Assess the Risk
Initially we hope to find, and to address all modifiable risk factors associated with susceptibility to periodontal destruction.
The main factors to assess are:
- Smoking – we consider smoking cessation.
- Diabetes and diabetes control.
- Stress relief – and management of stress.
- Personal plaque control is the major modifiable risk factor for periodontitis.
Treatment for Periodontal Disease proceeds as follows:
Fundamental phase of periodontal therapy
- The fundamental aspect of periodontal therapy is the control of plaque.
- Patients are instructed on how to perform optimal personal plaque control.
- All plaque retentive factors such as calculus, overhanging restorations, are removed through scaling and reshaping.
- All subgingival plaque on root surfaces is disrupted through root surface debridement. (similar to scaling).
How we Measure Success:
- Reduction in bleeding
- Reduction in probing pocket depths
- Reduction of tooth mobility
- Reduction of plaque
Periodontitis (gum disease with bone loss) is rarely, a painful condition. However, pain can occur from abscesses within the periodontal tissues, and from a severe form of gingivitis called – Acute Necrotising Ulcerative Gingivitis (ANUG). ANUG is different from acute gingivitis, and is commonly linked with systemic disease, immune-suppressive drugs, and heavy smoking.
The underlying factors need to be investigated.
Sufficient time must be given to allow for all tissue changes after treatment to occur fully, before conducting a periodontal re-evaluation, which forms the assessment stage for the planning of further phases of periodontal therapy.
This phase of periodontal therapy can be repeated with later, as periodontal tissue healing responses will have reduced periodontal pocket probing depths, allowing for greater accessibility to root surfaces in previously deep pocket depths.
Corrective phase of periodontal therapy
In the corrective phase of periodontal therapy, the treatment approaches to be adopted depend heavily on the success in controlling plaque on a daily basis and on the response to the preceding fundamental phase of therapy.
In addition to the ‘correction’ of residual periodontal defects, this corrective phase may also entail the orthodontic repositioning of drifted teeth and the replacement, by whatever means, of missing teeth.
This phase can often be a period during which periodontal defects heal and remodel in response to fundamental therapy, and sufficient time must be allowed for the healing to be completed.
Supportive care phase of periodontal therapy
The highest aim of supportive periodontal care is the prevention of new or recurrent periodontitis lesions. Regular recalls allow for new lesions to be caught early. Supportive periodontal care also entails the prevention and management of the sequelae of periodontal destruction, such as cervical dentine sensitivity(root sensitivity), root surface caries, tooth hypermobility.
Here at Nice Happy Smiles, Danielle Tippey provides most of the periodontal care.
She is a dental hygienist and therapist. The dentists plan out the treatment, and Danielle then works to this treatment plan. The dentists will also keep a close eye on how the periodontal treatment is progressing, to ensure good health before any ‘conservative treatment’ is carried out.
As the longevity and success of these other treatments is dependent on healthy supporting tissues (gums/ alveolar bone).