Non-surgical therapy.
Periodontal debridement (Deep cleaning) and Prophylaxis.
The initial stage of treatment for periodontal disease is a thorough cleaning that usually includes removal of bacteria and their products from the tooth surface followed by a prophylaxis (polish). The objective of these non-surgical procedures is to control the bacteria within the dental plaque, and remove the calculus (tartar – calcified dental plaque) from your teeth. Periodontal debridement and prophylaxis can be used as a stand-alone treatment or as a preventive measure for periodontal disease.
Periodontal debridement and prophylaxis are usually performed under local anaesthetic at the initial stages but during the maintenance phase of treatment they may be performed with topical anaesthetic.
Debridement is performed to remove plaque and calculus which is attached to the tooth surfaces. The process targets the areas of plaque accumulation both above and below the gum line. This can be performed with either a special dental tool called an ultrasonic scaler or with hand instruments. The ultrasonic scaler usually includes an irrigation process and sprays water in to the mouth. However studies have shown that the ultrasonic scaler is more efficient per unit of time compared with hand scaling.
Antibiotics or irrigation with anti-microbial (chemical agents or mouth rinses) may be recommended to help control the growth of the bacteria that cause periodontal disease. These additional approaches may be added to the treatment in patients with more progressive disease but not done for patients with mild to moderate disease. Antibiotic use may be considered if certain gene anomalies are detected which indicate a reduced ability of the immune system to remove bacteria.
Vitamin D status may indicate the need to consider the addition of vitamin D therapy as part of treatment but this should only be instigated after consultation with the patients medical team. Vitamin D therapy should only be administered by the patients medical team as there may be drug interactions and other medical issues of importance which need consideration in utilization of this therapy adjunct.
When deep pockets between teeth and gums are present, or if defects are present in the tooth surfaces which make it difficult for the periodontist to thoroughly remove the plaque and calculus, surgical access may be the only treatment alternative which allows these areas to be treated. The skill of the periodontist at periodontal debridement usually inversely relates to the frequency of surgical access used.
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