Laura Argello October 7, 2013 Periodontology Research Paper

Periodontal disease is a term describing any disease of the tissues surrounding the teeth, including gingival diseases and diseases of the supporting structures. These diseases are characterized by clinical attachment loss, alveolar bone loss, increased probing depth and gingival inflammation. Periodontal disease has many predisposing factors depending on the individual patient and sometimes their genetics. Some factors could be medications the patient is currently taking, teeth or oral abnormalities and any present diseases. Periodontal disease is most commonly due to two predisposing factors; inadequate personal oral hygiene, unhealthy eating habits, masticatory and occlusal deficiencies. Masticatory and occlusal deficiencies like missing teeth or ill-fitting partial dentures play a major role in the formation of periodontal disease because one wants to be comfortable when chewing their food when eating, not be in pain. When one is under these circumstances soft foods are popularly chosen, and are unfortunately also cariogenic. The soft foods tend to be simple carbohydrates that easily adhere to the tooth structure, thus having a direct affiliation to oral hygiene. Poor personal oral hygiene allows dental plaque to accumulate and form a biofilm not only on the tooth surface, but on the tongue and oral mucosa as well. The predominate bacteria that colonizes supragingivally is initially gram positive and coccoid bacteria. The bacterium found subgingivally is due to the mature supragingival plaque and bacteria. Subgingivally, there is a general presence of gram negative, anaerobic, motile and

Laura Argello October 7, 2013 Periodontology Research Paper asaccharolytic bacteria. On the tongue and oral mucosa, the majority of the microorganisms are from the streptococcus family. With time the microorganisms in the dental biofilm matrix thrive and initiate the inflammatory response resulting in gingivitis. From here, if the gingivitis is not reversed the disease present can progress into periodontitis. Once the disease has progressed into periodontitis the gum tissue is already inflamed and pulls away from the tooth and forms pocket that harbor the bacterium. The bodys natural immune system along with the bacteria begins to break down the connective tissue and bone causing mobile teeth and eventually lost teeth. While the bone and tissue lost with periodontitis is not reversible, the infection can be controlled. With patient consent, several treatment options are available and all depend on the severity of the periodontal disease. A treatment plan has four phases, each specific to a particular group, procedure and evaluation of the patients response. Phase I is the preliminary nonsurgical phase where immediate treatment needs are met; patient oral hygiene education is given, scaling and root planning is performed and antimicrobial agents are recommended. Phase II is surgical treatment that tries to restore the periodontium; periodontal surgery and endodontic therapy occur in this phase. Phase III is restorative treatment involving restorations and replacement of missing teeth with restorative dentistry, extensive orthodontics and occlusal therapy if needed. Phase IV is maintenance treatment and patients are in this phase for the rest of their lives.

Laura Argello October 7, 2013 Periodontology Research Paper Periodontal treatment is very effective if the patient is motivated enough to follow through and the dental team does a good job working alongside the patient to regain their oral health. As Beemsterboer mentions in Periodontology for the Dental Hygienist, Sigurd Ramfjord and Major Ash demonstrated that three month maintenance appointments are responsible for the long term success of periodontal treatment. Thanks to the advanced research done over the years, a disease classification system was developed in 1977 that made treatment planning a little simpler for the dental professionals. The system was modified up to 1999 when it became approved by an international group of periodontal experts in 1999 and was adopted by the American Academy of Periodontology as the preferred classification system. It is majorly important for patients to focus on maintaining good plaque control to prevent the disease from reoccurring. Proper disease prevention is accomplished by following through with a good oral hygiene regimen of brushing, flossing, using auxiliary aids and having regular dental visits. My treatment method of choice to treat a periodontitis patient would be scaling and root planing. I chose this because it is a nonsurgical procedure that should be the first step in regaining oral health and can be completed by a dental hygienist. The procedure for proper scaling consists of instrumenting on the crown and root surfaces of the teeth to remove plaque, biofilm, calculus, and stains. The instrumentation can be done by hand scaling or the use of sonic or ultrasonic cavitrons. An explorer and water/air tip syringe can be used to assure proper removal of the unwanted deposits. Root planing is to remove cementum or surface dentin that is rough, saturated with calculus, polluted with toxins or microorganisms.

