maintenance
When a tooth is affected by decay it is restored to function by insertion of a filling with no further treatment. Periodontal diseases are different in that recurrence of disease or new disease may occur at any time. For treatment to succeed in the long term, regular ‘maintenance’ is essential.
After the root planing appointments, patients are left for a short period, having been shown plaque control techniques to use at home. Initially, there will be a rapid improvement in the health of the gums. This will then plateau as the gums heal and stabilise. After a few months, the status of the gums may deteriorate slightly as a few sites around the teeth build up with plaque again. This can relate to a number of factors.
Healthy gums Healthy periodontal tissues
Firstly, there may be areas that are not being cleaned well at home - this is especially difficult in between the teeth and around the molar teeth. Secondly, there will be areas that are difficult for us to root plane such as grooves and in between the roots of molars. Thirdly, poor control of other risk factors such as diabetes and cigarette smoking will play an important role.
To ensure the maximum benefit from the initial treatment, the response to therapy is re-evaluated approximately four months after root planing. At that visit measurements are made around the teeth again with expectations of:
Reduction in plaque
levels
Few
bleeding sites
Shallower pocket depths
Healthier tissues overall.
Any sites that are bleeding, which are generally only a few, need to be cleaned. Oral hygiene is also reviewed and recorded. If all is progressing well, the next maintenance appointment is scheduled for up to six months time. After the first maintenance appointment the condition of the gums will continue to improve since the problem areas have been isolated. Most patients attend every 6 months for their maintenance but this can range from 3-6 months depending on factors unique to that individual and their response to treatment. Usually, the more care taken with plaque control at home, the less often maintenance appointments need to be scheduled. Long-term studies demonstrate that without regular maintenance periodontal health will deteriorate and further attachment loss may lead to tooth loss.
