19 Aug Orthodontic Best Practices: Treating Patients With Periodontal Disease
Periodontal disease is a serious oral health condition that necessitates the help of a dental professional. Due to the severity of this disease, there are various steps that must take place to reverse it or slow down its progression.
But what if you decide to get orthodontic treatment to realign your smile? Can you still get braces or another orthodontic appliance when you have periodontal disease? There’s no clear-cut answer, as every case differs.
Below, we’ll walk you through the steps typically taken for periodontal disease patients before undergoing orthodontic treatment.
Initial Consultation
Every patient receives an initial assessment before receiving orthodontic treatment. This is standard for each prospective patient. This inspection, however, is especially critical for those with periodontal disease or other oral health concerns.
During this consultation, the orthodontist will not only determine what type of orthodontic treatment the patient could benefit from, but also if they’re a good candidate for such treatment. For someone with periodontal disease, the orthodontist will want to do a more exhaustive consultation to ensure compatibility with treatment.
Patient Suggestions
While orthodontists aren’t periodontal specialists, they are still qualified to give dental advice or provide resources based on the patient’s current oral state. The goal isn’t to condemn or judge. These suggestions are aimed to educate and assist the patient.
Early stages of periodontal disease may be improved or reversed with a more thorough and rigorous daily oral health routine. The orthodontist or another dental health professional can help you come up with a solid plan for improving the health of your gums before treatment can be approved.
Assessment with a Periodontist
More likely than not, the patient will be referred to a gum specialist known as a periodontist. They can further assess the patient’s gum condition. The severity of the condition will be assessed based on things such as pocket depth, tooth mobility, bleeding on probing, and level of gum inflammation using a variety of equipment and tools.
The periodontist will help determine if the patient should get orthodontic treatment or if further gum assistance will be needed before returning to an orthodontist.
Gum Treatment
An assessment with a periodontist may reveal that the patient could benefit from treatment. Getting periodontal treatment may or may not allow the patient to get orthodontic treatment in the future. Either way, taking care of periodontal disease is important for the health of the patient.
Periodontitis treatments may include gum grafting, guided tissue regeneration, or crown lengthening. Non-surgical treatments may include medication, professional dental cleaning, scaling and root planing, and more frequent dental visits going forward. The type(s) of treatment needed come down to the severity of the patient’s condition.
Orthodontist and Periodontist Collaboration
In minor cases of periodontal disease, the periodontist may simply give their stamp of approval to One Devonshire Place Orthodontics. In other cases, the periodontist may outright deny orthodontic treatment. Then there are situations where the periodontist may approve treatment, but only if they remain in close collaboration with the orthodontist.
Collaboration between a periodontist and an orthodontist can ensure treatment goes smoothly. Without a periodontist on board, the orthodontic treatment may not go to plan and could even reject or cause worse oral health problems.
The orthodontist will play a role in determining which orthodontic treatment(s) would be needed based on the patient’s alignment and bite. Meanwhile, the periodontist will be mainly concerned about the health of the patient’s gums in coordination with the desired treatment.
Ultimately, the goal is to ensure the patient’s gums are healthy enough and well-stabilized before receiving orthodontic treatment. This extra precaution may seem exhausting, but in the long run, it’s important for the patient’s oral health.
Personalized Treatment Plan
Orthodontic treatment is always tailored to a patient’s specific situation. However, the treatment plan is even more personalized when the patient has a periodontal disease diagnosis.
The orthodontist and periodontist will have to agree on what treatment is appropriate, how it can be accomplished, and how long the orthodontic treatment may be needed.
Here are some treatment plan personalizations that may be made for someone with periodontal disease:
- Orthodontic treatment done in stages rather than all at once
- Partial orthodontic treatment rather than long-term
- Use of lighter materials that won’t apply as much force to the teeth
- Temporary implants to help keep orthodontic appliances in place during treatment
- Removable aligners instead of semi-permanent braces
- The extraction of weak teeth
- Avoiding treatment on certain teeth, like through the installation of segmental braces
- More frequent orthodontic visits to see how the treatment is going
- Regular periodontal checkups before and during treatment
Appliance Installation
After both an orthodontist and periodontist clear the patient for orthodontic treatment and a plan is set in place, the treatment can begin.
The installation appointment for someone with periodontal disease may take longer, depending on the specific modifications that need to be made for the patient’s sake. The orthodontist may need to be extra cautious when installing appliances. They may also have to make special adjustments that they wouldn’t normally do for patients without periodontal disease.
Frequent Monitoring
Even after the orthodontic appliance is installed, monitoring is still important. It’s even more critical for those with periodontal disease.
The patient may be advised to visit the dentist more often than the average patient for thorough professional cleanings. This can help ensure better gum health. Additionally, they will likely need frequent checkups with their periodontist to monitor their gums and their progression.
In some cases, the orthodontist may even request extra visits with the patient to ensure orthodontic treatment is going to plan. They can also make any adjustments as needed. This may mean continuing treatment as is, removing or adding oral appliances, or halting treatment altogether, depending on their findings.
Conclusion
There are many steps that must occur before one can get orthodontic treatment like metal braces. The steps are even more comprehensive for those with periodontal disease. While not every periodontal patient may be a good candidate for orthodontic treatment, the good news is that a periodontal expert may clear the patient to move forward with treatment.
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Last Updated on August 19, 2025 by Marie Benz MD FAAD
