What is perio maintenance cleaning?

What is perio maintenance cleaning?

Perio maintenance cleaning involves subgingival cleaning, and root planing to stop periodontal disease, and maintaining healthy tooth-perio (gums) attachments.
Periodontal health and aesthetically pleasant gum line can only be maintained by regular perio cleaning for removal of plaque, tartar and pathogens around periodontium.

The periodontium performs important functions: it regulates the chewing load, holds the tooth, protects it and promotes regenerative processes. Due to its complex structure, the periodontium is susceptible to various kinds of diseases, the prevalence of which reaches 98%.

Weak immunity, bacterial background of the oral cavity, heredity, body characteristics, improper oral hygiene and malocclusion can cause periodontal disease.

What Is Periodontal Maintenance

Periodontal disease is a lifelong condition that can be controlled, but not cured. Professional maintenance visits and cleanings are essential for successful treatment and prevention of recurrence of periodontal disease.

Periodontal maintenance is very important for long term results.
It is performed in the periodontics office once to four times a year depending on the risks specific to each patient.
It consists of cleaning the teeth and monitoring the condition of the gums.
It is all the more important to carry out after the installation of dental implants.

Genetics play an important role (up to 50%, according to studies) in the possibility that a patient suffers from periodontal disease.

For some people, toothbrush and floss, whether used properly or not, are not enough to prevent gum disease. Professional cleanings performed by a dentist or dental hygienist at regular intervals are essential to maintaining a healthy periodontium. The frequency of maintenance visits (exams) is tailored to the needs of each patient and the possibility of gum disease, but is usually every three months to once a year.

Periodontal maintenance is an ongoing program designed to slow the progression of periodontal (gum) disease in the gum tissue and bone that protects the teeth. Periodontal maintenance therapy is normally required for patients who have been treated for periodontal disease.

Periodontal maintenance helps protect the health of your gums.

Gum disease is caused by bacteria found in dental plaque. The toxins produced by these bacteria affect the bone that supports the teeth. If the plaque is not removed, it can harden and form stones (calculus) that can exacerbate the periodontal problem.

Even people who have excellent oral hygiene are unable to completely curb the formation of tartar on the teeth. These stones are formed when minerals in saliva harden or calcify the plaque on the teeth. Soft and sticky, plaque is continually forming. Therefore, daily use of the toothbrush and floss is important to remove plaque before it solidifies into tartar.

Periodontitis occurs when bacteria enter the gum, into the periodontal pocket, and destroy the ligament that holds the tooth in the socket. As a result, the gums bleed, the tooth loosens and runs the risk of falling out, as the surrounding tissues are damaged and cannot hold it.

Treatment of periodontitis begins with an assessment of the degree of damage in the area of ​​each tooth, after which the doctor selects a set of therapeutic measures for each affected area.

The importance of treatment

Even though daily dental care will reduce stone formation, regular professional maintenance is necessary to get rid of the buildup. During the maintenance cleaning, the dental hygienist will assess and record the depth of the periodontal pockets and check the condition of your periodontium.

These periodontal maintenance visits to the dentist can help prevent possible dental problems, such as increased bone or tooth loss. Treating the disease at an early stage can help you avoid problems with your oral and general health. Several studies have shown links between gum disease and heart disease, respiratory disease, diabetes control and premature births.

How is Perio Maintenance Cleaning done

The objectives and protocol for periodontal maintenance are well defined (Periodontology and implant dentistry. Philippe Bouchard et al. Volume 1. Page 543). Numerous scientific studies have proven the effectiveness of this monitoring, and have made it possible to define the content necessary for a maintenance session:

Clinical examination: monitoring of inflammation, dental plaque, tartar, possible periodontal pockets and periodontal recessions. The periodontal assessment, which has made it possible to record very precisely the state of the gums in the past, makes it possible to compare with the state of the gums observed previously.

Monitoring of the patient's state of health: any change in the patient's state of health will be taken into account. Diabetic patients can bring their test results, which are important for gum stability (see diabetes sheet ).

Maintenance surfacing: a complete surfacing, that is to say of the entire mouth in one session, will be carried out. Cleaning the supra- and subgingival dental surfaces is essential for the long-term stability of the gums and teeth.

Oral hygiene re-motivation: plaque control is a repetitive task, the effectiveness of which may fluctuate over time. Each periodontal maintenance session is an opportunity to improve brushing. The better the brushing, the longer the maintenance sessions can be.

