I woke up this morning thinking about one patient who saw me several months ago for non-surgical treatment of his periodontal disease. He had been surprised about how it did not take multiple visits, nor did
it require the scraping of hand instruments to treat his infection. And it makes sense that he would question our standards and practices; he had a history of treatment for the disease, as well as a decent clinical concept of how to treat it. His wife was a hygienist who dedicated her life to treating periodontal disease based on the most ideal knowledge base, instruments, and protocols available at that time in her career. He questioned the value of the treatment based on the shorter treatment times and lack of "hand scraping."
I realized there was a lot of things that have changed about how we recognize, treat, and manage periodontal disease that I may not have expressed to him. So I decided to drill down into the deep pile of knowledge we have accumulated over the past 10 years of clinical and scientific research. I want to do a better job of explaining the two different paradigms of treatment for periodontal disease. I want to help my patient as well as our readers understand there was a previously practiced "old-school" paradigm and a solidly established "new-school" paradigm that drives how we treat our patients today.
The new paradigm is focused on how practitioners manage the infection threshold for patients susceptible to periodontitis. Long ago, it was thought that periodontal disease was a bacterial disease; although some patients had more severe disease, and some patients less, bacteria was primarily responsible for tooth loss associated with the disease. But today, we realize three important concepts hold true for periodontal patients: 1) biofilm (the bacterial sludge) has to find a home around and between teeth, 2) the patient has to be susceptible to inflammatory disease like periodontitis(genetically and medically driven reasons for that), and 3) routinely altering the patient's susceptibility (shifting it towards being more resistant to disease) helps them keep their teeth longer. This newer model of management uses progressive technology to better mange the disease. Management is also more medically driven than it is dentally driven; heavy tartar or lots of bugs are not the sole focus for eliminating disease. That means we take a different approach to measuring, analyzing, and directing other treatments for the disease then we ever did before.
So biofilm piles up around and in between teeth like a bad TV rerun. It's episodic. And there's some nasty strains of bugs in there. Certain strains of the bugs are more aggressive and more resistant to treatment. So if doctors or hygienists try to simply hand scrape the bugs off the teeth, they just smear it around if it's not present in hard tartar. The bugs have also evolved ways to reside in the soft tissues. The new paradigm involves sonic or mechanical instruments to not only remove the biofilm from the teeth, but also irrigate or flush the biofilm from the holes in which they live. And research shows it eliminates the bugs. And sonic instruments can remove some inflamed soft tissue with less trauma than hand scraping. Lasers are also more effective: vaporizing biofilm and soft tissue where the bugs live has shown dramatic results in disinfection and healing of tissues. And research studies have shown how mechanical instrumentation is as good or better than hand instrumentation.We've traded muscles for technology: we have more effective and more efficient tools to treat the disease.We have seen patient outcomes with the new paradigm of that are as good or better than the old-school equipment and practices.
In my next blog, I'll discuss how controlling biofilms requires attention to follow-up visits and assessing the medical profile of every patient.
We have information available about periodontal disease on our website. Call us to set up a consultation about your health today.
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