Prepare for a Visit

Once bacteria damages your gum tissue, and the ligaments and bone supporting your teeth, you have a clear diagnosis of periodontal disease. Periodontal disease can be treated, and the damage it causes can be repaired. Then it must be managed through good oral hygiene and regular periodontal maintenance to keep it from progressing, causing additional damage, and negatively impacting your overall health.

Active periodontal therapy typically begins with scaling and root planing. In severe cases, you may require periodontal surgery. These treatments help get control of your disease and keep it from progressing.

Once these initial treatments are completed, you will require ongoing periodontal maintenance to ensure the disease remains under control. If you do not follow your dentist's recommended periodontal maintenance schedule, you should expect the disease to progress.

Periodontal maintenance is different from regular professional tooth cleanings. Periodontal maintenance removes the plaque and tartar from above and below the gum line in areas where disease may have damaged the connective fibers that stabilize your teeth. It may also require site-specific scaling and root planing. It is considered a "deeper cleaning" because once you have periodontal disease, you have pockets in your gums that extend deeper than normal professional cleanings and home oral care.

The benefits of periodontal maintenance include:

• Preventing or delaying the progression of periodontal disease.
• Identifying areas of continued inflammation and allowing your dentist to recommend treatment to bring the disease under control.
• Delaying the possibility of missing teeth by helping save the bone around them.
• Preventing or minimizing chronic inflammation associated with periodontal disease.
• Allowing your dentist to provide ongoing feedback on your efforts to control the disease.

Before the procedure

• Review your health status: You will share information that will help ensure that your dentist and their staff can provide safe and effective treatment and provide appropriate post-care guidance. Get important information here: Health history and current health status.
• Anesthesia: Before cleaning, your dentist or hygienist may use a local anesthetic if your teeth are particularly sensitive, though this is typically not needed.

During the procedure

• Gum pocket measurement: The dentist or hygienist will use a probe to measure the depth of the gum pockets around your teeth. They are also looking for bleeding and accumulation of tartar in deeper pockets. Over time, this allows your dentist to monitor the progress being made to control your disease. Gum pockets that measure between one and three millimeters are generally considered healthy, assuming there are no signs of inflammation like redness, bleeding, infectious drainage, or swelling. If there are signs of inflammation and pockets of three millimeters or less, a diagnosis of gingivitis is generally made. Pockets around four millimeters deep may indicate gingivitis if accompanied by redness, bleeding, or swelling. Pockets deeper than four millimeters may be an indication of periodontal disease. If accompanied by signs of inflammation, the disease is considered active.
• Grade and State: If you have been diagnosed with periodontal disease, your dentist will assign and continuously reevaluate a "stage" and "grade" based on a variety of factors.
  • The stage classifies the severity of the disease based on the extent of the damage. It also considers how challenging it will be to manage the disease over time. Stages range from 1 (least complex) to 4 (most complex).
  • The grade classifies how quickly the disease is likely to progress and how responsive it may be to traditional treatments. The grade also considers the likelihood that the disease may impact your overall health. Grades range from A (slow) to C (rapid).
• Cleaning: Your dentist or hygienist will use instruments to remove the tartar in the deeper pockets between affected teeth and gums to prevent the disease from progressing since it is difficult for you to reach them using normal oral care methods.
  • Some dental professionals use a combination of mechanical and ultrasonic or electric tools to remove tartar. Some of these tools can create sounds like a dental drill, but no drilling occurs.

After the procedure

• Follow-up care: Your dentist or hygienist should give you specific oral hygiene instructions to help you better manage the areas of your mouth that are difficult to clean or remain inflamed.

The frequency of periodontal maintenance

Periodontal maintenance treatments are typically recommended more frequently than professional tooth cleanings because the treatment helps ensure that bacteria is removed before it causes more damage. Increased frequency is important because it is difficult or impossible to clean periodontal pockets effectively with a toothbrush and dental floss.

The American Academy of Periodontology states that maintenance visits at three-month intervals are effective for most people. If your periodontal disease is advanced or you do not maintain good oral hygiene, your dentist may recommend more frequent treatments. If you maintain good oral hygiene and have less aggressive periodontal disease, you may need maintenance less frequently.

Your dentist will recommend a frequency for your periodontal treatments based on:

• Your disease's original diagnosis (generalized or localized; early, moderate or severe; chronic or aggressive).
• The health of your teeth, gums, bone, and areas of continued inflammation.
• Whether your mouth has areas where plaque forms more quickly or is more difficult to remove.
• Your age, overall health, and any special conditions that may make it difficult to properly clean your teeth and gums and treat your periodontal disease.
• Your motivation to control your disease and maintain your teeth.

Managing your disease at home

You and your dentist should discuss the best way to manage your periodontal disease. Your dentist may suggest nutritional supplements and oral hygiene aids to help keep your disease from progressing between professional visits.

Additional treatment you may need

• If your dentist finds localized areas of inflammation, you may need to be treated with antimicrobial agents.
• You may need localized scaling and root planing to control areas of active inflammation.
• If any of your teeth have become loose, you may need periodontal stabilization splints.
• If your periodontal disease continues to worsen, you may require additional scaling and root planing or periodontal surgery.
• Occasionally, severe periodontal disease may require tooth removal. If so, your dentist may recommend that the affected teeth be replaced to ensure proper chewing and stability of the remaining teeth.

• Once you have received treatment for periodontal disease, it must be actively managed by following your dentist's recommended maintenance schedule and proper home oral hygiene. Even with the recommended maintenance and hygiene guidelines, the disease may progress. Without proper maintenance, your scaling and root planing or periodontal surgery will not be effective over time, and your disease will progress. You will most likely have to start the entire process again or risk tooth loss and deterioration of your jawbones. Missing teeth can be a serious condition that should be addressed as soon as possible.

Periodontal maintenance is the generally accepted method to manage periodontal disease after treating active periodontal disease with either scaling and root planing or periodontal surgery.

• If you choose not to have periodontal maintenance following treatment of periodontal disease, your dentist will not be able to monitor and treat areas of continued inflammation.
• If you delay or refuse treatment, your periodontal disease may ultimately result in infection, pain, swelling, tooth and bone loss.
• Not treating chronic periodontal inflammation may contribute to general health problems, including life-threatening conditions.

• How often do I need periodontal maintenance treatments? You should discuss this with your dentist at every visit, as the frequency may change based on the status of your disease.
  • Are you making this suggestion based on my plan coverage or in the best interest of my oral health?
  • What do I need to do to have the best chance of successfully managing my disease?
    • What risk factors are affecting the progression of my periodontal disease?
    • What risk factors can I control?
    • Besides brushing and flossing, are there other hygiene and oral care strategies I should employ to manage my periodontal disease?