Periodontal Maintenance

Following therapy, regular hygiene visits are vital to maintaining periodontal health. Maintenance, along with good oral hygiene, are the keys to good oral health.

For cases where there are some residual pockets deeper than 3mm, or where the patient has shown a high susceptibility to breakdown, three month (or more frequent) recalls are critical. In these cases where the patient cannot reach all areas with oral hygiene techniques, bacteria form colonies (plaque) immediately after treatment.

Normally, it takes plaque about 28 days to develop into a more aggressive threat. The first three months there is minimal bone loss, but after ninety days the breakdown dramatically increases. If the plaque is removed every three months, the plaque aggressiveness will stay low.

At the periodontal maintenance appointment the following procedures are performed:

• Update of medical and dental history
• Oral cancer exam
• Clinical decay examination
• Clinical periodontal examination
• Review of oral hygiene as needed
• Scaling above the gum level
• Removal of bacteria below the gum line
• Root planing under the gum level as needed
• Recommend fluoride as needed
• Polishing
• Doctor check
• Confirmation of recall frequency and scheduling of next appointment

(Full mouth radiographs, which show the entire root surface, are taken every 3-5 years to determine if the bone level is stable. Other types of x-rays such as vertical bitewings are taken annually to assess bone health and check for cavities. (See Dental x-rays))

An important observation at a periodontal maintenance appointment is whether the tissues bleed when probed. If there is no bleeding, the mouth may be healthy. With smokers, the lack of bleeding does not equate to health. If there is bleeding, and it is seen on several subsequent recalls, addition treatment in that area is warranted. A change of the bone level as seen on x-rays also requires attention.

The periodontal maintenance appointment should be comfortable and pleasant.