There is a common question asked by dental professionals and it’s also a question we get from our dental patients.

The question is, “Can we alternate periodontal maintenance with a prophy?”

Read this blog to know the truth and what you really need to do when your patient has completed periodontal therapy – Scaling and Root Planing.

The purpose of this information is to help dental professionals communicate the value of oral disease and inflammation which can contribute to other systemic diseases.

There has been an important paradigm shift in the last 20 yrs. Have you caught the wave? What’s new is that dental hygienists are no longer “cleaning teeth.”

Today’s most successful dental practices are treating the whole body not “just” the mouth. We can help our patients live a longer and healthier life.

Why Periodontal Maintenance?

According the American Dental Association, “Periodontal maintenance is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.”

Notice these important phrases as you read this description of Periodontal Maintenance.

1. instituted following periodontal therapy.
2. for the life of the dentition.
3. If new or recurring periodontal disease appears, additional diagnostic and treatment must be considered.

Some insurance companies don’t cover periodontal maintenance. Are you in the business of providing your patients only what their insurance will pay for?

If you said “Yes,” think again.

What if your patient asked you, “Dental hygienist, is cleaning my teeth when you told me my gums are bleeding, the best service you have to offer me?”

What would you say?

Can you honestly answer that a “cleaning” will put a halt to periodontal disease?

Think again. Do your research. There are thousands of journal articles to support the mouth-body connection and how to put a halt to systemic disease and periodontitis. If you have not read this information, I assure you, putting a halt to inflammation does not include “cleaning teeth.”

Prophylaxis Does Not Address Inflammation and Halt Progression of Disease

According to the American Dental Association, Prophylaxis includes the following, “Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.”

As you read the above two descriptions, Periodontal Maintenance and Prophylaxis, notice the clear distinctions between these two dental hygiene services.

• Periodontal Maintenance is after periodontal therapy.
• Prophylaxis is intended to control irritational factors.

Periodontal Maintenance includes site specific scaling where indicated and Prophylaxis is intended for irritational factors.

When a dental office offers adjunctive services such as localized antimicrobial antibiotics and/or soft-tissue diode laser, these can be included in the Periodontal Maintenance service however, Prophylaxis is indicated for a healthy patient and these adjunctive services are not a part of treating a healthy patient.

What Your Patients May Think

Your patients may only think that Periodontal Maintenance is more expensive, and they don’t want to return for this service when their insurance won’t pay for it.

Dental hygienists and all clinicians must show patients and help them understand what is happening in their mouth.

Super important that during the exam process to engage your patient. Before you lay your patient back in the chair, before you begin and services, explain to your patient what you will do during today’s appointment.

Ask them to listen and participate during the exam process. If you are completing a comprehensive periodontal exam (CPE), explain the numbers you will call and let your patient know what these numbers mean. For example, “4 mm’s means inflammation. If you hear a 5 or higher, that means active infection and we will put a plan together, so you don’t have infection in the near future. Let your patient know that you will ask them what the highest and lowest number they when you are completing your CPE. This is engaging your patient in their treatment.

When you have completed all of your wellness exams, with doctor and the patient, you can now make a diagnosis. It is super important that once you complete your wellness exams when you see anything abnormal, show your patient what you see. Include your patient by asking them what numbers they heard and ask them to look at what you see by showing them intra-oral pictures, x-rays and your CPE. Help your patient to take ownership of their disease.

Once patients truly understand the disease process and the cascade of events that can occur with their systemic health when active gum disease is left untreated, you will find it much easier for patients to pay and schedule treatment for preventive maintenance (AKA: Periodontal Maintenance).

As you are explaining “active gum disease” to your patient, sit with them knee-to-knee and eye-to-eye showing them what you see. Ask your patient questions as you look together at their x-rays, their comprehensive periodontal exam (CPE) and intra-oral pictures, etc.

An example of what you will explain to your patient:

 “Mr. Patient, during your gum maintenance appointment (AKA: Periodontal maintenance) I will remove bacteria and plaque buildup below the gumline (AKA: hard and soft deposits).

Two years ago (Or say the last time they had SRP/Perio Therapy), we treated you for active infection and inflammation. As we have talked about before, inflammation and gum disease contribute to systemic diseases such as high blood pressure, diabetes, rheumatoid arthritis, Alzheimer’s, etc., etc.

I will be using these special instruments to remove bacteria, soft plaque and hard deposits below and above your gumline. (If you use a soft tissue laser you will explain the following) Each time you return for your gum maintenance I will re-treat these areas with my laser which we have previously treated for gum disease This will regenerate the fibers that hold your gums in place and our laser is FDA approved (If you have Millennium Laser) to regenerate bone that was lost during active gum disease.

Gum disease is episodic and at times we need to retreated these areas. At times the disease can become active disease, with infection and inflammation. Just like sometimes you may have the flu and other years you are perfectly healthy, it’s the same thing with gum disease.”

Once your patients understand the value of periodontal maintenance (“gum maintenance” or preventive care”) and when they know that putting a halt to inflammation, infection and active gum disease, will help them live a longer and healthier life, they will be more comfortable paying for the correct service.

I have yet to meet a patient who did not want to live a longer and healthier life, have you?

I sure hope not!

Let’s share this message about optimal oral health and how this relates to living a longer and healthier life!

Will you help me conquer this disease process?

ABOUT DEBBIE SEIDEL-BITTKE, RDH, BS