Periodontal Maintenance
Studies have shown people who do not maintain regularly have 20 times the amount of bone loss as those who do.
Periodontal disease is an ongoing infection with periods of activity. It cannot be cured. As with all chronic diseases, the goal is control. There may be times when certain areas of your mouth are no longer in remission. Since there is usually no discomfort during these periods of disease activity, most patients will not be aware they are losing more bone. The only way to know this is by routine examination and assessment at the periodontal maintenance visit.
There are three components involved with controlling periodontal disease:
- Daily Plaque Control – After treatment, it is imperative that you maintain a very high level of plaque control to prevent the harmful bacteria from reforming. Poor plaque control may lead to additional breakdown, which will require retreatment. Brushing two three times per day and flossing at least once daily have shown significant long-term benefits in most studies. However, the quality of your brushing and flossing is far more important than the frequency. As necessary, we will suggest additional aids to improve your plaque control effectiveness.
- Genetic Susceptibility & Disease Risk Factors – Some patients have a greater chance of additional breakdown even with high levels of plaque control. Usually this is related to genetic makeup and risk factors. Smokers generally have the highest rate of re-infection.
- Periodontal Maintenance Visits – Routine cleanings and evaluation.
At the periodontal maintenance appointment, our highly-trained hygienists perform the following procedures:- Update of medical and dental history
- Soft tissue cancer exam
- Clinical periodontal examination including pocket depth measurements
- Review of oral hygiene as needed
- Scaling above the gum level
- Selective scaling under the gum level as needed
- Placement of topical antibiotics in deeper pockets as needed
- Polishing
- Application of fluorides and desensitizing agents as needed
- Periodic doctor check
- Confirmation of maintenance (recall) frequency
Digital full mouth radiographs are taken every three years to determine if the bone levels are stable. These will be shared with your referring dentist. (See Dental X-Rays.) Single films may be taken at any visit if a significant change in pocket depth is observed. A change of the bone level usually requires selective treatment.
Your periodontal maintenance appointment will be comfortable and require approximately 30 to 60 minutes. Topical anesthetic or Oraqix® gel is utilized on the rare occasion that a patient has sensitive gums. As always, for your comfort and relaxation a TV, iPod, Walkman, and Discman are available.
How Often Do I Need to be Seen for Periodontal Maintenance Care?
Research has clearly demonstrated that patients seen every three months for periodontal maintenance are far more stable than those seen at longer intervals. This is usually quite surprising to patients used to going every six months. However, that interval was recommended in a 1950’s toothpaste commercial for decay and has no scientific support for periodontal disease.
The maintenance frequency is customized for each patient depending on their disease level (early or advanced), oral hygiene accuracy, risk factors, and disease susceptibility. This can be as frequent as two months or as long as six months.
Normally, it takes plaque about three months to develop into an aggressive infection. For the first three months, there is minimal bone loss, but after this the breakdown can dramatically increase.
Studies have shown people who do not sustain regular periodontal maintenance have 20 times the amount of bone loss as those who do.
Where Should Periodontal Maintenance Care Be Done?
For most patients with chronic periodontitis, the first few periodontal maintenance visits will be at our office to help ensure disease stability. Subsequently, we usually suggest alternating with your general dentist. This helps provide the best overall care – we help keep your gums healthy and your dentist helps to keep your teeth healthy.
In some cases, your general dentist will be providing all of your periodontal maintenance. Conversely, if patients demonstrate unstable disease, all maintenance may be done at our office.
If all periodontal maintenance is done at our office, you will still need to be seen by your general dentist on a regular basis for cavity/restoration checks.
Will My Insurance Company Pay for Periodontal Maintenance That Often?
For those patients that have dental insurance, contracts are usually written to provide benefits for two periodontal maintenance visits per contract year. For the vast majority of periodontal patients, this is totally inadequate. Most patients prefer to be seen on the correct interval for periodontal maintenance to help decrease the need for additional treatment. They know the additional investment in prevention will result in improved oral health, longer retention of their teeth, and decreased out-of-pocket expense. With more recent findings that periodontal disease can significantly affect overall health, most patients are even more willing to schedule periodontal maintenance on an ideal basis.