An Examination of Periodontal Treatments

Andrea Schubert
Kirkwood Community College
Periodontology
October 13, 2014

Andrea Schubert
Perio Research Paper
10/13/14
Periodontology Research Paper

Periodontology is the set of periodontal diseases which are

characterized by; clinical attachment loss (CAL), alveolar bone loss (BL),
increased probing depths and gingival inflammation. (Clark 2013). This loss
in attachment creates a lengthening of the sulcus which forms a pocket
along the root surface. Plaque biofilm and bacteria sit inside of this pocket
cause an inflammatory response that can result in further damage the
surrounding gingiva. Plaque biofilm is important to define because it is an
important agent in defining disease. If the plaque biofilm is not removed and
left untreated it can continue to worsen and lead to bone loss, recession, or
mobility in teeth. Some predisposing factors which play a role in periodontal
disease are age, gender, race, hormone levels and tobacco use. Males have
a greater risk than females; also older people are more likely than younger
people to get the disease. This is the case also with people who have HIV
and diabetes, these categories of people also are more likely to have
Periodontal Disease. Those who use tobacco also have an increased likely
hood of getting the disease.
Periodontal disease is caused by the formation of dental plaque. This
plaque is formed in a specific complex arrangement of bacteria. There are
between 300-400 different species of bacteria which are seen as present in

the oral cavity. These bacteria are formed in several different shapes such as
cocci, rods/bacilli, filaments, fusiforms, or spirochetes. Bacteria in the oral
cavity start out as gram positive which causes bacterial adherence and
aggression. Around day seven a shift occurs, bacteria which are not
removed from their surfaces in the oral cavity shift into gram negative
bacteria. Lipopolysaccharides are in gram negative bacteria and these are
known endotoxins, these toxins are not good as they are used to kill tissue.
Several different treatment options are around which be used in
helping out a patient with Periodontal Disease. Surgery is a more invasive
procedure to help with the disease process, while the majority of treatment
can be handled with non-surgical techniques. These non-surgical treatments
are; systemic antibiotics, gingival curettage, scaling and root planing are the
different options of choice. Periodontal surgery is used on patients when nonsurgical treatments are found to not be sufficient. The advantage the surgical
procedure gives us is that they are able to access the root surface. This
allows one to be better able to access furcations, infrabony pockets and
other areas which would be more difficult to access during scaling and root
planing. Periodontal flap surgery is the most common surgical procedure
available to use today.
Non-surgical treatments include antibiotics are a systemic method of
treatment, examples of what these are and the bacteria which they work
against are; tetracycline, which can be used against aggressive perio, it

works against bacteria A.a. and is taken orally. Another of which is

petronidazole which also works against aggressive perio but works on the
bacteria P.p. not A.a. and lastly augmentin is used as a refractory antibiotic.
There are limitations when using the systemic delivery of antibiotics due to
organisms which are now becoming antibiotic resistant. This systemic
therapy is not used unless symptoms are shown. Gingival Curettage is
another non-surgical treatment option. It involves scraping the surface of
the gingival tissue with a curette, also referred to as closed curettage. This
procedure involves removing tissue that has become inflamed next to the
pocket wall. Clinical trials have shown that the gingival curettage is no more
beneficial than scaling and root planing. Scaling and root planing is
considered the treatment of choice for nonsurgical treatment of chronic
periodontal disease. Clinical trials show that scaling and root planing help
aid in the gain of attachment in many periodontal patients. This is seen
through probing depths which have improved as well as a reduction in
gingival inflammation. While these procedure stated above may help out the
patient is no homecare treatment is completed the treatment which the
dental hygienist will not prove beneficial. A patient has to be willing to take
care of their oral health outside of the dental office by brushing and flossing.
Scaling and root planing is the chosen method of choice for a patient
who has Periodontal Disease, this is the step for mechanical removal of
bacterial accumulation. Scaling is seen as the focus of application for
instruments to properly remove sub gingival calculus. This also benefits in

removing plaque biofilm and deposits as well. The American Academy of

Periodontology (AAP) define scaling as instrumentation of the crown and
root surfaces of the teeth to remove plaque, calculus, and stains from these
surfaces (Perry, 2014, pg 210) Root planing is define as a treatment
procedure designed to remove cementum or surface dentin that is rough,
impregnated with calculus, or contaminated with toxins or microorganisms
(Perry, 2014, pg 210). Not everyone is a good candidate for scaling and root
planing. Those who have mild to moderate perio are the best candidates
because their pocket depths are not over 7mm, they also do not have a lot of
furcation involvement. These abnormalities of more difficult patients make it
harder to do the proper treatment. The cost per quadrant for this treatment
is about $235 which makes the total approximately $1000 for the treatment
of your full mouth. (The Family Dental Center, Coralville). The task of scaling
and root planing is planned out and performed by dental hygienist in the
clinic. No additional training other than being a registered dental hygienist is
needed in this.
Scaling and root planing is the most beneficial treatment for
periodontal disease and the most sought after treatment for success. Having
scaling and root planing as our treatment of choice allows our patients the
benefit of having the chance to begin again. It allows them the opportunity
to work hard and keep their mouth clean. It gives them a more fresh start of
how to properly care for their mouth in the least invasive way as possible.
There is known to be a 85% success rate when scaling and root planing is

mixed with good home care. This high number should be an incentive to
patients to do well. Even though scaling and root planing is seen as the most
successful non-surgical treatment method, it may have adverse reactions
which may require some caution. Potentially harmful bacteria may be
released into your bloodstream. Gum tissue also has the possibility of
becoming swollen and infected. Antibiotics can be given for these situations
to help eliminate any risks possible.
Patient compliance is key in success of the treatment of periodontal
disease. In order to keep the patients state of periodontal disease from
becoming refractory proper oral hygiene instruction and at home care is
needed. A patient needs to be responsible themselves for showing up to
recall appointment on a 3-4 month basis which all periodontal disease
patients are scheduled based off of. This recall basis is to ensure proper
health of the oral cavity and allow for progress and make sure everything is
moving in a positive direction. During recall appointments it is vital for us as
hygienists to go over oral hygiene instruction and make the patient
demonstrate to us how they are currently flossing and brushing. During
recall appointments it is beneficial to be positive towards the patient; you
want help keep the patient motivated. We expect for our patient to being
doing their home care properly and if they arent catching on we need to
figure out how we can adapt their home care routine. If they need auxiliary
aids to help them better brush or floss we will dispense whats necessary.

Works Cited
ADAM. (2014, October 12). Periodontitis Treatment. Retrieved October 12,
2014, from
http://www.nytimes.com/health/guides/disease/periodontitis/treatment.
html

Clark, S. L. (Presenter). (2014, October). History of periodontology and the

dental hygienist. Lecture presented at Kirkwood Community College,
Cedar Rapids, IA.
Perry, D., Beemsterboer, P., & Essex, G. (2014). Periodontology for the dental
hygienist. (4th ed.). St. Louis, MO: Elsvier Saunders.
Root Planing and Scaling for Gum Disease. (2011, August 5). Retrieved
October 13, 2014, from http://www.webmd.com/oral-health/rootplaning-and-scaling-for-gum-disease
Wilkins, E. M. (2013). Clinical practice of the dental hygienist. (11th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins, a Wolters Kluwer
business.