Achieving Successful, Long-Term Results in Periodontal Treatment
Achieving Successful, Long-Term Results in Periodontal Treatment
Successful periodontal therapy includes:
1. Involving the patient. Involving each patient in his/her diagnosis and treatment is essential in achieving results. The level of priority that patients give their dental health, and the associated lifestyle choices they make, will ultimately decide the long-term outcome of treatment. Therefore, dental professionals must enter a non-judgmental role of "coach" to help identify habits that contribute to gum disease so that patients may make necessary changes. If these contributory habits persist, no level of treatment will be successful long-term.
2. Using appropriate forms: There must be a meaningful system to collect data at each visit and trained staff to interpret the data. Forms that show probing depths, bleeding and plaque control are critical. Records should be compared with patients from visit to visit; emphasizing all the positives and collaborating on ways to improve any negatives.
3. Using a disclosant: Lack of effective plaque control is a huge limitation in achieving results. Plaque control that subjectively appears to be excellent may be found to be quite poor when objectively measured. Set a plaque-free goal of 80% or better. There are a number of longitudinal studies that assess the long-term merit of periodontal therapy and it has been shown that perio therapy is very effective when a disclosant is used and the patient achieves a plaque-free level in the 80-90% range. There is no substitute for disclosing.
4. Focusing on inflammation: No bleeding-upon-probing and no marginal redness is the best indicator that there is no longer infection. When scaling is performed effectively, surgical treatment on single rooted teeth can almost always be avoided. After effective nonsurgical treatment, which requires managing plaque control to 80% or better and keeping BOP at 5% or less, patients have an excellent chance at staying healthy.
5. Taking advantage of the newest periodontal technology: The Perioscope is a real eye-opener. It allows us to see that calculus is present in furcation sites following root planing almost 100% of the time. Without removal of the calculus, inflammation in these sites will persist. The 48x magnification provided by the Perioscope allows us to visualize and most effectively remove the calculus, thereby eliminating the inflammation.
Of course it also allows us to avoid surgery in areas that do not require regeneration, an advantage that patients truly appreciate.
6. Paying particular attention to furcations: Don't expect to get the same result for furcations that you do for single rooted teeth. Once a furcation is involved, (even an early one), there is risk of recurrent inflammation. Furcations require additional treatment with either the Perioscope or periodontal surgery for removal of calculus and possible regeneration. They will always need to be monitored closely.
7. Knowing when to use antibiotics: Antibiotics are rarely needed to successfully treat periodontal disease. Also, the trend in dentistry, as in medicine, is to reduce antibiotic usage to avoid creating antibiotic resistance or clostridium difficile colitis (C-dif). Culture/DNA sensitivity tests often show evidence of antibiotic resistance and even multiple antibiotic resistances. (That is why two antibiotics are often recommended today, where as that was not the case 15 years ago). The ultimate key to inflammation control is not antibiotics, but rather, the effective removal of plaque and calculus. Patients truly can be healthy, stable and inflammation-free without the use of antibiotics.
8. Limiting the use of topical antibiotics: As the Perioscope has shown us, calculus is present in even early furcations almost 100% of the time after scaling and root planing. Therefore, placing topical antibiotics in these areas is like painting over rust - the results are short lived. Once again, the goal is resolution of inflammation and this can only be achieved through effective removal of the cause of the inflammation, i.e. PLAQUE AND CALCULUS.
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