6. The Goals Of Periodontal Treatment In More Detail – Part 2

In arti­cle #5, the first goal of peri­odon­tal dis­ease and gin­givi­tis treat­ment, aware­ness of the dis­ease process and recog­ni­tion of its warn­ing signs was dis­cussed. Other goals of peri­odon­tal treat­ment and the team mem­bers’ roles in achiev­ing those goals will now be discussed.

The next four goals can be grouped together because they are inter­re­lated goals, which mean the achiev­ing of one goal con­tributes to the achiev­ing of the rest of the goals in this group of goals. These goals are to stop peri­odon­tal dis­ease pro­gres­sion, reduce the future risk of peri­odon­tal dis­ease pro­gres­sion, remove the cause of peri­odon­tal dis­ease and remove or reduce the risk fac­tors con­tribut­ing to the pro­gres­sion of peri­odon­tal dis­ease when ever possible.

Before dis­cussing these goals, it is impor­tant to under­stand the dif­fer­ence between a “cause” and a con­tribut­ing “risk fac­tor”. Both the cause and con­tribut­ing risk fac­tors must be con­sid­ered in the treat­ment of peri­odon­tal dis­ease for long term effec­tive treat­ment of this disease.

A “cause” is some­thing that must be present or absent for a dis­ease process to begin. A con­tribut­ing “risk fac­tor” is a con­di­tion or behav­iour that is present or absent that aids in the spread and sever­ity of a dis­ease process once it has begun due to its cause. A con­tribut­ing risk fac­tor alone does not cause the disease.

The cause of peri­odon­tal dis­ease and gin­givi­tis is bac­te­r­ial plaque ( a soft sticky film of bac­te­ria ) on cal­cu­lus that is under the gums in the space between the gums and teeth. There­fore by pre­vent­ing the for­ma­tion of bac­te­r­ial plaque and cal­cu­lus above and below the gums the cause of this dis­ease is pre­vented. By remov­ing the bac­te­r­ial plaque and cal­cu­lus above and below the gums, the cause of this dis­ease is being removed. Once the cause of this dis­ease is no longer present, the dis­ease process is stopped, heal­ing can take place and the risk of future dis­ease pro­gres­sion is greatly reduced.

Con­tribut­ing risk fac­tors are con­di­tions or behav­iours that affect a person’s immune response to the dis­ease process. The immune response may be low­ered or may be increased to the point where the immune response causes more dam­age than the actual cause of the dis­ease. In peri­odon­tal dis­ease it is often the immune response to the cause of this dis­ease that causes more gum and bone destruc­tion than the actual cause of the dis­ease itself. There­fore as part of the long term treat­ment of peri­odon­tal dis­ease, the con­tribut­ing risk fac­tors must be stopped or less­ened as much as pos­si­ble to achieve long term treat­ment success.

Some of the more well known risk fac­tors con­tribut­ing to peri­odon­tal dis­ease pro­gres­sion and sever­ity are: smok­ing, uncon­trolled dia­betes, poor oral hygiene, irreg­u­lar den­tal vis­its and clean­ings, any dis­ease affect­ing the immune sys­tem and genetics.

Other than genet­ics, all of these other risk fac­tors can be con­trolled, treated or changed. Smok­ing, although not easy, can be stopped or reduced. Dia­betes can be con­trolled, oral hygiene can be improved and den­tal vis­its and clean­ings can be reg­u­larly done.

The patient’s role in elim­i­nat­ing or reduc­ing the change­able risk fac­tors can not be stressed enough. Ulti­mately in the long term, it is what the patient does or does not do in man­ag­ing these risk fac­tors that deter­mines the long term suc­cess or fail­ure of peri­odon­tal dis­ease treat­ment per­formed by the den­tal office mem­bers of the team.

The den­tal office team member’s role is to edu­cate the patient about the cause and risk fac­tors of peri­odon­tal dis­ease and gin­givi­tis, remove the cause of these dis­eases as allowed by the patient and main­tain the treat­ment results as allowed by the patient. As allowed by the patient means that it is the ulti­mate deci­sion of the patient as to the extent of needed treat­ment the patient will want, the extent the patient reduces the risk fac­tors and the extent the patient attends the den­tal office for reg­u­lar main­te­nance vis­its. With­out the patient’s co-operation, the den­tal office team mem­bers can not suc­cess­fully treat peri­odon­tal dis­ease and gin­givi­tis on a long term basis.

In topic #7, the other remain­ing goals of peri­odon­tal dis­ease treat­ment will be dis­cussed as well as the team mem­bers’ roles in achiev­ing these goals.