Guidance of treatment

A revised classification for periodontal disease

The revised classification for periodontal diseases has highlighted:1

The definition of periodontal health 

Clinical gingival health may be classified on an intact periodontium or a reduced periodontium (patient with history of periodontitis who is currently stable or non-periodontitis patient e.g. recession, crown lengthening)

The critical role of proactively managing gingivitis to prevent progression to periodontitis & attachment loss

The distinction in risk between patients with an intact and reduced periodontium – lifelong increased risk of recurrent progression for stable periodontitis patients with reduced periodontium

Patients with history of periodontitis require site specific monitoring during periodontal maintenance programmes to monitor gingival inflammation

Gingivitis is a major risk factor and necessary pre-requisite for periodontitis - Sites of gingivitis that do not progress to attachment loss have been shown to be characterised by less gingival inflammation over time. Sites which do progress have been shown in longitudinal studies to have persistently greater levels of inflammation.1

What are the key implications of the new periodontal classification?

Domniki Chatzopoulou specialist periodontist, a senior clinical lecturer in periodontology talks about what the key implications of the new periodontal classification are for patients with periodontal disease

Inflammation should not be ignored!

Longitudinal studies have highlighted the significant role of gingival inflammation in the progression of periodontal disease.1 Periodontal health was defined for the first time in the revised periodontal classification guidance.1 It highlighted the importance of actively managing gingivitis and preventing its progression to periodontitis, providing a clear distinction in risk between patients with intact and reduced periodontium.

Whilst patients may return to gingival health following treatment for periodontitis, the reduced periodontium means they will always be at lifelong increased risk of recurrent progression vs non sufferers.1

BSP flow chart

Plaque control for patients with a reduced periodontium

The level of plaque accumulation necessary to induce gingival inflammation and impact upon its progression varies between individuals.2 Despite the fact that mechanical cleaning is the optimal advice for plaque removal, many patients do not effectively remove their supragingival biofilm with brushing alone and so may benefit from specialist products. This includes patients with a reduced periodontium.

Formalised guidance for treatment of Stage I-III periodontitis

The European Federation of Periodontology (EFP) has developed an S3 level clinical practice guideline for the treatment of Stage I-III periodontitis to formalise the link between classification of periodontitis and approaches to treatment and prevention.3 The guidance outlines a stepwise approach which, depending on disease stage, should be used incrementally.

What are the 4 key stages for the treatment of stage I-III periodontitis?

 

EFP S3 level clinical guideline for treatment of stage I-III periodontitis

  • STEP 1

    STEP 1: for all periodontitis patients, irrespective of disease stage

    Aimed at guiding behaviour change by motivating the patient to undertake successful removal of supragingival dental biofilm and risk factor control and may include:

    • Interventions to improve the effectiveness of oral hygiene: motivation, OH advice including brushing and interdental cleaning
    • Adjunctive therapies for gingival inflammation (including: Adjunctive antiseptics may be considered, specifically chlorhexidine mouth rinses for a limited period of time, in periodontitis therapy, as adjuncts to mechanical debridement, in specific cases) 
    • Professional mechanical plaque removal (PMPR), which includes the professional interventions aimed at removing supragingival plaque and calculus, as well as possible plaque-retentive factors that impair oral hygiene practices.
    • Risk factor control (Smoking cessation, improved metabolic control of diabetes etc.)

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  • STEP 2

    Step 2

    STEP 2: should be used for all periodontitis patients, only in teeth with a loss of periodontal support and/or periodontal pocket formation

    Aimed at controlling (reducing/eliminating) the subgingival biofilm and calculus (subgingival instrumentation)

    • Use of adjunctive physical or chemical agent
    • Use of adjunctive host-modulating agents (local or systemic)
    • Use of adjunctive subgingival locally delivered antimicrobials 
    • Use of adjunctive systemic antimicrobials (Adjunctive antiseptics may be considered, specifically chlorhexidine mouth rinses for a limited period of time, in periodontitis therapy, as adjuncts to mechanical debridement, in specific cases).

  • STEP 3

    Step 3

    STEP 3: to be considered if the endpoint of step 1 and 2 have not been achieved (presence of pockets >4mm with BOP or presence of deep periodontal pockets >6mm)

    Aimed at treating areas of dentition which are non-responsive 

    Repeated subgingival Instrumentation with or without adjunctive therapies, Access flap periodontal surgery, Resective periodontal surgery and Regenerative periodontal surgery.

  • STEP 4

    Step 4

    STEP 4: supportive periodontal care. To be used if endpoints of step 1 and 2 have been achieved

    Aimed at maintaining periodontal stability in all treated periodontitis patients

    • Combines preventative and therapeutic interventions defined in steps 1 and 2

Chlorhexidine has clinically proven antimicrobial activity

The antimicrobial effects of chlorhexidine persist because it binds strongly to the skin and mucosa. Chlorhexidine has bacteriostatic, bactericidal, fungicidal, fungistatic and some virus killing properties.8 Unlike some formulations, the antimicrobial activity of chlorhexidine is not affected by the presence of bodily fluids such as blood.8

Corsodyl products enhance plaque removal, alongside daily brushing, to help maintain gum health

Sensodyne Sensitivity & Gum packshot

Corsodyl toothpaste with sodium bicarbonate for daily use

  • The unique formulation of Corsodyl toothpaste is chlorhexidine free
  • 4 x greater plaque removal†4
  • Sodium bicarbonate penetrates the plaque layer disrupting the polysaccharide matrix & loosening the structural integrity of the biofilm.5

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corsodyl mouthwash

Corsodyl treatment range with chlorhexidine digluconate for short term use An adjunctive range of formats to suit your patients' needs

  • Rapid antimicrobial – kills plaque bacteria in less than 30 seconds6,7
  • Lasts – up to 12-hours substantivity forms protective antibacterial layer to prevent plaque build-up6
  • Broad spectrum activity

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