Oral Hygiene Instruction - The first step toward periodontal health begins with good oral hygiene. If you've been diagnosed with periodontal disease, you probably are more susceptible to the disease. For this reason, you may need to keep your teeth cleaner than most people. Be sure to review your at-home oral hygiene routine including, tooth brushing and flossing (in between teeth) techniques and the use of special hygiene aids, with your periodontal team. Good oral hygiene and professional cleanings can go a long way toward preventing certain forms of periodontal disease and also reversing early stages of diseases like gingivitis. The goal of the periodontal team is to help patients become the very best (A+) cleaners.
Scaling & Root Planing - Scaling and root planing (SRP) is a careful cleaning of the root surfaces of teeth to remove plaque and calculus from deep within the pockets and smooth the tooth root to remove bacterial toxins. This deeper cleaning is more in-depth and detailed than a routine dental cleaning and will usually require more than one appointment. In the periodontal specialty practice, scaling and root planning is also performed with the use of a dental endoscope (Perioscope) in order to allow the periodontist or periodontal hygienist to "see" the bacteria, calculus and infection at higher magnification. This allows for a more thorough cleaning than with traditional and "blind" scaling and root planing alone. The periodontist may also elect to utilize a periodontal laser (LANAP) to selectively disinfect bad bacteria and remove diseased and infected tissue from deep within the pocket. For comfort, your periodontist or periodontal hygienist will numb (local anesthesia) the area prior to treatment.
Systemic Antibiotics - In some cases, systemic antibiotics (orally administered) that specifically target periodontal pathogens are prescribed at the time of SRP procedures. Antibiotics are drugs that fight infections caused by bacteria. However, each time you take an antibiotics, you increase your chance of developing drug resistant bacteria. Therefore, it is really important to take antibiotics only when necessary. Systemic antibiotics are different from locally delivered antimicrobials which are actual drugs placed into the periodontal pocket as opposed to taken orally.
Occlusal/Bite Adjustment - When tooth surfaces are not in harmony between the upper and lower teeth, an "occlusal adjustment" may be necessary for a patient. This is because teeth that do not fit together properly can affect the rate of progression of periodontal disease or contribute to other oral health problems. Maybe a periodontist has recommended a bite adjustment because periodontal disease has damaged the supporting structure of your teeth and caused them to shift. Maybe you recently had restorative dental work that has slightly changed the way your teeth fit together. These and other reasons - from genetics to teeth clenching or grinding - can require an occlusal adjustment to help you achieve occlusal harmony and create a bite that is functional and healthy. At times, a periodontist might prescribe an "occlusal guard" or "bite guard" to be worn at certain times - day or night - to minimize the effects of teeth grinding/clenching and mechanical overload.
Disease Re-evaluation - Following adequate time to respond to your Phase 1 treatment, you will be asked to return to the periodontist's office for a re-evaluation to determine if further "Active Therapy" is warranted. If the answer is "yes", then your periodontist will develop a treatment plan to help continue restoring your mouth to a state of health. This may require a surgical or Phase 2 mode of therapy to remove any remaining infection and decrease residual pocket depths to reduce the risk for recurrent/progressing disease in the future. If the answer is "no", then you'll enter into a "Maintenance" phase or specialized treatment for periodontal disease. These appointments tend to be more thorough than traditional six-month cleanings, can be more often and will help to further protect the health of your teeth and gums.