Penam Periodontics - Evidence based Personalized Periodontics

Periodontitis Treatments

We pride ourselves on the fact that we offer the latest treatments that comply with evidence based best practice. As we learn more, we may vary the therapies offered based upon any newly available evidence. The cause of periodontitis are small repeated infections by specific bacteria which may grow within the dental plaque in some individuals.

The aim of our therapies are to:

  • Control the bacteria which cause the disease; and
  • Correct any issues that may be created as a result of the infection.
  • Analyse patients for any susceptibility which may contribute to their disease, along with an assessment of their genes.
  • Develop a personalized therapeutic approach to the patients disease and risk. This will require interaction with the patients medical team.

The overwhelming evidence shows that thorough non-surgical periodontal therapy (periodontal debridement and prophylaxis) is the basis of modern periodontal therapy. This therapy must precede any other therapies as it is principally aimed at reducing the bacteria which are the cause of the disease. The combination of non-surgical therapy with antibiotics in the more severe cases is a more aetiologically based therapy than surgery and we will offer this approach in preference to surgery where the evidence suggests it offers the best outcome for the patient. The evidence shows that periodontal surgery for the treatment of periodontitis should only be performed in those areas where the non-surgical therapies are not effective in bacterial control.

Treatment Outcomes/Prognosis

The treatment outcome of or prognosis for the disease is dependent upon how well we can control the disease. When we first see you we try to estimate your long term prognosis based upon the amount of tissue loss, the signs of disease progression (plaque amount, bleeding from sites, etc.). A study assessing how well we are capable of doing this showed that at the first examination we were poor judges of the prognosis. This was the result of a number of factors which we could not estimate, including how you the patient responses to treatment, you’re underlying genetic susceptibility or your smoking status and whether you will QUIT.

However our ability to estimate the prognosis improves dramatically once we start to see the results of treatment, your response to what we suggest or do and our ability measure the frequency of potentially active sites in your mouth.

Many dentists and dental hygienists measure periodontal disease by assessing pocket depth. The pocket depth is a representation of the past history of the disease and not disease activity. In our practice we assess disease activity by assessing a number of measures including, bleeding, and any of a number of markers of inflammation. The University of Bern has a site which uses a series of measures to assess the disease activity and the recall frequency of the patients. This website is The measures assessed are: Age, Number of teeth, the number of sites measured around each tooth, the number of sites that bleed when probed, the number of sites >5mm in depth the number of missing teeth, the percentage of bone loss at the most advanced site, whether the patient has a systemic disease and a simple assessment of smoking activity.

If there are sites of disease activity we need to treat these in the most appropriate way. The basis of the treatment is remove the aetiological agent - bacterial plaque. This can be done in at least four different ways: 1) simple scaling of the sites; 2) using surgical access to clean the sites; 3) debridement along with antimicrobial agents such as antibiotics; and 4) combinations of 1 or 2 with 3. The decision will be made in consultation with you, knowing your disease and systemic disease or genetic susceptibility status.

The prognosis of some teeth may be determined by the extent of the disease you present with. Highly mobile teeth with pocketing >6mm are at high risk of losing the tooth. However, it is our job to work with you to retain the remaining teeth.

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