashes containing the antimicrobial agent chlorhexidine may be recommended for use before and after periodontal surgery. Side effects of chlorhexidine mouthwashes include temporary tooth discoloration, and rarely, severe allergic reactions (UMMC 2013; Sugano 2012). However, antibiotic use in periodontal disease has come into question since they appear to add little to the efficacy of scaling and root planing and increasing numbers of oral bacteria are becoming resistant to commonly-used antibiotics (Sugano 2012). Doxycycline, a common antibiotic, may be used orally at very low doses to slow destruction of the gums and periodontal ligament (Tariq 2012; Kawar 2011).
- Surgery. Flap surgery, or periodontal pocket reduction, involves removing sections of the gum that are severely affected, creating access to deeper tissues and the tooth root so cleaning techniques can be more effective. Surgical options for addressing tissue degeneration include gum grafts and bone grafts (UMMC 2013; Kawar 2011).