Periodontal treatment: controlling a chronic infection

  1. Control of risk factors
  2. Non-surgical treatment
  3. Periodontal re-evaluation
  4. Surgical treatment
  5. Periodontal maintenance

Chronic periodontitis can be described as a chronic infection. The treatment of this disease therefore involves controlling this infection. To do this, it will be necessary to achieve control of the quantity of bacteria on the one hand, and control of their aggressiveness on the other.

By definition one does not cure a chronic disease, one stabilises, one obtains a remission. This stabilisation in the face of the disease is sought by a specific treatment strategy: to move from an initial treatment following an assessment, to re-evaluate it and correct it if necessary by complementary actions to place the patient in a situation of stabilisation by regular maintenance.

Controlling the amount of bacteria

Excessive bacteria are linked to poor dental hygiene and tartar. It would therefore be sufficient to control these two parameters in order to control the quantity of bacteria, which would already be a huge step forward.

Controlling the aggressiveness of bacteria

The presence of a high proportion of aggressive bacteria is induced by the presence of periodontal pockets; areas of gum detachment where these bacteria proliferate more easily. If, therefore, it were possible to reattach the gum, it would be possible to control the proportion of aggressive bacteria.

The means of action

There are four possible courses of action:

  • Antibiotics
    In a number of cases, antibiotic therapy will be combined with local treatment. The choice will be dictated by the acute or specific nature of the infection.
  • Antiseptic mouthwashes
    The effectiveness of antiseptic mouthwashes will depend primarily on the product used. But even for the most effective products (chlorhexidine-based), this effectiveness will be limited to the surface where brushing can also be effective. Antiseptic mouthwashes will therefore not be able to cure periodontitis, but will be used as a supplement, for example, in cases where brushing must be suspended.
  • Improvement of dental hygiene
    Interdental cleaning is generally the most important aspect of dental hygiene. Interdental cleaning should be carried out every day before brushing. Three instruments are available.
  • Restoring the gingival seal
    The gingival seal is provided by fibrils that form the epithelial attachment. These small fibres are among the first elements to be destroyed in the event of gingival inflammation. If, on the other hand, the gingival inflammation could be permanently removed, it is hoped that these fibrils would reappear and the epithelial attachment would be restored. From then on, it would be sufficient to disinfect the portion of the root where the gingiva is detached in a durable manner to see the gingiva reattach.
    • Mechanical disinfection
      Disinfection of this portion of the root can be done mechanically by trying to make this surface as smooth as possible. In fact, smoothing any surface leads to the removal of a film of the material that is being smoothed. It is the removal of a film from the root surface, combined with the instrumentation of these infected sites, that causes a disinfection capable of inducing gingival re-attachment. The treatment therefore consists of scaling the portion of the root where the gingiva is detached, followed by smoothing this portion. This step is called root planing.
    • Root planing
      This is usually done under local anaesthetic and in the vast majority of cases is done non-surgically. There are, however, a certain number of lesions whose depth or, above all, complexity make them inaccessible to non-surgical treatment. In this case a surgical approach, by flap elevation, will be applied. This scaling and root planing treatment is carried out in 2 or 4 sessions. The postoperative course is generally very acceptable.

Monitoring and re-evaluation

After this work, a first control is carried out. In this first check, about 80% of the sites treated should be resolved. The remaining 20% should show progress and this progress can continue over the next 12 months. To promote this further healing and to maintain it when it is achieved, the patient is enrolled in a maintenance periodontal care protocol called "periodontal maintenance".

Periodontal maintenance

This periodontal maintenance will be applied at a variable frequency depending, in particular, on the quality of the patient's plaque control, his or her state of health, and the number and extent of residual lesions.

By Frédéric De Beule, Member of BSP's Board