Periodontal care and treatment is something that takes time to implement correctly. It requires curative periodontal treatment (elimination of bacteria) and maintenance that will last a lifetime. The periodontal treatment plan given by a dentist will take place in numerous stages over several months.

An evaluation of this magnitude can only be done by a Periodontist. It may include several elements depending on the type of periodontitis and its aggressiveness. The specialist will choose which options to move forward with and which to ignore.

What are the different ways of assessing the severity of periodontitis?

Your dentist has different tools that he or she can use. The first stage of treatment includes two or three sessions performed by a dental hygienist or a prophylaxis assistant. This step is intended to eliminate the microbial dental plaque deep to the edge of the gum and to ensure that there is no new formation of the plaque.

The patient must follow the instructions given by the clinic pertaining to oral hygiene at home. Without this periodontal pretreatment, success may be short-lived. During the first few appointments, the hygienist or dentist will:

• Conduct an initial interview to detect general risk factors for periodontal disease
• Perform a clinical examination to identify local periodontal risk factors.
• Chart: Pocket depth measurements are taken using a periodontal probe.
• Take a bacterial assessment (by microscope or sample) to detect very aggressive bacteria.
• Conduct a genetic test by salivary sampling (the PST test): the objective is to know if you have genetic predispositions for the development of the periodontal disease.
• Perform a retro-alveolar X-ray assessment: a series of small radiographs are taken to evaluate the treatment plan.

Learning Plaque Control

A well-done plaque check will enable long-term success of periodontal therapy. Each person has the ability to prevent periodontal disease. Checking for plaque should be done every night for at least five minutes. This is to control and limit the deposits of dental plaque under the gums.

To properly check for plaque, you must disinfect the gums using a toothbrush and possibly an antiseptic paste. The use of toothbrushes and dental floss to clean between teeth is essential. After a few weeks, you will see a decrease in gum inflammation and a reduction in bleeding (if applicable). Once the problem is remedied, do not stop – it should be done every single day.

Surfacing and Periodontal Lithotripsy

Phase 2 of treatment covers the complete removal of all pathogenic plaque on the root surface and is considered to be “real” non-operative periodontal therapy. This step is performed under local anesthesia and is combined with disinfection measures. Disinfection of areas prone to serve as a reservoir for the spread of bacteria is a necessary part of this step and will help prevent the need for tooth replacement.

Two to three months after step 2 of the treatment, the success of the therapy is evaluated by comparing the newest checkup to the initial one. If all pockets no longer require treatment, the goal of periodontal treatment is considered fulfilled, and the periodontal therapy ends with phase 4 (supportive periodontal therapy). This is the ordinary course for most cases of periodontitis.

If, on the other hand, pockets still have to be treated, corrective therapy is recommended. Lithotripsy is a surfacing technique performed by ultrasound. Lithotripsy is performed by the dentist under local anesthesia. It involves removing bacteria and tartar deep in the periodontal pockets using curettes and ultrasound.

There is no gum detachment or stitches needed, but several sessions are necessary. Following this treatment, there is a risk of sensitivities to cold food and drink for several months.

Reassessment appointments

Reevaluation helps to control how the periodontium has responded to treatment and will help define further therapy. During this reassessment, various elements will be analyzed:

• Is the patient still motivated to check their gums daily?
• Are there still periodontal pockets?

Different situations are possible:

• Healthy pockets (<4 mm) means the patient will go straight into routine maintenance.
• Shallow pockets (between 4 and 6 mm) – it is necessary to undergo new surfacing or new lithotripsy sessions.
• Persistent deep pockets > 6 mm: Periodontal surgery will be necessary to eliminate any remaining deep pockets.

Periodontal Surgery

The indication for periodontal surgery is the persistence of deep pockets detected during re-evaluation appointments. Periodontal surgery is performed under local anesthesia. A detachment of the gum is performed to allow direct access to very deep pockets.

Thorough cleaning is performed, as with any type of dental care in Ocean Springs. A bone filling or the use of specific material – like gels or membranes – may be used. The gums are then re-plated and held by sutures.

Operative follow-ups are scheduled in the case of oral surgery. This treatment phase aims to eliminate the bone defects that appear when lingering pockets persist. If the pockets are very deep, bone osteoblastic strengthening techniques may be considered appropriate (regenerative corrective therapy). If the pocket’s depth is small, the specialist may decide to eliminate the pockets by ablation and reshape the bone (resorption therapy).

Follow-up appointments – especially during bone strengthening – should only be scheduled after six months have passed. Phase 4 treatment is the last step in any periodontal therapy. In the sense of a postoperative treatment, this is the key to long-term success and ensures the result. This phase involves regular professional dental cleaning that can extend to lasting pockets.

Professional maintenance

The periodontal expert is there to help you maintain the results. But why should people undergo professional maintenance?

• Their mouth has returned to a healthy state, and the periodontal pockets are gone.
• Despite rigorous plaque control, deposits can accumulate in hard-to-reach areas.
• Checking for plaque every night is tedious, but it only needs to be done once a week.

The goal is to maintain the results obtained and to prevent new bacterial pockets from forming, despite plaque control. This is a session during which the Ocean Springs, MS dentist will motivate the patient to check for dental plaque. If needed, the specialist will find and eliminate plaque and tartar deposits located in hard to reach places.