Last updated: 11/24/2009

Many factors contribute to periodontal disease, and the process that leads to the need for surgery may occur early or take many months or years to develop. Early primary tooth mobility or early primary tooth loss in children may be due to very serious...

underlying diseases, including hereditary gingival fibromatosis, a fibrous enlargement of the gingiva; conditions induced by drugs for liver disease; or gum conditions related to leukemia. Patient-related factors for chronic periodontal disease include systemic health, age, oral hygiene, various presurgical therapeutic options, and the patient's ability to control plaque formation and smoking. Another factor includes the extent and frequency of periodontal procedures to remove subgingival deposits. Gum inflammation can be secondary to many conditions, including diabetes, genetic predisposition, stress, immuno-suppression, pregnancy, medications, and nutrition.

The most telling signs of early gum disease are swollen gums and bleeding. If gingivectomy is considered, consultation with the patient's physician is important, as are instruction and reinforcement with the patient to control plaque. Gingiva scaling and root planing should be performed to remove plaque and calculus to see if gum health improves.

The protective responses of the body and the use of dental practices to overcome the pathology of periodontal disease may be thwarted and the concentration of pathogens may be such that plaque below the gum line leads to tissue destruction. Refractory periodontitis, or the form of periodontal disease characterized by its resistance to repeated gingival treatments, and often also associated with diabetes milletis and other systematic diseases, may require surgery to remove deep pockets and to offer regenerative procedures like tissue and bone grafts.

The level of damage is determined by signs of inflammation and by measuring the pocket depth. Healthy pockets around the teeth are usually between 0.04–0.11 in (1–3 mm). The dentist measures each tooth and notes the findings. If the pockets are more than 0.19–0.23 in (5–6 mm), x rays may be taken to look at bone loss. After conferring with the patient, a decision will be made to have periodontal surgery or to try medications and/or more gingival scaling.

Risks for infection must be assessed prior to surgery. Certain conditions, including damaged heart valves, congenital heart defects, immunosuppression, liver disease, and such artificial joints as hip or knee replacements, put the oral surgery patient at higher risk for infection. Ultimately, the decision for surgery should be based upon the health of the patient, the quality of life with or without surgery, their willingness to change such lifestyle factors as smoking and bad nutrition, and the ability to incorporate oral hygiene into a daily regimen. Expense is also a factor since periodontal surgery is relatively expensive. Long-term studies are still needed to determine if such medications as antibiotic treatments are superior to surgery for severe chronic periodontal disease.