In article #5, the first goal of periodontal disease and gingivitis treatment, awareness of the disease process and recognition of its warning signs was discussed. Other goals of periodontal treatment and the team members’ roles in achieving those goals will now be discussed.
The next four goals can be grouped together because they are interrelated goals, which mean the achieving of one goal contributes to the achieving of the rest of the goals in this group of goals. These goals are to stop periodontal disease progression, reduce the future risk of periodontal disease progression, remove the cause of periodontal disease and remove or reduce the risk factors contributing to the progression of periodontal disease when ever possible.
Before discussing these goals, it is important to understand the difference between a “cause” and a contributing “risk factor”. Both the cause and contributing risk factors must be considered in the treatment of periodontal disease for long term effective treatment of this disease.
A “cause” is something that must be present or absent for a disease process to begin. A contributing “risk factor” is a condition or behaviour that is present or absent that aids in the spread and severity of a disease process once it has begun due to its cause. A contributing risk factor alone does not cause the disease.
The cause of periodontal disease and gingivitis is bacterial plaque ( a soft sticky film of bacteria ) on calculus that is under the gums in the space between the gums and teeth. Therefore by preventing the formation of bacterial plaque and calculus above and below the gums the cause of this disease is prevented. By removing the bacterial plaque and calculus above and below the gums, the cause of this disease is being removed. Once the cause of this disease is no longer present, the disease process is stopped, healing can take place and the risk of future disease progression is greatly reduced.
Contributing risk factors are conditions or behaviours that affect a person’s immune response to the disease process. The immune response may be lowered or may be increased to the point where the immune response causes more damage than the actual cause of the disease. In periodontal disease it is often the immune response to the cause of this disease that causes more gum and bone destruction than the actual cause of the disease itself. Therefore as part of the long term treatment of periodontal disease, the contributing risk factors must be stopped or lessened as much as possible to achieve long term treatment success.
Some of the more well known risk factors contributing to periodontal disease progression and severity are: smoking, uncontrolled diabetes, poor oral hygiene, irregular dental visits and cleanings, any disease affecting the immune system and genetics.
Other than genetics, all of these other risk factors can be controlled, treated or changed. Smoking, although not easy, can be stopped or reduced. Diabetes can be controlled, oral hygiene can be improved and dental visits and cleanings can be regularly done.
The patient’s role in eliminating or reducing the changeable risk factors can not be stressed enough. Ultimately in the long term, it is what the patient does or does not do in managing these risk factors that determines the long term success or failure of periodontal disease treatment performed by the dental office members of the team.
The dental office team member’s role is to educate the patient about the cause and risk factors of periodontal disease and gingivitis, remove the cause of these diseases as allowed by the patient and maintain the treatment results as allowed by the patient. As allowed by the patient means that it is the ultimate decision of the patient as to the extent of needed treatment the patient will want, the extent the patient reduces the risk factors and the extent the patient attends the dental office for regular maintenance visits. Without the patient’s co-operation, the dental office team members can not successfully treat periodontal disease and gingivitis on a long term basis.
In topic #7, the other remaining goals of periodontal disease treatment will be discussed as well as the team members’ roles in achieving these goals.
