Phase 8: ongoing maintenance

It's easy to fall into a false sense of security once the nonsurgical phase of periodontal treatment is complete.

by Beverly Maguire, RDH

It's easy to fall into a false sense of security once the nonsurgical phase of periodontal treatment is complete. In reality, it's a work in progress. As we all know, periodontal disease is a chronic bacterial infection; there's no cure at the present time. Early diagnosis and conservative treatment can offer many patients a workable alternative to bone loss, tooth loss, and infections that can affect their overall health.

Professional treatment protocols are indispensable for ensuring initial stabilization and healing of the infection. Nonsurgical treatment, however, is not enough to produce stability forever. Without consistent daily plaque removal, periodic professional debridement, and, when necessary, surgical treatment, the disease will reactivate.

The research is compelling in support of the three-month periodontal-maintenance interval to control disease activity over a patient's lifetime. However, those familiar demons — insurance mentality and patient pressure — can force us to return our perio patients to a six-month prophy status once they appear to be stable. Sound familiar? We've all been there! Refresh your memory and review the ADA CDT-3 manual's definitions of prophy, root planing, and periodontal maintenance procedures. These codes describe three distinct procedures designed for varied circumstances: preventing disease, treating disease, or maintaining periodontal health.

"Prophylaxis" is not synonymous with perio maintenance. Perio maintenance procedures involve probing and charting, evaluating perio status, communicating the findings to the patient, instrumentation of all pocket areas, detoxification, and review of the patient's plaque-control efficiency.

A partnership must develop between the periodontal therapist and the patient. Without the involvement of both parties, there is a greater probability for recurrent disease and subsequent bone and tooth loss.

Periodontal patients predictably lapse, relapse, and collapse in their efforts to control this disease. Daily home-care routines may fluctuate as well as the intervals of professional intervention.

Managing periodontal disease is not about perfection, but rather progress. As long as we plan for it and are aware of it, it's no different than managing the ups and downs of weight control. We're the personal trainers providing oral health coaching!

Perio maintenance procedures are unequivocally effective in managing this disease. It's easy to become complacent when patients stabilize; however, it's our professional responsibility to monitor the disease and act when instability recurs. Our patients assume as much, and depend on us to inform them should the disease worsen. Prompt retreatment or referral can make all the difference and increases the rate of success exponentially. Abundant scientific research and the recent development of new products that treat and maintain periodontal disease have benefited our profession substantially. With the periodontist as a partner in treatment, new products and refined treatment protocols are key to patient management and stability.

Perio maintenance procedures can be more difficult than the treatment itself. It takes a great deal of effort and thought to constantly gather data and monitor changes that indicate recurrent disease. Changes in pocket depth, numbers of bleeding sites, bone levels, and overall health can be just a few of the red flags that indicate disease activity.

The critical thinking that goes into managing this disease for a lifetime is complex. The nebulous nature of periodontal disease is both our nemesis and our delight! It's rewarding to see the tremendous improvements made in managing this disease over the last two decades. That's progress!

Beverly Maguire, RDH, is a practicing periodontal therapist. She is president and founder of Perio Advocates, a hygiene consulting company based in Littleton, Colo. She can be reached at (303) 730-8529 or by email at PerioAdvocates@aol.com

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