Kendre Kamm

Periodontology

Shaunda Clark

8 October 2018

Periodontology Research Paper

Periodontal disease is an inflammation and infectious disease targeting the alveolar bone,

surrounding tissues, the gingiva and mostly the periodontium. It can range in severity from slight

chronic, moderate, or advanced periodontal disease. Slight would include factors such as: 3~4

mm pockets, BOP, localized areas of recession, horizontal bone loss is common, lamina dura is

fuzzy, and the alveolar bone is 3-4 mm from the CEJ. Moderate case type include many similar

factors listed above from slight such as BOP, horizontal bone loss or vertical bone loss. Apart

from those, 4~6 mm pockets, possible furcations, a chance of minor mobility, loss of ⅓ of the

supporting alveolar bone, and the alveolar bone is 4-6 mm. Moving further to Advanced perio,

BOP, horizontal/vertical bone loss remains a common flag for disease. Advanced patients

present 6 mm + pocket depths, grade II-III furcations, class II-III mobility and the alveolar bone

is 6mm+ from the CEJ.

Periodontal disease is initially caused by bacteria and biofilm accumulation over time

without being properly removed by standard brushing and flossing. The bacteria then harbors

underneath the gum line leading to inflammation and swelling of the tissues. The individual will

most likely present with gingivitis. then adding the predominant bacteria causing disease, a

conducive environment for bacteria to grow and spread, and finally a susceptible host response.

There are a plethora of predisposing factors including the following: smoking, diet, age,
medications, systemic diseases, orthodontics, traumatic factors like a fall or car accident causing

damage to the mouth, lips, teeth or jaw, food impactions, chemical injury, stress or emotions, and

hormones. Accumulation of biofilm and bacteria on the surface of the teeth when not thoroughly

removed and the addition of poor oral hygiene will strongly increase the chance of developing

periodontal disease.

The predominant bacterial species most responsible for the etiology of periodontal

disease include gram-negative bacteria, ​P. gingivalis ​is thought to be most responsible for the

cause of disease due to specific high virulence factors. Other virulent species that composes

periodontal disease in addition to ​P. gingivalis​ are the ​Tannerella forsythensis b​ acterium,

Treponema denticola b​ acterium, ​A. actinomycetemcomitans​ “​a.a​”,

P. intermedia, F. nucleatum, Campylobacter​ species, ​Eubacterium noratum,​ and

Peptostreptococcus micros ​are also some examples.

The leading most effective treatment for periodontal disease scaling and root planing.

This procedure consists of disruption and removal of plaque biofilm present in periodontal

pockets. Detailed scaling and root planing is a crucial step in the treatment and maintenance of

the disease. Without a full non-surgical periodontal treatment, the removal of the destructive

bacteria may not be 100% successful, leaving the gingiva susceptible to further bacteria

accumulation. After therapy, it is possible for a patient to still present with gingivitis and remain

the same periodontal state for a long period of time.

Based on the text ‘Periodontology for the Dental Hygienist’, as a primary care provider in

the treatment and therapy of periodontal disease, hygienists are thought to obtain significant

responsibility for maintenance after the patient has completed active periodontal treatment. Our
overall goal of dentistry is to help our patients keep a fully functional dentition for a lifetime.

Prevention of disease outside of the dental office relies on the patients' motivation and

compliance. It is important to discuss the postoperative instructors with your patients after they

undergo periodontal therapy so they are aware of the healing process to avoid possible

complications. Nutritional counseling may be needed to help educate them on the role diet plays

in regards to the health of not only the oral cavity but the body as a whole.

Beginning the process of periodontal therapy for the majority of patients consists

assessing and evaluating the patient, then developing a diagnosis with the dentist. After that, the

next steps if indicated by the dentist would be to take updated radiographs, record full mouth

periodontal charting, comprehensive oral evaluation, and discussion of treatment options.

Scaling and root planing by a hygienist will be performed, post-operative instructions will be

provided to the patient, and routine follow up appointments with your hygienist are needed to

observe the healing phase. Modifications to home care techniques may be made and a fluoride

treatment may be needed as well.

Every person acquires different bacteria within their oral environment. Different

environments bring rise to various species of bacteria on the mucosa, tongue, palate or teeth. If

the individual has radiographic calculus, radiographic bone loss, 4+ mm probing depths, BOP

present and tenacious calculus would ideally be a perfect candidate for my chosen treatment

method.

The cost of periodontal therapy is a common concern when discussing treatment options

with the patient. At a general private practice, a full mouth periodontal treatment consisting of

scale and root planing can cost up to $1,000+. Selective therapy per single quadrant costs around
$310. The patient will be seen for follow up/ reevaluation appointment 4-6 weeks after treatment

to track progress, healing, and compare results. If localized areas are not improving, referral to a

periodontist is needed. If improvement is seen and home care is under control, most patients will

remain on a 3-4 month recall for prophylaxis generally costing $150 until stabilized.

When a patient presents with early stages of periodontal disease, our role as a dental

hygienist is to prevent the progression of the disease by performing the best treatment option for

the patient. If removal of the bacterial plaque biofilm is effective, the necessary treatment like

placing a perio-chip can be performed by a licensed dental hygienist. If their periodontal state

continues to decline after treatment, it is best to refer them to a specialist. Extensive surgery

options like a Periodontal flap, packing with perio-chip, laser treatment etc. will be performed by

a doctor who specializes in periodontal therapy.