Laura Argello October 7, 2013 Periodontology Research Paper A hygienist wants to aim for a clean, glassy, hard surface to be sure the pocket and root surfaces are clean to prevent bacterial attachment on any rough surfaces. Root planing, like scaling can be accomplished by hand scaling or the use of a cavitron. Scaling and root planing is ideal for all periodontal diseases; gingivitis, slight, moderate, severe and aggressive periodontitis. The cost for these procedures varies greatly. It depends on the location, insurance, and number of visits needed, exams performed, radiographs made, use of anesthesia and any auxiliary agents recommended. This procedure is done by dental hygienist, but can also be done by a dentist and periodontologist. As far as special training needed to perform the procedure, the hygienist, dentist and periodontologist all have to of had the proper education and certification. After scaling and root planing therapy the periodontal tissues are generally much healthier, exhibiting a healthier pink color, firmness, reduced inflammation, reduced bleeding on probing and brushing, shallower probing depths, tighter gingival tissue around the teeth and removal of extrinsic stains. I think this is the treatment of choice for periodontal disease because it is very effective at improving the periodontium and it is much less invasive than surgical treatments. It is a very successful treatment of choice with compliant patients. There is 16-95% compliance in private perio clinics with 3 month intervals. With regular maintenance visits and proper oral hygiene, the success rates can be amazing and long lasting. Some insufficiencies found from scaling and root planing is being able to debride subgingival surfaces in pocket depths of 5mm or greater. There may also be furcation

Laura Argello October 7, 2013 Periodontology Research Paper involvement present in the deeper pockets that may require surgical therapy to thoroughly debride the subgingival surfaces. Scaling and root planing failure rates would be due to noncompliant patients that do not follow through with good home oral hygiene or maintenance appointments. The patient is expected to be compliant with the treatment and maintenance of their periodontal therapy. The patient needs to be motivated and be cooperative in caring for their personal oral hygiene. A patient needs to be able to go home and remember to brush twice a day with the proper brushing technique appointed to him/her. They need to start a flossing routine of one to two times per week. The patient should be aware of their dental status and use any auxiliary aids, dentifrices, or mouth rinses recommended for their specific situation. The patient should also be responsible and show up to their dental appointments on time, make sure they make any necessary payments. The dental hygienist is often responsible for providing treatment for phase I therapy. The hygienist is also responsible for educating the patient on the importance of oral hygiene and prevention. Motivating the patient to begin and maintain good oral hygiene is also essential. This can be done by education the patient on the relationship between plaque biofilm and the periodontium. A hygienist is also responsible for customizing the treatment plan to fit each individual patient. There may be a need for alterations in regular dental hygiene care for diabetic patients. Their appointments cannot be too lengthy, their meal schedule, timing and dosing of their

Laura Argello October 7, 2013 Periodontology Research Paper insulin may also vary. Patients with physical or mental disabilities may also present challenges during the appointment that require treatment plan modifications. Patients on systemic medications could have some oral effects on the patient, requiring the hygienists to be extra cautious when scaling and root planing. Some patients may require assistance to maintain good oral home care. Their care takers need to be thoroughly informed on what needs to be done. If the patient is an elder or has a bone disease they may need a larger handle for their toothbrush to be able to grasp it and need extra auxiliary aids to be able to floss. Noncompliant patients normally have some sort of fear that keeps them from being compliant. Some factors include; their socioeconomic level, economic concerns, influence of family and friends, perceived indifference from a dental hygienist in the past or present, and failure to understand the significance of oral care. A hygienist has the responsibility to help the patient become more compliant through simplifying the information being given; accommodate the information specifically for them, reminding them of their appointments and keep records of their compliance. The hygienist should also provide positive reinforcement to help the patient.

Laura Argello October 7, 2013 Periodontology Research Paper

References Barjenbruch, T., OConnor, L., & Reichwage, P. D. (2013). Effective, conservative, contemporary nonsurgical periodontal treatment. RDH. Retrieved October 5, 2013 from http://www.rdhmag.com/articles/print/volume-23/issue-10/feature/effective-conservativecontemporary-non-surgical-periodontal-treatment.html Clark, S. (2013) Periodontology Class Notes. Kirkwood Community College. National Institute of Dental and Craniofacial Research. (2012). Periodontal (gum) disease: causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research. Retrieved October 5, 2013 from http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm Perry, Dorothy A., Beemsterboer, Phyllis L., & Essex, G. (2014). Periodontology for the Dental Hygienist. St. Louis. Saunders. Seibert, W. S. (2011). FAQ about periodontitis and periodontal disease. Central Illinois Premier Specialists in Periodontics. Retrieved October 5, 2013 from http://www.gumdoc.net/patientinformation/frequently-asked-questions.html Wilkins, Esther M. (2013). Clinical Practice of the Dental Hygienist. Philadelphia. Lippincott, Williams, and Wilkins.