If your initial assessment and examination showed that you had any level of gum disease that included a form of periodontitis then you may be placed on a Periodontal Program that would be able to address this condition. In some cases a Periodontist may need to devise your treatment plan.
A periodontal program is a Treatment Plan of action that involves having a baseline record of your condition and then any treatment done is measured against this record. In this way we are able to visually see improvements using these records as evidence. A Hygiene Therapist can conduct this Treatment Plan.
The purpose of the proposed therapy is to:
- Stop the disease process and prevent it from progressing any further.
- Keep the treatment simple and painless.
- Educate the patients so that correct home care is maintained
If your assessment showed that you have pockets with depths greater than 3mm. This shows that there is the presence of inflammation and a diseased condition. It is often accompanied by bleeding gums, plaque and tartar. If gum disease is allowed to continue, then bone loss can occur, eventually leading to loosening of the teeth.
Treatment Sessions with the Hygiene Therapist involve the following:
Appointment 1 – Baseline Cleaning Visit
On this visit the Hygiene Therapist will conduct the following:
- A “tour” of your mouth to assess the condition of your mouth.
- Review of any computerised baseline assessment records.
- Oral hygiene instructions will be given. For example, brushing techniques that are specific to your mouth, the use of floss and other interdental cleaning aids will be explained. The use of a tongue cleaner for fresh breath will be advised too.
- Advice will be given on any therapeutic agents such as the new generation of oral rinse and toothpastes.
- A Nutritional Analysis sheet will be provided, and advice given on its completion.
- If fluoride desensitising is required, then this too will be conducted on this visit.
The hygienist will then scale your teeth to remove any heavy deposits of tartar (calculus) all around the mouth with ultrasonic and special hand instruments. Your teeth will have all stains removed and be polished.
Appointment 2 – Reassessment and re-measurement visit
After one month, the hygienist will review your home-care cleaning procedures and complete the following examination:
- Periodontal status: assessing the colour, contour and consistency of the gums.
- Plaque score: your aim is to reach 10% or less.
- Bleeding score: if you have maintained good oral hygiene during your home care, there should be a reduction in the inflammation of the gums.
- Pocket depth: there should be a reduction in the depth.
- Do a Nutritional Analysis if you were advised of this on your last visit.
- You will also be given any necessary dietary and decay prevention advice.
The hygienist will then scale your teeth to remove any subsequent deposits of tartar (calculus) all around the mouth with ultrasonic and special hand instruments. She may need to irrigate the gum crevices with antibacterial agents. Also, she will removal any stain and plaque with polishing agents. In some instances, the Hygiene Therapist may start work on the residual deeper pockets on this appointment.
Appointment 3 – New Treatment Plan & Deep Cleaning Visit
One month after Appointment 2, the hygienist will make another assessment of the:
a) Periodontal status – generally how your gums are and a diagnosis will be made.
b) Plaque score- this should now be significantly less.
c) Bleeding score – this should also be significantly less.
d) Pocket depth – there should only be very deep pockets remaining.
Based upon these measurements and Gum Analysis, the Hygiene Therapist will then create another Treatment Plan which then will address the “pockets” of detached gum that are 4mm and above. Generally, you should have seen an improvement by this stage on much of the inflammation around the mouth. However, there may be some residual, very resistant or deeply infected areas that will not respond. For these areas deeper cleaning will be required. Hence, the therapist will create a new protocol to address this.
The number of subsequent appointments will be based upon how much Chronic Periodontitis is present. Typically, there will be four appointments – each constituting deep cleaning of each quadrant of the mouth. Sometimes, if there are fewer pockets the hygiene therapist can do this work in two visits, working on each side of the mouth each time.
Your Subsequent Treatment Appointments
These visits will entail deeper cleaning of the pockets that are more than 4-5mm. Since this may be uncomfortable for you, the particular areas of your mouth with the deeper pockets will require a local anaesthetic to be administered.
Once your gums are numb from the anaesthetic, the hygiene therapist will then use fine tipped hand instruments to clean inside the pocket areas. She may also use ultrafine ultrasonic instruments to flush out and oxygenate the pockets creating an environment in which optimal healing can take place. She will be scaling away all the tarter and infection build-up that is deep in the gum pocket which has been inaccessible to you.
Sometimes irrigation of gum crevice with antibacterial agents is also needed.
A review visit will be made depending on how long the hygienist feels that you will require for everything to heal. In most instances, this is one month. On this visit the hygienist will review your home cleaning procedures; also pocketing, plaque and bleeding scores are carried out. Here you should see some significant improvements.
If however, there is resistant infection, then the hygienist may consider either a referral to our Specialist Periodontologist or a repeat process of the above appointments to give the resistant areas an additional deep cleaning.