Scaling and root planing with the use of ultrasonic instruments provide several clinical

benefits. This method is popular for its effectiveness in the removal of pathogens, disruption of

bacterial biofilm and arresting the progression of periodontal disease. This method is very

reliable and can clinicians can easily examine the progress and improvement. Updating

measurements of gingival attachment levels and pocket depths are important pieces of

information needed to track the results of my chosen treatment method.

Clinicians have hypothesized scaling and root planing is the removal of existing

endotoxins, calculus, and disruption of biofilm. A handful of studies have shown that the

removal of supragingival and subgingival bacterial deposits result in the healing of inflamed

tissues and arrest the disease progression. Studies have shown that after a non-surgical therapy

was performed, the percentage of plaque and deposit on surfaces reduced from 65% to 12% and
dropped to 8% following adequate oral hygiene habits where they remained stable for about a 6

month period. The combination of professional dental care and thorough hygiene habits at home

are excellent proof that the relationship between the clinician and the patient can make a

difference when it comes to out of office recovery methods.

Drawbacks to periodontal therapy are minimal but possible. The duration for healing

varies from person to person depending on the severity of their periodontal state. The recovery

process for periodontal disease can be uncomfortable. Treatment can be painful and most

patients complain of sensitivity following treatment because the “coat” of calculus that was

surrounding the teeth has been removed, exposing more areas of the tooth that wasn’t exposed

before. In some cases, patients may develop slight mobility of teeth after the calculus is removed

because essentially the calculus was anchored to the tooth holding it in place. There is a

contraindication for ultrasonic SRP for patients with respiratory problems or patients with a

cardiac pacemaker because the high amount aerosols can interfere and/or cause complications for

certain individuals.

A small percentage of patients that undergo periodontal therapy present with negative

outcomes. Several patients do not respond to the treatment regimens there for taking an

alternative route is needed. Changes to the treatment plan will be noted and adjustments will be

made. Failure can depend on various external factors including the patient's overall health status,

other systemic conditions, dexterity, sensitivity to OTC products, allergies, financial limitations,

or faulty restorations.

Abounding home care practices and repetitive oral habits are underlying factors for the

improvement and long-term maintenance after undergoing SRP. Remaining compliant with
reevaluation appointments and for the hygienist to display reinforcement for the patients good

work at home is important in building the trust between yourself and your patient during this

confusing processes of treatment and recovery. They are the ones experiencing the pain and

discomfort so it is helpful for them to know they can rely on us to answer any questions they

have during it.

Our role as a dental hygienist is to improve the periodontal health of our patients and

maintain their oral health by educating them with correct preventive techniques for them to be

able to keep their periodontal state at a healthy and stable level. Being able to recognize

periodontal disease at an early stage is crucial in order to help provide the most effective

treatment for the patient. Communication, commitment, and collaboration with other dental

professionals will help achieve successful long-term maintenance of their periodontal health.

Discussing with the patient what their periodontal state is at currently will help them

understand the risks of further regression and the importance for improvement. They may

slightly understand the process of non-surgical periodontal therapy but not to the extent they

need to. If healing doesn’t go as planned, you can discuss with the patient that there other options

on the market but more of a financial jump when referring to a specialist. I think it is useful be

hands on with them by physically showing them what their teeth and gingiva looks like

compared to a clinically healthy, non-periodontal diseased candidate whether that is with images

of a healthy mouth and/or examples of healthy dental charts and radiographs. Allowing the

patient to see the results of periodontal treatment may help motivate them to stay on top of their

homecare methods. Using terms that are understandable to the patient is helpful when discussing

techniques and recommendations.

 When it comes to maintaining a healthy oral cavity, discussing home care methods with

the patient is critical for a successful therapy. The use of subgingival water flosser for the patient

to use at home will help flush out any existing bacteria or biofilm, antimicrobial adjuncts,

brushing 2x/day and flossing at least 1x/day will still be needed for a successful therapy. An

electric toothbrush and the use of a flossing aid or soft picks would be beneficial if the patients'

dexterity is limited. A healthy diet and a strong immune system will make the recovery process

easier.

Motivation and commitment are going to be important in order to get the best possible

results. If a patient is unwilling to improve their home care methods then recovery will be a

longer and more painful process. Routine dental check-ups are important and getting updated

periodontal probe measurements will help monitor the success of treatment.

References:

Bronstein, Diana, and Jon B Suzuki. “Periodontal Disease Management.” ​Dimensions of

Dental Hygiene,​ 19 July 2018.

Clark, Shaunda. “​Calculus and Other Disease Associated Factors Unit 103.”​ KCC. 10

September 2018. Lecture

Clark, Shunda. “​Gingivitis Unit 104.​” KCC. 18 September 2018. Lecture

Clark, Shaunda. ​“Periodontal Anatomy Unit 102,” ​KCC. 20 August 2018. Lecture

Hebl, Lisa. “ ​Oral Pathology Powerpoints​” KCC. 2018. Lecture

Perry, Dorothy A., et al. ​Periodontology for the Dental Hygienist​. Elsevier, 2014.

Wilkins, Esther Mae., et al. ​Clinical Practice of the Dental Hygienist.​ Wolters Kluwer,

2017.