Periodontal disease (commonly called gum disease) is an infection of the soft tissue, ligaments and bone that supports a tooth within the jaw. This infection is caused by harmful bacteria that live within our mouth. Regardless of how well or how often we brush and floss our teeth, bacteria is always present in our mouth. Dental hygienists are specialized health care providers that, through ultrasonic, hand instrumentation and lasers, remove harmful bacteria that cause inflammation, infection and bone loss.
Does my health put me at risk for gum disease? Does gum disease impact my overall health?
People who suffer from illnesses that compromise their immune systems (HIV, cancer, hepatitis, stress) or illnesses that compromise their circulation (diabetes, smoking) are far more prone to aggressive periodontal disease and bone loss due to higher rates of infection and poor healing. Nutritional deficiencies caused by diet (vitamin B,C,D deficiency, iron deficiency) or illnesses affecting nutrient absorption (like celiac disease) can also greatly impact the health and healing ability of our bones, gums and teeth.
Dental literature is full of studies demonstrating the correlation between gum disease and systemic illness. This makes sense considering that our mouths are linked to the rest of our bodies through our blood stream. When bacteria is present in our mouth it causes inflammation. Swollen gums act as a portal for bacteria and their associated toxins to enter into our circulatory system.
These harmful toxins circulate throughout our entire body and put us at risk for numerous significant illnesses. Periodontal disease is closely associated with heart disease, stroke, adult onset diabetes, rheumatoid changes, osteoporosis and bone density issues, thyroid cancer and low birth-weight/preterm babies.
Our overall systemic health impacts the health of our gums, and the health of our gums impacts the overall health of our bodies (it’s a vicious cycle!). If your goal is to be optimally healthy and to improve and extend the quality of your life, managing gum disease becomes a critical intervention in achieving this goal!
The goal of periodontal maintenance is:
To prevent or minimize recurrence of infections in patients who were previously treated for gum disease (gingivitis, periodontitis, peri-implantitis).
To prevent or reduce the incidence of tooth or implant loss by monitoring oral health and assessing any restorations or replacement of the natural teeth that may be required to increase the probability of locating and treating other conditions or diseases found within the oral cavity in a timely manner.
A periodontal maintenance visit is more than just a cleaning!
Determining the frequency of periodontal maintenance visits is a complex issue that includes many factors (like quality of saliva, home care habits, systemic health, smoking, genetic factors, diet, previous history of gum disease) and maintenance programs need to be individualized to the needs of each person.
Research has been done to evaluate the effectiveness of dental hygiene visits at intervals of 2 weeks,2 to 3 months, 3 months, 3 to 4 months, 3 to 6 months, 4 to 6 months, and up to 18 months. In general, the data suggests that for patients with acceptable oral hygiene habits and only mild gingivitis, a periodontal maintenance schedule including scaling, oral cancer screening and spot probing every 6 months is ideal.
However, for most patients with a history of periodontitis, numerous clinical studies suggest that periodontal maintenance should be performed at intervals of less than 6 months. Research suggests that because the return of harmful bacteria to pre-treatment levels generally occurs within 9 to 11 weeks after hygiene appointments, most patients with a previous history of periodontitis should see a dental hygienist at least four times per year (or every 3 months). This scaling interval has been shown to cause a significant decrease in the bacteria counts and inflammatory markers and decrease the likelihood of progressive disease, compared to patients receiving periodontal maintenance on a less frequent basis.
Moreover, mechanical, chemical, surgical, and/or non-surgical therapy may need to be reinitiated in some periodontal maintenance patients at specific sites that manifest disease progression. This may be indicated particularly at sites associated with previous attachment loss.
The time required for periodontal maintenance appointments should be dictated by such factors as the number of teeth or implants present, patient cooperation, oral hygiene skill and compliance, systemic health, previous frequency of dental hygiene re-care appointments, instrumentation access, history of disease or complications, and the distribution and depth of the periodontal pockets. Although periodontal maintenance traditionally has been delivered over a 45 to 60 minute period, the time required for effective periodontal maintenance needs to be individualized. Adherence to suggested periodontal maintenance intervals will affect the success of treatment.
The information used to create this document can be referenced in the Journal of Periodontology and sites over 90 research articles in support of its claims. (J Periodontol 2003;74:1395-1401)