The main goal of treatment for periodontal disease is to achieve and maintain a healthy functioning dentition for the patient. Given that bacteria are the primary cause of periodontal disease, current periodontal therapy revolves around the physical removal of bacteria and bacterial retentive factors, and the prevention the reformation of bacterial plaque. Advances in our understanding of the pathogenesis of periodontal disease has not changed this basic tenet.
The initial phase of therapy is often termed cause-related therapy, as the bacterial plaque and plaque retentive factors are targeted in this phase of treatment. The objectives of cause-related therapy are to control supragingival plaque levels (to prevent caries and gingivitis) and to arrest periodontal disease and prevent its progression. The following procedures are generally employed to accomplish this:
a. education of the patient to understand the disease process and motivate them to combat the disease
b. providing oral hygiene instruction so that the patient can develop an effective self-performed plaque control regime
c. the removal of plaque and calculus deposits on teeth through scaling and root debridement procedures
d. and the removal of plaque retentive features such as overhanging restorations and ill-fitting crowns
The process of scaling and root debridement (deep clean) is most often performed with the use of hand instruments and ultra-sonic scalers. Depending on the level of severity and treatment needs, this treatment may be performed over one or multiple visits with or without local anesthetic. Severe cases generally require up to four one-hour visits of cleaning. The adjunctive use of antimicrobials is generally not required.
A periodontal review is generally performed three months after the completion of initial phase therapy. This review involves retaking the measurements of the gum pockets and comparing these measures with the initial charting to assess the healing response to the initial treatment. In most situations, this visit will also involve a light clean as well. Your periodontist will then discuss with you your future treatment needs. Periodontal disease is a chronic condition (similar to diabetes mellitus), and hence requires a life long commitment to excellent plaque control and periodic professional maintenance (as is appropriate to your case). The long-term management of periodontal disease always requires regular cleaning with a dental professional in order to prevent recurrence of disease.
