Periodontal disease is inflammation and infection of the surrounding

tissues and bones that support the teeth. It happens when the gums are
infected and goes without treatment. This can cause clinical attachment and
alveolar bone loss which makes the gums pull away from the teeth and form
pockets. This can cause the teeth to become loose and fall out or they may
even need to be pulled out. It is the number one reason why adults have
tooth loss. The clinical signs of periodontal disease are bad breath, red or
red-purple gums & sometimes pale gums, gums are shiny (loss of stippling),
gums bleed easily, gums are tender when touched, loose teeth, swollen
gums, bone loss, and pocket formation.
Plaque builds up below the gum line. When the gums are inflamed it
causes a pocket to form between the gums and teeth which fill up with
plaque. Swelling will catch the plaque in the pocket. If the inflammation
continues it will lead to harm of the tissues and bone surrounding the teeth.
Since plaque contains bacteria there will probably be an infection and
possibly an abscess which can increase bone damage. So therefore bacteria
cause periodontal disease. The bacteria that are subgingival are anaerobic
which means it does not need oxygen to survive. They are also gram
negative rods. The most predominant bacteria are Porphyromonas gingivalis
(P.g.) which is the most common, Bacteroides forsythus (B.f.), Prevotella
intermedia (P.i.), Camphylobacter rectus (C.r.), Actinobacillus
actinomycetemcomitans (A.a.), and Treponema.

Some characteristics of periodontal disease are that it is common in

adults, subgingival calculus is present, and changeable microbial pattern. It
is also slow to moderate progression, classified by extent and severity, and
have systemic diseases. According to E.M. Wilkins & the article Gum disease,
some factors that increase the risk of developing periodontal disease are
poor oral hygiene, diet and eating habits, smoking or chewing tobacco,
genetics, crooked teeth that are hard to keep clean, pregnancy, diabetes,
illnesses such as cancer or AIDs, and medications. There are also modifying
factors such as stress and smoking.
According to S. Clark , some treatment methods are mechanical
removal of bacterial accumulation (scaling and root planing), surgical repair
(pocket reduction/osseous reintegration), systemic antibiotics, and local
delivery (perio chip). There are also bone grafts, gum grafts, and dental
implants. It is hard to say if surgical repair and local delivery are effective
because each case is different. It also depends on how far the disease has
progressed, if the patient keeps up with homecare, or if the patient smokes.
The National Institutes of Health did some clinical trials on smokers and non
smokers and the effect of periodontal therapies in 2013. The results show
that with scaling and root planing every 3 months and using antibiotics when
needed helps get rid of the bacteria that is harboring below the gum line.
This helps prove that scaling and root planing are very effective when
dealing with periodontal disease. We need to get the bacteria out before the
gums can get any better. However, the smokers had trouble with getting

their gums in better shape due to still smoking. Homecare is very important
with treatment because if you do not help by brushing and flossing daily the
bacteria are still going to harbor below the gum line and your gums will
never get any better. Brushing and flossing disrupts the bacteria which
causes the gums to be healthier. According to P.L. Beemsterboer, G. Essex,
and D. A. Perry, the goals of the treatment plan are to eliminate and control
etiologic and predisposing factors of disease, maintain health, and prevent
recurrence of disease. So as long as you have good daily homecare, have 3
month recalls, dont smoke, and have good eating habits then you should be
on the right track for a healthier mouth.
My chosen method of treatment would be scaling and root planing.
Scaling is when we scrap off the calculus from above and below the gum line.
Root planing is when we get rid of rough spots on the root of the tooth and
help remove bacteria that add to the disease. The dentist, periodontist, or
dental hygienist can do this. Dental hygienist and general dentists perform
preventive scaling and root planing, and treat early stages of periodontal
disease. Additional training is required to treat more advanced cases. In such
cases, a general dentist would refer a periodontist for treatment. Periodontist
go to school for an additional 3 years of post-dental school. This means they
can perform surgical treatments. Scaling and root planing varies in prices
depending on where you live and what office you go to. The average cost of
scaling and root planing per quadrant around here is $200. The ideal
candidates for scaling and root planing are people who have issues with

