Gingival Recession:Cause,Classification & Treatment

The latest research and science behind periodontal disease is your biggest tool to convince a patient to begin—and stick with—preventive and SPT appointments. The first step is to clearly understand the information behind your case to the patient. The following are key points about periodontal disease to have in your toolbox when you talk to patients.

Periodontal disease is an inflammatory disease that affects the soft and hard tissues that support the teeth. The early stage of this disease is gingivitis. In later stages, the teeth may become loose, and the bone surrounding the teeth can degenerate. The most advanced stage of periodontitis is termed chronic periodontitis.1 Major risk factors for this disease include an inherited or a genetic predisposition, smoking, lack of routine home care, age, diet, certain systemic diseases, and various medications.2

Any time bleeding is present, pathological change is occurring in your patient’s mouth that needs to be evaluated and appropriately treated sooner rather than later. When periodontal disease is present, the potential for bone loss has already begun. Depending upon the patient’s risk factors, bone loss can occur quickly and become aggressive very easily. In patients with few or no risk factors, periodontal disease can be reversed with early nonsurgical intervention.3 With this knowledge, a patient will be much more likely to say yes to your treatment plan.

Phase 1 treatment is complete after the patient undergoes scaling and root planing, followed by a successful postoperative report from the 6-week re-evaluation appointment. This 6-week re-evaluation appointment is the first of the SPT appointments. During the early stage of periodontal disease and at the end of phase 1, the periodontium has the best chance to reverse the diseased state and, in many cases, halt the progression of further oral and systemic disease. Patients need to know, however, that this is not the end of the story. After phase 1 therapy is complete, a patient is now and forever considered a periodontal patient, which means regular SPT is a must to prevent active disease. A regular prophy just won’t do. If your patient were to ask, alternating prophylaxis appointments with SPT appointments is not appropriate and should not be considered as an appropriate phase for future treatment. Bone loss is not reversible, and it is imperative that patients understand this. Removal of the biofilm and microbiological factors also becomes very important for future health of the patient.4

For years, we have understood that periodontal disease is episodic. Make sure your patients understand what that means. It is another key point to use when explaining why regular periodontal maintenance is crucial. Periodontal pathogens will repopulate a healthy and recently scaled sulcus as early as 9 to 12 weeks post-scaling.5 That means a patient can brush and floss all day long, or even see the dental hygienist every 3 months; yet this may not be enough to prevent the return of periodontal pathogens. Without these pathogens removed, bone loss is likely to continue. Other clinical studies have shown that even with the supragingival environment as the single source for colonizing bacteria, a complex subgingival microbiota can develop within one week.6

You can strengthen your case for preventive care even more when your patient is aware that oral health affects the whole body. Countless studies have emerged during recent years suggesting a strong link between periodontal health and systemic health. For example, when patients with Crohn’s disease receive the appropriate treatment for periodontal disease, research reports a decrease in the enzymes that would normally increase inflammation in the sulcus—and the body.7 In addition, much research states that when a patient with type 2 diabetes mellitus is diagnosed with periodontal disease, nonsurgical periodontal therapy was associated with improved glycemic control.8 The role of the dental hygienist becomes extremely valuable when patients’ teeth are not merely "cleaned." Scaling, root planing, and various adjunct chemotherapeutic intervention along with lasers can improve a patient’s oral health8,9 and thus may actually help a patient live a longer, healthier life.

Your chances of getting a yes to nonsurgical periodontal therapy and routine SPT appointments will increase when patients understand the vital link between their oral health and systemic health. On that note, what’s even more effective is to share science’s good news. Decades of research and advances in periodontal therapy have proven that the majority of patients who receive routine preventive care can retain their dentition throughout their lifetimes.10 Many patients who do routine, long-term, supportive, nonsurgical therapy can maintain optimal gingival health that is free from reinfection.

If you have your patients’ attention at this point, they will probably want to know how often they need to come in for periodontal therapy. Although each patient will need an individualized treatment plan, dental hygiene appointments for routine preventive care will ideally range from 2- to 6-month intervals.11 Presenting the scientific evidence to patients takes good communication, and their understanding will leap forward, giving them a reason to sit up, listen, and take action, saying, "Yes!" to case acceptance of nonsurgical periodontal treatment.

Written by Debra Seidel-Bittke, RDH, BS