Managing periodontal care can be a challenge

Let’s keep it simple: almost all patients have some type of periodontal disease.

Gingivitis, where inflammation is confined to the soft tissue, involves no bone loss. Periodontitis, on the other hand, means bone loss.

Whenever you have periodontitis, you also have gingivitis, but just because you have gingivitis does not mean you have periodontitis. Sound a bit confusing? It’s really not.

Consider this:

The diseases can be classified as follows:

∙ Type one: gingivitis-inflamed tissue, no bone loss

∙ Type two: early periodontitis with mild bone loss but without furcation involvement

∙ Type three: moderate periodontitis with moderate bone loss and early furcation involvement

∙ Type four: periodontitis or advanced periodontitis, which involves severe bone loss and extensive furcation invasion

The cause is, unsurprisingly, bacteria, mostly Gram-negative, combined with cell walls that have a lipopolysaccharide base or endotoxin that causes inflammation. The bacteria are anaerobic and can be motile or nonmotile.

So you’ve a patient with periodontal disease. The key to finding the causes has to do with the patient themselves.

First, when was the patient’s last visit and why? The answer gives you the patient’s dental IQ.

Dealing with a patient who does not go to the dentist makes it more difficult to treat periodontal disease. If you see in the patient history that your subject smokes a half pack of cigarettes a day or consumes a good deal of alcohol, it will be an uphill battle for both of you.

Also consider the patient’s hygiene: is it good, fair, or bad? If bad, then once again, it’s not going to be easy. Consider this  your unofficial dental risk assessment. The higher the risk, the poorer the outcome you can expect.

To quantify such a risk, look at the number of missing teeth, decayed teeth, and teeth with restorations. Any patient with more than ten—excluding wisdom teeth and missing premolars due to orthodontic care—is a red flag. You will have an uphill battle resolving your patient’s periodontal disease.

I have always looked at periodontal disease as similar to weight problems. The majority of patients with weight issues will diet, but very few stick to the diet and even fewer keep the weight off in the long term. In my experience, what I often see in periodontal disease is short-term success and long-term failure.

But that, of course, can change depending on how you coach  your patients before, during and after treatment. Getting them on to a program that is successful with result in better outcomes for them and more business for you as they come in more regularly and refer you to friends and family.

Your success can be their success.