Periodontal treatment

Gingivitis, Periodontal disease, and heart disease

Periodontal disease and its precursor gingivitis, is one of the most common disease processes, with almost everyone affected at some stage of their life. It usually progresses with little or no pain, and many are unaware that they have the disease. It is obvious to the trained eye (and nose) of the dental team. It is now established that bacteria involved in gum disease cause diseases of blood vessels and the heart, contributing to clots, strokes and heart attack. So periodontal disease should be taken very seriously and treated vigorously.

The disease is almost always preventable by straightforward home care. Unfortunately many, being unaware they have the problem, do not carry out necessary measures to prevent its progress.

The main crux of our efforts is to identify whether, and to what extent you have a problem, and explain how you may prevent it.

Where possible, it is more economical to have this treatment with the hygienist rather than the dentist. The reason for the difference in cost is that the dentist is prevented from carrying out other treatment for which he has been specifically trained.

The procedures carried out during treatment sessions are as follows:

Treatment	Visit	Procedure	Basic	Additional time may be allocated for
Treatment of gingivitis. British Periodontal Examination (BPE) reading of 1	Visit 1 of 1	Time allocated	20	40
		Show and explain the presence of disease	Yes
		Demonstrate self care procedures	Yes
		Suggest the materials/ brushes etc required to allow effective home care.	Yes
		Disclose plaque		Yes
		Tooth brushing / flossing		Yes
		Professional polishing	Yes
Treatment of periodontal disease with a BPE reading of 2	Visit 1 of 1	Time allocated	30	60
		Show and explain the presence of disease	Yes
		Demonstrate self care procedures		Yes
		Suggest the materials/ brushes etc required to allow effective home care.		Yes
		Disclose plaque		Yes
		Tooth brushing / flossing		Yes
		Supragingival scaling	Yes
		Subgingival scaling	Yes
		Professional polishing	Yes
Treatment of periodontal disease with a BPE reading of 3, depending on the extent you may be offered the use antibiotic paste to quickly resolve the inflamed gums and protect your general health as shown under BPE of 4, below.	Visit 1 of 2	Time allocated	30	60
		Show and explain the presence of disease	Yes
		Demonstrate self care procedures	Yes
		Suggest the materials/ brushes etc required to allow effective home care.	Yes
		Disclose plaque		Yes
		Tooth brushing / flossing		Yes
		Supragingival scaling	Yes
		Subgingival scaling	Yes
		Professional polishing		Yes
		Remove overhangs from existing fillings		Yes
		reshape/replace fillings allowing easier cleaning by reducing food traps. Replacing fillings requires additional time		Yes
	Visit 2 of 2	Time allocated	30	60
		Demonstrate the effectiveness of home care since previous visit	Yes
		Disclose plaque		Yes
		Tooth brushing/ flossing/ other methods		Yes
		Supragingival scaling	Yes
		Subgingival scaling	Yes
		Professional polishing	Yes
Treatment of severe periodontal disease with BPE of 4, per sextant involved. Treatment as outlined above required for sextants not at level 4.	Visit 1 of 3	Time allocated (may be split into two visits of 40 minutes)	80 minutes
		Root planing of every tooth after root filling of non-vital teeth or those suspected to have disease passing from the root surface of the tooth to the pulp or vice-versa.	Yes
		3 minute application of citric acid to expose collagen fibres on roots, so that re-attachment of the gum can take place	Yes
		application of tetracycline paste into every pocket with the aim of providing a bacteria free area for healing to proceed.	Yes
	Visit 2 of 3 after 1 month	Time allocated	5
		Assess the healing process	Yes
		splint teeth if necessary	Yes
	Visit 3 of 3 after 3 months	Time allocated	5
		Assess the healing process and take any possible remedial action	Yes
		Plan to deal with hopeless teeth.	Yes

What does the Basic Periodontal Examination (BPE) mean?

It is a screening examination to indicate the severity of gum disease. The levels are:

Level	Meaning
0	Healthy
1	Bleeding of gums. Gingivitis, which is reversible if treated promptly.
2	Tartar is present, and/or there are pockets no deeper than 3mm deep. After treatment the pockets can be kept clean by normal homecare.
3	Tarter and/or pockets no deeper than 7mm. Difficult to keep clean by normal homecare, unless you use an irrigation device. Usually repeat hygiene visits are necessary.
4	Pockets deeper than 7mm. Almost impossible to keep clean and will require regular professional support throughout life.