Periodontal Disease and Frequency of Periodontal Maintenance

 

Periodontal Disease is an infection of the gums. The contributing factors of this disease are many: oral hygiene, chemistry, genetics, stress.

Case Histories

I patient, 37 year old male, whom I have not seen in at least 5 years came to my office last week. In the past he has had a deep cleaning and was subsequently referred to a periodontist. I have learned that the patient had another deep cleaning a year and a half ago, plus he had gum surgery on his upper front teeth where crowns were placed 7 years ago.

When this patient gave me his recent dental history he reported that he was seeing a periodontist, had some work done at his office, but after 2-3 months his gums started to look red and puffy and he was frustrated with that.

The reality is that when someone is prone to gum disease issues he must seek professional assistance every 3-4 months. Even with best hygiene (20 minutes of flossing and using appropriate medicaments to rinse with daily), some people need to see a hygienist to get those hard to get to places. With this particular patient he was under a great deal of family stress to contribute to the gingival inflammation. When he returns I will check the status of his gums and either do a periodontal maintenance at that time or refer him back to his periodontist for further treatment.

On the other end of the spectrum, I had a patient come in 2 months ago after not seeing her for almost 3 years. I asked my hygienist how her gums were and she told me that there was hardly any plaque to clean! Some people just have the correct chemistry that does not promote plaque and calculus (tartar) formation—a rare lucky one. In fact she is the only one of my current patients who are so lucky.

SO, WHAT DOES THIS ALL MEAN?

The bottom line is that each patient must be treated for their particular condition. I try to put people into 2 camps: the routine patients who usually need to come in every 6 months, and the challenged patients who need to come in for often (every 3-4 months). The more challenged patients usually have had some kind of deep cleaning at some point in their life, and if they fall down on their flossing and follow up professional care, may need another deep cleaning. If the bone loss is significant, usually 6 mm or more of pocketing in at least one place, they may need to see a periodontist who may perform gum surgery to physically get the pockets reduced (usually by adding bone).

The dental profession has truly improved in their choices for periodontal treatment over the last 30 years. At that time the technology did not exist to add bone. The treatments usually included removing bone to smoothe out the bone around the pockets. The result was that the pockets were now 3 mm (that’s the magic high number) but at the expense of losing more bone. I always had a difficult time with that. Now bone can be added or stimulated to grow in the area where bone is missing and the gum tissue can lay in a more favorable position over bone with the deep pocket being eliminated.