Periodontal disease is bacterial infection of the gums that breaks down gum tissues and bone structures that surround the teeth. Everyone has bacteria in the mouth. However, patients with periodontal disease have 10x times the bacterial a normal person has. There is significant scientific papers that connect and support periodontal disease with other systemic (body) disease, such as heart disease. Once there is bone loss due to periodontal disease, it is irreversible – but it can be controlled and prevent further bone loss, which is why it is so important for patients who are diagnosed and scheduled for perio maintenance every 3-4 months to show up for their appointments. Gum disease can be brought under control with good hygiene at home and with perio maintenance.
A periodontal maintenance is a professional cleaning done by the hygienist with scalars, tools that are used for plaque removal on the coronal portion (visible area) of the tooth. Periodontal maintenance is a type of cleaning that involves going below the gum line (subgingival). There are 3 major differences between a routine prophy cleaning and perio maintenance.
First, a perio maintenance is for patients who have had any form of gum disease or currently have active gum disease. Patients with some form of gum disease display bone loss, pockets, and bleeding. Typically the recommended treatment is to have a deep cleaning initially then to follow-up with perio maintenance every 3 or 4 months. Patients who have had deep cleaning before have “pockets” that were created by plaque buildup between the gum and teeth. Plaque can easily buildup below the gum line (not visible) due to these pockets. Routine perio-maintenance cleaning every 3-4 months helps keep the gum pockets free of plaque, helping the gum re-adhere back to the tooth and prevents additional bone loss. This means that the patient who is put on a perio maintenance schedule will have to come to the office 3-4 times a year versus a patient who is put on a routine prophy cleaning every 6 months.
The second major difference between a regular prophy cleaning and perio maintenance is that the hygienist will clean and remove all deposits below the gum line. By definition, perio maintenance is considered therapeutic dentistry or treatment for gum disease – whereas a regular prophy cleaning is defined as a preventative dentistry. Many patients get confused with the differences between a regular cleaning and perio maintenance, because they “don’t feel any difference.” This confusion arises from that fact that many hygienist do subgingival scaling or cleaning below the gum line on patients who are only classified and scheduled for regular cleanings/prophy. This is a clerical error of definitions in the office that is not utilized correctly. Patients who require more subgingival cleanings should be classified as perio maintenance patients and told of such classification.properly, ask the hygienist to show you and they will be more than happy to give you an educational demonstration. Other types of flossing devices can be purchased to help you reach hard-to-reach spots.
Finally, at Dr. Varani’s office, perio maintenance patients receive a medicated irrigation. Due to the nature of perio maintenance cleanings that involve scaling below the gum line, we provide our patients with a medicated irrigation along the gum line after the scaling procedure. A syringe with the medicated solution is squirted/irrigated in between the gums after the cleaning. This medicated irrigation prevents infections and helps the patient’s gums to heal. The medicated irrigation is a germicidal solution with properties used to treat swelling, bleeding gums, and redness. The medicated irrigation is mint flavored, so it adds to a refreshing, clean feeling after treatment.
Like all cleanings, a coronal polishing finishes the treatment. A coronal polishing is a step that removes any stains and buildup from the crown portion of the teeth. A coronal polishing procedure utilizes a type of pumice-like paste and dental instrument to polish. This step leaves the teeth shiny and free of stain. Flossing is also done by the hygienist. Please ask the hygienist to show you how to floss properly, especially if you have bridge or connected crown work.
Patients with periodontal disease, either active or inactive, bear the scars of the disease process – such as bone loss and pocketing – which is rarely generalized throughout the mouth. Periodontal disease is a bacterial and/or viral proliferation of pathogens that overwhelms the host defenses and spurs the host’s own immune system to initiate a breakdown of supporting tooth structures. Periodontal disease also is episodic in nature. Destructive episodes can occur unbeknownst to the patient and can be triggered by stress, disease, or other systemic problems.
We also know that periodontal disease is not a “curable” disease, but it is controllable in most patients. Therefore, when a patient has experienced periodontal disease in the past, we must be ever-vigilant to monitor for signs of active disease long after the disease has been brought under control through good periodontal therapy.
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