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Periodontal
maintenance therapy is essential
Periodontal maintenance therapy may be the
most crucial portion of periodontal therapy. If
periodontal maintenance is not a regular portion of the
care provided, progression of the destructive changes will
likely ensue.
Removal of supragingival plaque through
use of a mechanical abrasive device (toothbrush) is the
most widely used method of plaque removal. Manual
toothbrushes effectively remove plaque deposits from the
facial, lingual and occlusal surfaces, provided the
patient has received adequate instruction and training.
For patients with poor plaque control, limited motor
function or orthodontic appliances, powered brushes may
provide additional benefit.
Dental floss is used to remove plaque deposits
interproximally. The effectiveness of dental floss depends
on whether the tooth surface being cleaned is flat or
convex. With attachment loss, the probability of dental
floss effectively removing plaque deposits becomes
lessened. Interproximal cleaning aids, such as
interproximal brushes, single-tufted brushes and wooden
rubbing sticks, may provide improved cleaning to complex
root surfaces.
Antimicrobial agents are considered
adjunctive. Some first-generation agents, such as PVP-iodine,
thiocyanate, histatin and hydrogen peroxide, have shown
potential beneficial effects in plaque control and
inflammation reduction. Chlorhexidine is a widely used
second-generation chemotherapeutic agent that is effective
for plaque and gingivitis control. The critical element in
the use of chlorhexidine seems to be the concentration
used rather than the method of application. Another
second-generation product, triclosan, provides both
improved plaque control and decreased gingival
inflammation.
Periodontal maintenance or recall is
essential for long-term periodontal health.
Maintenance-appointment intervals of no longer than three
months will prevent disease progression in most patients.
However, the maintenance schedule should be
individualized. The duration of maintenance appointments
usually ranges from 45 to 60 minutes. The extensiveness of
procedures depends on the patient's history, the results
of the previous appointments and the dentist's clinical
judgment. Maintenance evaluations should include an
organized charting system that records clinical attachment
levels, as well as a bleeding index.
The patient must comply in two ways:
thorough plaque control on a daily basis and attending
recall appointments. Periodontal disease will recur and
progress in patients who do not continually practice
effective plaque control and regularly keep maintenance
appointments.
Supervised, repeated reinforcement of
oral-hygiene instruction is required for long-term
plaque-control effectiveness. Patients will likely be more
compliant if they feel they share control over the success
of treatment and the long-term results. Compliance can be
improved by simplifying patient instructions, improving
communications, accommodating patient needs and by giving
positive rather than negative reinforcement.
Periodontal maintenance is an integral and
crucial part of periodontal therapy. Patients receiving
periodontal therapy, whether surgical or nonsurgical, will
experience disease progression unless maintenance therapy
is provided on a regular basis.
Source: Hancock, E. B., and Newell, D. H. The role of
periodontal maintenance in dental practice. J Indiana Dent
Assoc 2002; 81 [2):25-30.
JANUARY/FEBRUARY 2003 . CDS REVIEW
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