plaque and calculus at the gum line. They should also have early signs of
gum disease such as discolored gums, sore gums, and bleeding gums.
I chose scaling and root planing as my method of treatment because it
is something that I can do. Dental hygienists do this every day and knowing
that we are helping make peoples gums healthier makes me so happy. This
treatment is also shown to be a very effective procedure, which is another
reason why I chose this as my method of treatment. I found a study on the
effect of scaling and root planing from a group of people that are in the
department of periodontology at the School of Dental Medicine in Zagreb.
The study shows that there were 19 subjects with chronic periodontal
disease and 9 with aggressive periodontal disease. The mean plaque value
was 0.94, gingival bleeding value 0.98, mean pocket depth 3.9 mm and
attachment loss 4.1 mm. The results after scaling and root planing the mean
plaque decreased to 0.72, gingival bleeding decreased to 0.75, mean pocket
depth decreased to 3.0mm, and attachment loss decreased to 3.8mm. This
shows that scaling and root planing makes a huge difference and is very
effective.
The only drawback to scaling and root planing treatment would be if
the pockets are too deep then it may be more challenging to clean them. The
only thing I found about a failure rate was that it is very small at 4.9% and it
did not say what it was due to. However, a study from G.M. Rabbani, M.M.
Ash, and R.G. Caffesse, show pockets more than 3-5 mm were difficult to

scale and pockets even deeper than 5 mm were the most difficult. I
personally think that getting in there and scaling and root planing what you
can and flushing away some of those bacteria are better than not doing
anything at all. Also, if a patient refuses to go to a periodontist, but still
comes to see you then its better to clean what you can and help that patient
get some of the bacteria out of there. I would still recommend them to go to
a periodontist since they would be able to do a better job though.
Expectations of the patient are to have them start stepping up in good
daily homecare. According to the article Periodontal (gum) disease: causes,
symptoms and treatments they should be brushing their teeth twice a day
with fluoride toothpaste and flossing regularly to remove the bacteria
between the teeth. If they are a smoker they should try quitting. Also, they
should visit the dentist regularly and have a cleaning every 3 months. The
responsibilities of the dental hygienist are to educate, motivate, and
customize. We need to educate the patient on what is going on in their
mouth and what periodontal disease is. We need to get them to understand
what is going on so they can try to help the disease from progressing. The
next step is to motivate the patient. If we explain that if the disease
progresses their teeth will eventually all fall out, they might be more
motivated to help stop that from happening and get better at daily
homecare. Periodontal disease can also lead to other health problems so that
may be another reason for the patient to get motivated. The last thing is to
customize the procedure for the patient. Every patient is different so we may

need to modify some things for each patient. They can have slight,
moderate, severe, or aggressive periodontal disease. They are all different
and need different care for each. For slight periodontitis they will probably
need more than one appointment. Moderate periodontitis will need to be
done in quadrants which will take several treatments and a referral to a
periodontist should be considered. Severe periodontitis will need to be
treated by quadrants which will take several treatments and it also may
require therapy by sextants according to P.L. Beemsterboer, G. Essex, and
D.A. Perry. It should be strongly considered going to a periodontisit. Last but
not least aggressive periodontitis may be treated in single or multiple
appointments and will require a referral to a periodontist. So depending on
what case of periodontal disease they have the hygiene appointments may
differ. According to S. Clark, patients usually need many sessions to develop
a high degree of effectiveness. We also need to be patient and persistent
with our patients. The patient may have some compliance issues such as
having poor oral hygiene and inconsistent frequency of recare in resolving
their disease state. They may also be more susceptible to periodontitis. By
motivating the patient to step up in good homecare though by brushing and
flossing daily, eating right, not smoking and having regular 3 month recalls
they should be in the right track.

Sources

Aurer, A., Gall-Troselj, K., Ibrahimagic, L., Ivic-Kardum, M., Jurak, I., & Pavelic,
K. The Effect of Scaling and Root Planing on the Clinical and
Microbiological Parameters of Periodontal Diseases. Retrieved October
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Ash, M.M., Caffesse, R.G., & Rabbani, G.M. The effectiveness of subgingival
scaling and root planing in calculus removal. Retrieved October 10,
2014 from
http://www.ncbi.nlm.nih.gov/pubmed/7014822

Beemsterboer, P.L., Essex, G., & Perry, D.A. (2014). Periodontology for the
dental hygienist.
St. Louis, Missouri: Saunders, an imprint of elsevier Inc.

Clark, S. (2014). Periodontolgy class notes, Kirkwood community college.

National institutes of health (2013). Effect of three periodontal therapies in

current smokers and non-smokers. Retrieved October 10, 2014 from

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term=scaling+and+root+planning+periodontal+disease&rank=8&sect=X70
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N.a. (2014). Gum disease. Retrieved October 10, 2014 from

http://www.mouthhealthy.org/en/az-topics/g/gum-disease

N.a. (2012). Periodontal (gum) disease: causes, symptoms, and treatments.

Retrieved October 10, 2014 from

http://www.nidcr.nih.gov/oralhealth/topics/gumdiseases/periodontalgumdisea
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Wilkins, E.M. (2013). Clinical practice of the dental hygienist. Philadelphia,

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