Additional x-rays: x- rays are not taken at each session. However, in case of doubt about the state of a tooth or its gum, an X-ray may be performed. Achieving a radio report long cone is recommended every 4 to 5 years.

Checking of teeth and caries: the clinical examination, surfacing and possible x-rays allow detection of possible caries at an early stage. They are therefore less important, and easier to treat.

Periodontal maintenance check-up: finally, a complete reading of the pocket depths can be carried out regularly, every 2 years on average, or when a recurrence is suspected.

The session lasts on average 45 minutes, and rare are the patients needing anesthesia in periodontal maintenance. Since surfacing is more intensive than scaling, scaling at the dentist becomes unnecessary. If the periodontist detects a cavity or any dental need, he will invite the patient to resume an appointment with his dentist.

Frequency of visits

Your dentist will recommend a frequency of visits for your periodontal maintenance. This will depend mainly on your general health, whether or not you are taking medication, the type of treatments you have received, how you have responded to these treatments, and how quickly plaque builds up in your mouth. However, the most important factor is how well you take care of your dental hygiene at home.

The frequency is between one and four sessions per year. This frequency has been the subject of scientific studies with a high level of proof: it is defined by the risk factors specific to each patient. Two Swiss authors, Lang and Tonetti, published a benchmark study on the subject in 2003. And they made available an internet tool, on the site of the Faculty of Dental Surgery in Bern, making it possible to evaluate the frequency specific to each patient. ( Lang NP, Tonetti MS Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health Prev. Dent. 2003; 1 (1): 7-16).

The six main risk factors to consider are:
Percentage of bleeding gums: any bleeding means inflammation and risk of loosening (see the gingivitis sheet ) Depth of residual pockets after treatment: the depth of periodontal pockets is a reliable indicator of prognosis (see the periodontal assessment sheet )

Number of teeth lost due to periodontal disease
Bone loss in relation to age: this parameter was included in the classification of periodontal diseases of 2018 (see the periodontitis sheet )

Patient's state of health ( diabetes for example)
Tobacco: smoking is a major aggravating factor in periodontitis.

The periodontist will then adjust the result according to the specific situation of each patient. In particular, it will take into account the speed at which dental plaque and tartar are redeposited, and the quality of the patient's brushing. Better brushing equals less frequent maintenance sessions. Thus, patients with a high risk of recurrence will come to the periodontics office every 3 months, while patients at low risk will come once a year.

What Happens Without Perio Maintenance Cleaning

Periodontal maintenance cleaning is essential for the success of long-term periodontal treatment. A very long-term Swedish study (30 years) showed to what extent adequate maintenance reduced the risk of recurrence of heaving, and even the risk of cavities. 550 patients were enrolled in 1972, and followed up until 2002. A first group, called the test group, was monitored regularly according to the recommendations in force.

The second group, called the control group, is made up of patients who have not regularly followed their maintenance.

However, all the patients in the control group were examined in 2002. The patients in the first group did not lose gingiva in 30 years, while those in the second group lost an average of 1.2 mm, and the patients in the first group have had on average 2 caries in 30 years,(Axelsson et al.

The long term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance J Clin Periodontol 2004, 31: 749-757, cited by Wolf and Rateitschak in periodontology Masson 2005).

A reminder system is therefore offered to the patient: respecting the frequency of maintenance is very important, which is why periodontists offer their patients to help them to be very regular. With the patient's agreement, an email can therefore be sent to them when they return to periodontal maintenance.

Implants Maintenance and Peri-implantitis Prevention

The frequency of maintenance also has a direct impact on the appearance of peri-implantitis . Peri-implantitis is to the implant what periodontitis is to the tooth, that is to say a loosening that can lead to the loss of the implant. The main cause of these two related pathologies is the bacteria contained in dental plaque. Maintenance is therefore also very important for implants.

The rate of peri-implantitis is much lower in patients who adhere to the recommended frequency of maintenance: peri-implantitis is a rare disease when maintenance is well performed, but very common in the absence of maintenance. (Mombelli A. Maintenance therapy for teeth and implants. Periodontol 2000. 2019; 79: 190–199.).


References

Ultrasonic vs. hand instrumentation in periodontal therapy: clinical outcomes
Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis
Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis
Maintenance therapy for teeth and implants
Nonsurgical periodontal therapy

Den Tim


Practicing Dentistry for 20 years