Periodontal Maintenance and Followup Care

Periodontal Maintenance (STEP THREE)

Following therapy, regular cleanings are vital to maintaining periodontal health. Maintenance, along with good oral hygiene, are the keys to good oral health. Studies have shown people who do not maintain regularly have 20 times the amount of bone loss as those who do.

For cases where there are some residual pockets deeper than 3mm, or where the patient has shown a high susceptibility to breakdown, three month (or more frequent) recalls are critical. In these cases where the patient cannot reach all areas with oral hygiene techniques, bacteria form colonies (plaque) immediately after treatment.

Normally, however, it takes plaque about three months to develop into an aggressive infection. The first three months there is minimal bone loss, but after ninety days the breakdown dramatically increases. If the plaque is removed every three months, the plaque aggressiveness will stay low.

At the periodontal maintenance appointment the following procedures are performed:

• Update of medical and dental history


• Soft tissue cancer exam


• Clinical decay examination


• Clinical periodontal examination


• Review of oral hygiene as needed


• Scaling above the gum level


• Root planing under the gum level as needed


• Polishing

(Full mouth radiographs, which show the entire root surface, are taken every 3 years to determine if the bone level is stable. See Dental X-Rays)

An important observation at a periodontal maintenance appointment is whether the tissues bleed when probed. If there is no bleeding, the mouth is healthy. If there is bleeding, and it is seen on several subsequent recalls, addition treatment in that area is warranted. A change of the bone level as seen on X-rays also requires attention.

The periodontal maintenance appointment should be comfortable and pleasant, and for those patients who need help relaxing, nitrous oxide ("laughing gas") is available.