Tuesday, April 9, 2013

Management of Periodontal Disease

Recent epidemiologic surveys and studies have provided important information on the prevalence, extent, and severity of periodontal diseases in the United States. Over 50% of adults had gingivitis on an average of 3 to 4 teeth. Subgingival calculus was present in 67% of the population. Adult periodontitis, measured by the presence of periodontal pockets ≥ 4 mm, was found in about 30% of the population on an average of 3 to 4 teeth. Severe pockets ≥ 6 mm were found in less than 5% of the population. Attachment loss ≥ 3 mm was found in 40% of the population. Gingival recession accounted for a significant amount of attachment loss. The prevalence of early-onset periodontitis ranged from less than 1% in 14- to 17-year-olds to 3.6% in young adults aged 18 to 34. Extensive and severe periodontitis was much more prevalent in minorities, people with less than a high school education, and those who had seen a dentist infrequently and had subgingival calculus. Smoking and diabetes have been identified as risk factors, especially diabetics with poor metabolic control, a long duration of the disease, and extensive subgingival calculus.

“It is now beyond question that dental plaque is the main etiological factor in the pathogenesis of periodontal disease” says DrCherukuri from her Chino, California dental practice.

The basic approach to periodontal treatment has always been and remains the removal of supra and sub gingival bacterial deposits by scaling and root planing.  Non surgical periodontal treatment is the cornerstone of periodontal therapy and the first recommended approach.  Non surgical periodontal therapy has evolved over the years but still considered the “gold standard” to which all other treatments are compared.

Severe generalized periodontitis is a form of chronic periodontitis that appears to be associated with an exaggerated host response.  The supplements of adjunctive host modulating  agents like Subantimicrobial Dose of Doxycycline provides clinically and statistically significant benefits in the reduction of pockets in patients with severe, generalized periodontitis.

Surgical procedures have been shown to be effective in treating moderate to advanced periodontitis when followed by appropriate maintenance care. Deep pockets of>_ 7mm demonstrate more pocket reduction with surgical flap procedure than compared to scaling and root planning alone.

Decisions for or against soft tissue surgery must be made on the basis of individual patient considerations.

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