accessibility ACCESSIBILITY
Tampa Bay Periodontics and Implant Dentistry
James G. Wilson, DMD
Diplomate, American Board of Periodontology

Nonsurgical Periodontal Therapy

Some people think periodontal therapy in a periodontist's office always means surgical treatment.  The fact is, in its earlier stages, periodontal disease responds quite favorably to nonsurgical periodontal therapy.  Only in its more advanced stages of destruction is surgical intervention necessary.  In fact, surgery is reserved for those situations when nonsurgical therapies have failed to achieve the desired clinical outcome of periodontal health, and to repair damage to gum tissue and bone as a result of periodontal disease.  Because of his years of additional training in the diagnosis and management of periodontal disease, Dr. Wilson has specialized capabilities to perform an accurate risk assessment and develop an appropriate plan for management of your periodontal condition.  Dr. Wilson follows the American Academy of Periodontology treatment guidelines which stress that periodontal health should be achieved in the least invasive and most cost effective manner.

The primary cause of periodontal diseases is the body's inflammatory response to bacterial plaque.  The purpose of nonsurgical periodontal therapy is to remove or eliminate the etiologic agents which cause inflammation: dental plaque, its toxins, and hardened dental plaque referred to as calculus or tartar.

Oral Hygiene Training

Proper oral hygiene is the first step towards periodontal health.  If you've been diagnosed with periodontal diseases, you may be more susceptible.  For this reason, you may need to keep your teeth cleaner than most people.  We take seriously our role as coaches for your daily oral hygiene efforts.

There are so many products on the market it can become confusing when choosing which to utilize in your home oral hygiene efforts.  Dr. Wilson is a strong believer in the value of oral hygiene aides such as electric toothbrushes, interproximal brushes for between your teeth, and dental floss.  We see excellent results with electric toothbrushes like the Oral B Braun or Sonicare brushes.  Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque.  You need to brush and floss in conjunction with the irrigator.

If used in conjunction with brushing and flossing, fluoride toothpaste and mouth rinses can reduce tooth decay as much as 40%.  Tarter control toothpaste will reduce tartar above the gum line, but gum disease starts below the gum line so these products have not been proven to assist in prevention of gum disease.  Sensitive teeth toothpaste can assist with controlling the sensitivity brought on by exposure of the roots due to periodontal diseases.  Anti-plaque rinses contain agents that may help bring early gum disease under control.  They should be used in conjunction with brushing and flossing.

Your periodontal hygienist is the best person to select the products that are best for you.  Dr. Wilson encourages his patients to bring their oral hygiene aides with them to prophylaxis, scaling and root planing, and maintenance visits so that continuous oral hygiene training can take place.

Prophylaxis

A prophylaxis is a routine dental cleaning performed on patients with normal, healthy mouths to maintain health and prevent the initiation of dental diseases.  Traditionally, it has also been utilized for the management of mild gingivitis patients who do not have significant calculus (tartar) built up below the gum line.

Scaling and Root Planing (Deep Cleaning)

Scaling and root planing (also referred to as a deep cleaning) is a careful cleaning of the root surfaces to remove plaque and calculus (tartar) from deep periodontal pockets and to smooth the tooth roots to remove bacterial toxins and make it more difficult for plaque to accumulate along the root surfaces.  When performed properly, scaling and root planing can reduce gingival inflammation and probing depths, and can shift the bacterial composition living in the pockets from one associated with disease towards one associated with health.  It is considered an active treatment for periodontitis and the results of the therapy should be assessed for success at some point after adequate time for healing has been allowed.  For those patients who achieve periodontal health following scaling and root planing, ongoing maintenance therapy is necessary to sustain health.

After scaling and root planing, many patients do not require any further treatment, however; nonsurgical therapy does have its limitations.  Areas that have not responded favorably to scaling and root planing (continued to show signs of periodontal disease) may require further treatment.  Multiple studies in the periodontal literature have shown the limitations of effectively scaling and root planing in a pocket greater than 4 millimeters in depth. Because of the complex anatomy of the root surfaces below the gum line, scaling and root planing is a much more demanding procedure than a prophylaxis.  It is often necessary to perform the scaling and root planing treatment over the course of more than one appointment and with the adjunctive usage of local anesthesia so that a thorough job to be performed in a comfortable manner for the patient.

Locally Delivered Antimicrobials

Locally delivered antimicrobials are antibiotic medications that are delivered directly into periodontal pockets to suppress or eradicate periodontal bacteria.  The most common locally delivered antimicrobial in the dental market today is Arrestin.  When used properly, these medications have definite indications in the treatment of patients with periodontitis. Locally delivered antimicrobials are utilized in conjunction with thorough scaling and root planing of the pocket.  With inadequate scaling and root planing the medications will have little benefit.  Because studies have not shown a clinically significant difference in pocket depth reduction utilizing locally delivered antimicrobials versus scaling and root planing without these medications, Dr. Wilson does not recommend their usage in most cases during the initial scaling and root planing process.  Because of their cost and need for multiple continued applications over time, he does not recommend treating multiple sites versus instituting definitive periodontal therapy.  Dr. Wilson recommends the usage of locally delivered antimicrobial medications in those patients with a few sites in a quarter of their mouth that have not responded favorably to scaling and root planing therapy.  He also recommends these medications for patients who have had definitive periodontal therapy and have localized areas that have persistent signs of periodontal disease recurrence after treatment.  As with scaling and root planing, if localized antimicrobials are utilized as a method for active periodontal disease treatment, the success of this treatment should be evaluated at a reevaluation appointment.  Areas that continue to show signs of periodontal disease may require further treatment.

Reevaluation

A reevaluation should be performed following adequate time to respond to your active treatment of periodontal disease.  For areas that continue to exhibit signs of periodontal disease, further active therapy may be indicated.  Treatment options available to Dr. Wilson included continued nonsurgical therapy, laser periodontal therapy, periodontal surgical therapy, dental implant therapy, or a combination of each.  Dr. Wilson's periodontal training and years of management of patients utilizing different modalities of treatment provide him a unique perspective to anticipate your expected response to various treatments available for management of your periodontal condition.  We are proud of our abilities to be a patient advocate and provide guidance for what we feel is most appropriate treatment while respecting your right to know about alternative treatments their risks and their benefits.

Periodontal Maintenance

Periodontal maintenance is a specialized program developed for each patient once periodontal health has been improved.  These appointments tend to be more thorough than traditional six-month cleanings.  They are designed to prevent periodontal disease from occurring in patients who have undergone treatment for periodontitis or dental implant therapy.  This ongoing phase of treatment will allow Dr. Wilson and his hygienists to assess your periodontal health and make sure infection stays under control.  Periodontal diseases are chronic diseases, just like diabetes.  Without careful, ongoing treatment, periodontal diseases can and often do recur.

 

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