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Maintenance

 

 

Why is Periodontal Maintenance Necessary?

Periodontal therapy involves many factors and events, including probing, radiographs, diagnosis, case typing, treatment planning, scaling, irrigating, surgery, prescribing, re-evaluating, and periodontal maintenance, among others. Some or all of these activities are necessary to arrive at a successful clinical outcome; however, only one of them determines the longevity of our successful treatment results - periodontal maintenance.

Periodontal disease is a chronic, non-curable bacterial infection that requires ongoing therapy. When we achieve disease resolution, the patient is healed – not cured. The patient is never cured; the disease is just stabilized. Periodontal disease is very similar to other diseases such as diabetes and hypertension. These are not infectious disorders; they are chronic and non-curable but very controllable, just like periodontal disease.  When someone has diabetes or hypertension, he or she must continually take medications, insulin, eat a healthy diet, exercise, etc., to control the disease. If the person fails to do so, the signs and symptoms return and health potentially deteriorates.

Periodontal disease is identical. The treatment we undertake – surgical, nonsurgical, laser, chemotherapeutic, or any other therapy – is designed to achieve disease resolution. The treatment, however, is not curative. It is not a one-and-done disease.  Ongoing therapy is required. Effective home care is daily therapy to reduce the bacterial load. Periodontal maintenance is professional therapy every three months. Without adequate home care and maintenance, the signs and symptoms of the disease will always return and the patient's health will potentially deteriorate.

Periodontal maintenance is every three months for life – the life of the patient or life of the dentition. This is not an arbitrary interval. When a biofilm (bacterial plaque) is forming, the early colonizing bacteria are not pathogenic; they cannot cause periodontal disease. If this biofilm is not eliminated or adequately dismantled, the later colonizing periodontal pathogens come onboard the biofilm. They become the predominant species in three to 12 weeks, and 12 weeks is obviously three months. That's when we want to get them, every 3 months not every 6 or 12 months. The timing of biofilm development provides a sound bacterial rationale for maintenance every three months.

Patients can only get periodontitis if they are genetically susceptible to it, which is true for all diseases. When we provide effective periodontal treatment of any type, we have not done genetic engineering. The patient is genetically susceptible to periodontitis forever; he or she never gets over it. All it takes is the genetic predisposition and enough periodontal pathogens, and the disease will always return.  This is the essence of why periodontal disease is non-curable.

Research shows that periodontal patients who do not receive proper maintenance lose two to three times more teeth and need active therapy twice as often as those having proper periodontal maintenance. Successful periodontal therapy requires considerable attention to the patient's dental, medical, and family histories, clinical presentation, risk factors, and underlying biological processes. Proper periodontal maintenance to enhance the longevity of the favorable results we achieve is simple: every three months for life. It's all about periodontal maintenance.                                                                By Richard H. Nagelberg, DDS, Dental Economics 12/2010

Your periodontal maintenance appointment will usually include:

  • Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.
  • Examination of existing restorations: Check current fillings, crowns, etc.
  • Examination of tooth decay: Check all tooth surfaces for decay.
  • Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
  • Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
  • Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

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