Managing gum disease in patients
Managing periodontal disease
As highlighted in the causes and mechanisms section of this site, it is universally agreed that periodontal diseases are initiated by plaque bacteria.1 Whilst regular dental visits and dental prohylaxis plays an important role in maintaining gum health, it is the action of patients between dental visits that makes the difference. For this reason, any treatment of periodontal disease, from early stages or signs of inflammation, needs to start with effective daily toothbrushing and interdental cleaning.
It has been widely acknowledged by the EFP and AAP that the adjunctive use of oral hygiene products such as specialist toothpastes or mouthwashes may also help enhance plaque removal. Find out more about parodontax products.
In addition to enhancing plaque removal it is important to be aware of any risk factors which may leave patients at increased risk of developing periodontal disease. Advice could be provided to sign post patients for smoking-cessation support or patients could be referred to their GP to help improve metabolic control for diabetes.
You can read more about the role of lifestyle risk factors in periodontal disease here.
Should we be looking for clues in a patient’s lifestyle to assess their risk for gum disease?
As with other non-communicable diseases (NCD’s), we are discovering more information about the impacts of a modern lifestyle on gum disease. Does this information hold the key to managing the condition and reducing the prevalence of gum disease?
EFP S3 level clinical practice guidelines for treatment of periodontitis
In July 2020, the European Federation of Periodontology published the first evidence-based treatment guidelines for periodontitis.2 This new guidance has been developed to help inform treatment and benefit patients from around the world.
It was drawn up as part of XVI European Workshop on Periodontology where 90 experts from 19 countries evaluated 15 systematic reviews on different forms of periodontal therapy to develop recommendations for the first 3 stages of periodontitis as defined in the new global classification.2
According the clinical practice guidelines, the first step of therapy is aimed at behaviour change to ensure improved supra-gingival plaque removal and risk factor control:2
- OHI, adjunctive therapies for gingival inflammation, professional mechanical plaque removal (PMPR)
- Risk factor control e.g. smoking cessation, improved metabolic control for diabetes
This step is aimed at controlling subgingival calculus and biofilm. Includes use of:2
- Adjunctive physical or chemical elements
- Adjunctive host-modulating agents
- Adjunctive subgingival locally delivered antimicrobials
- Adjunctive systemic antimicrobials
This step is used to gain further access to gingival instrumentation or to regenerate/resect lesions that add to complexity and may include:2
- Repeated subgingival instrumentation with or without adjunctive therapies
- Access flap periodontal surgery
- Resective periodontal surgery
- Regenerative periodontal surgery
By combining preventive and therapeutic indications this step aims to maintain periodontal stability in all periodontitis patients in the first and second steps of therapy.2 If recurrent disease is detected in recall visits patients may need re-treatment. Healthy lifestyles and oral hygiene form a part of this stage.
Non-surgical periodontal treatment
According to guidelines from the American Academy of Periodontology, periodontal health should be achieved in the least invasive and most cost-effective manner.3 Non-surgical periodontal treatment is the first step ahead of surgery.
Key elements of non-surgical periodontal treatment include:
- Scaling and root planing (followed by ongoing maintenance therapy)
- Tray delivery systems to administer prescribed medications as an adjunct to scaling and root planing
Useful resources for the management of periodontal disease
FDI periodontal disease chairside guide
This chairside guide helps assess patient risk and also with management of periodontal disease.
Image taken from FDI periodontal disease chairside guide
FDI white paper on prevention and management of periodontal diseases
This white paper provides a comprehensive summary of prevention and treatment for the management of periodontal diseases.
Image taken from FDI White Paper
EFP S3 level clinical guidelines for the management of periodontal disease
Access the evidence based guidelines for the management of stage I-III periodontitis following the 2017 Global Classification Workshop.
Image taken from EFP S3 level clinical guidelines