From the Guidelines
Periodontal disease should be treated with professional dental cleaning, scaling, and root planing, and in severe cases, surgical treatments like flap surgery or bone and tissue grafts may be necessary, as recommended by the American Dental Association 235. The treatment of periodontal disease typically involves removing plaque and tartar from the teeth, both above and below the gum line, to prevent further inflammation and infection.
- Daily oral hygiene practices, including brushing twice daily, flossing, and using an antimicrobial mouthwash, are essential for prevention and management of periodontal disease.
- For chronic periodontitis, the use of systemic sub-antimicrobial dose doxycycline (20 mg twice daily for 3-9 months) as an adjunct to scaling and root planning may be recommended, as suggested by the American Dental Association 235.
- In cases of acute dental abscesses, the treatment is only surgical, such as root canal therapy or extraction of the tooth, as recommended by Medecins sans frontieres 233.
- The European Society of Endodontology 234 recommends that antibiotics should not be used in patients with acute apical periodontitis and acute apical abscesses, unless there are systemic complications or the patient is medically compromised.
- A study published in Periodontology 2000 [2@] highlights the importance of periodontal disease management, especially in patients with cognitive impairment, and emphasizes the need for dental practitioners to navigate complex challenges in obtaining informed consent and providing appropriate treatment.
- Another study published in Nature Reviews Nephrology [3@] provides recommendations for the management of dental health in patients with X-linked hypophosphataemia, including regular dental visits, preventive care, and optimization of medical treatment before initiation of orthodontic treatment.
From the Research
Periodontal Disease Treatment
- The primary goal of scaling and root planing (SRP) is to remove subgingival calculus and biofilm deposits, creating a biologically compatible root surface and reducing the inflammatory burden 1
- Periodontal inflammation is clearly related to the presence of calculus and biofilm, with surfaces of subgingival calculus covered in a biofilm of metabolically active bacteria 1
- Current evidence suggests that inflammation associated with periodontal infections affects both the immediate oral environment and the patient's systemic health 1
Importance of Scaling and Root Planing
- SRP is still critical to the treatment of periodontitis, particularly in cases involving deep probing depths (≥ 5 mm) and root surfaces with anatomical and surface irregularities 1
- The execution of a "definitive" SRP requires time, exceptional skill and perseverance, and patient compliance with periodontal maintenance 1
- Sites with persistent nonresponding probing depths and signs of inflammation following a definitive SRP should be considered for surgical intervention 1