Periodontal diseases are the infections of gums, which gradually destroy the support of natural teeth. The advances are plentiful as well as the ailment supports requiring cure. Dental Plaque, in other words bacteria and toxins is the main reason of gum ailment in individuals who are genetically susceptible. Every day brushing as well as flossing will help to stop most periodontal situations. Here, personal hygiene and self-care will do more towards prevention, which as the saying goes, is better than cure. A person undergoing subgingival periodontal debridement should be re-evaluated for checking the patients’ improvement as well as prophylaxis and oral hygiene instruction. What is the importance of oral hygiene? Adults who are past the age of 35 years lose more teeth owing to gum ailment, than from cavities of the teeth. According to a study, Three out of four adults are affected at some time in their life span. The best way to prevent cavities and Periodontal Diseases is when good tooth brushing and flossing techniques are performed daily (Periodontal Diseases and Their Prevention). In a study conducted upon patients who were subjected to 6, 12-, 24-, 36-, 48-, and 60-, month reexaminations showed that the patients who were careful with their standard of self maintained oral hygiene did not have recurring cases of periodontal disease. Patients with less plaque free surfaces were found to have more sites with additional loss of attachment (Lindhe , Westfelt , Nyman , Socransky , Haffajee ).
Plaque causes both periodontal diseases and cavities. Plaque has no color, it will have microorganisms or germs that exist and survive on the teeth. Systematic every day brushing and flossing gets the germs removed and plaque kept at distance. Devoid of appropriate self-care or personal care, the plaque solidifies into an uneven absorbent material known as calculus or in other words tartar. Tartar can be removed only through the help of special instruments handled by a dentist. It will cause the gums to turn red in color, puff up and hemorrhage very effortlessly. And in the case of contaminants that are created by the microbes in the plaque, if extended, the gums detach from the teeth causing cavities with complementary bone obliteration to form. Following the worsening of the gum tissue and bone, that holds teeth in place, this can cause an untreated patient to surely shift towards the loss of teeth. If the patient removes plaque in time, all this can be avoided. But if a patient suffers from the ailment, surgery is the only way as the disease may have caused more grave damage to the bone that supports the teeth. Teeth would become wrecked even under the gum line. This means the bone has to be restored by a technique called the guided tissue regeneration damage repairs by Crown lengthening and even the gums may be extended by gingival graft.
The patient after such treatment should return for post surgical treatment in 7 to 14 days. At this time any stitches if present may be removed and the adaptation of the treated portion is evaluated. The surgical site also needs some cleaning. The therapeutic reaction and oral cleanliness will also be appraised in two appointments. It may very well be clear now that even after debridement, the diseases can recur. Periodical re-evaluation is necessary to prevent this. The chances of recurrence of periodontal diseases are certain if a stringent plan of helpful periodontal care is not followed. A most important task in averting additional incidents of periodontal disease is the deletion of plaque by appropriate brushing, flossing and also using other cleaning techniques that is prearranged by the dentist (Periodontal Diseases and Their Prevention).
In the case of periodontal disease, patient has many options. He could leave the disease as it is which is ill-advised. He could try non surgical treatment, which includes endoscopy, laser treatment and even ultrasonic options. Surgical debridement which would be invasive as well as expensive. The last option is to ask for a referral. Some of the sites in patients do not respond to debridement. Sometimes they are resistant even to surgical therapy, or if surgery is irrelevant, patients with chronic inflammation and increased pockets. It also occurs in cases of subgingival levels such as caries, root fractures, perforations and cases requiring documentation. Patient care should include adequate topical and local anesthesia. Visualization may be difficult if inflamed pockets and abscessed are under heavy bleeding
Oral hygiene plays a great part in the recovery as well as effectiveness of subgingival debridement. Debridement has got an advantage of around double that of Supragingival Plaque control. When comparisons where made in a survey, the lessening of pocket depth was 0.59 and 1.18 for SPC and SGD, correspondingly. With regard to clinical attachment level change, subgingival debridement was found to be beneficial. The role of post treatment re-evaluation was also emphasized. This was found to confer oral hygiene even in extreme cases of lack of self-care because the patient thought that he would appear before the doctor again and took precautionary self-care, leading to gain in attachment (Summary Review/Periodontology).
Microbial and contributing factors of periodontal disease are eliminated in the first stage itself, thus arresting the progression of the disease. Steps should be taken for the appropriate elimination of supra and subgingival calculus moreover biofilm should be assumed. The risk factors, like malnutrition, smoking medications should be assessed and controlled. It is also advisable that oral self-care practice and tutoring to manage and reduce dental biofilm also should be prearranged. After these steps the results will be that the gingival, periodontal ligament, cementum and the alveolar bone is reinstated. The antimicrobial agents will be applied after appraisal of the microbial samples. A number of visits are practiced conventionally for the elimination of the biofilm and calculus from the crown, root surface as well as in the periodontal pocket. A series of appointments with dentist at just about one to two week gap for the purpose to permit for oral hygiene instruction, debridement, healing, and re-evaluation of treatment are widely used nowadays. If gross removal is used, as in earlier times, it would result in the continued proliferation of micro organisms and would increase the potential for formation of abscesses. The gingival margin would restore to health partly and this would make admittance to subgingival deposits further complicated. It is to be noted that certain men are prone to this disease. Like asthma, diabetes etc., there is no cure fore periodontal disease (Kacerik). Time and again the serious factor is not whether the modus operandi is surgical or non-surgical, but the eminence of debridement that is used for the root surface treatment. It has also been confirmed that sites with an initial pocket depth exceeding 3mm will act in response to both methods uniformly well. Patients if they are re-evaluated show only a limited recurrence of periodontal disease Lindhe , Westfelt , Nyman , Socransky , Haffajee ). It is to be noted that certain men are prone to this disease. Like the case of asthma and diabetes, there is no cure fore periodontal disease. Only with proper after-surgery instruction and self-care can the occurrence is controlled (Kacerik).
As far as it goes, nothing is more effective than patient instruction to prevent the disease. With proper instruction and revisits this troublesome disease may be kept at bay.
Reference
Kacerik.M. 2005. Changing trends in periodontal debridement. Web.
Lindhe J, Westfelt E, Nyman S, Socransky SS, Haffajee AD. Long-term effect of surgical/non-surgical treatment of periodontal disease. 1984.
Periodontal Diseases and Their Prevention. Web.