My preventive ethos is simple, I encourage patients to attend regularly for reviews and spend time brushing well with the appropriate cleaning kit twice a day.
The periodontium is the very foundation for teeth and it is important to have a strong and healthy foundation for a beautiful smile.
Research shows that inflammatory diseases of the mouth such as periodontal diseases are directly associated with diabetes and heart disease.
Treating inflammation helps manage periodontal diseases and so, in turn, helps in the management of chronic inflammatory conditions.
The power of three
Periodontal treatment is divided into three phases.
The initial phase is focused on plaque control and deep cleaning (root surface debridement) to reduce the plaque and tartar from gum pockets. After a few weeks, we reassess the response to this therapy.
The second phase is corrective and, sometimes, involves surgery at the deeper sites.
The need for this kind of treatment is usually decided upon and planned at the reassessment appointment. After this, the third phase is the maintenance phase that usually involves three-monthly recalls to a hygienist.
The patient’s journey is a vital part of my treatment ethos. There is no dental treatment that can be described as relaxing, but I do try to ensure it is as comfortable as possible.
This is particularly important in periodontics as the success of the treatment is largely dependent on the patient being compliant, and the patient is more likely to be compliant with our advice if their experience has been rewarding.
The power of a shared philosophy
A treatment plan is devised following an initial consultation with me.
I ensure the whole team, from the practice manager and receptionist to the dental nurse and hygienist, is singing the same tune.
We have regular meetings, during which ideas are shared. We also attend lectures and conferences together and, I find, it is useful to have a simple practice manual with flow charts to which the team may refer.
For a practice to be effective, it needs a shared ideology.
I also try to get to know my referring dentists and encourage them to join us for our practice continuous professional development lectures and case discussion so they too may share in my treatment philosophy and play their role in the long-term management of the stabilised, but still susceptible, periodontitis patients.
The power of predictability
My philosophy is to treat the patient and not just the mouth.
Similarly, I treat the whole mouth, including the gums and supporting bone, and not just the teeth.
Most patients who have decided to see a specialist for treatment have already made a conscientious decision to seek healthier gums and teeth.
My role is to provide them with the most predictable treatment and I find they appreciate that.
If you are honest with your patients, they will listen. Any complex work we do in periodontics or implant dentistry would be futile unless we have the patient on board in maintaining excellent oral hygiene.
Following adequate periodontal treatment, it should be borne in mind that the replacement of any missing teeth with implant-supported reconstructions should also include a maintenance programme, because patients who have lost teeth as a result of periodontal disease are also at risk of developing peri-implantitis (Ong et al. 2008).
The power of a power brush
The oral hygiene kit I would advise periodontitis patients to have would be an electric toothbrush (smaller oscillating-rotating brush head for effective access), interdental brushes and fluoride toothpaste.
I always recommended power brushes as most patients welcome any help they can get in stabilising their periodontal disease.
I find Oral-B brushes to be effective and patient friendly.
From a periodontal perspective, mechanical plaque removal and the use of a stabilised stannous fluoride toothpaste are key in maintaining healthy gums and tooth-supporting structures.
Dr Constantine Ong is a periodontist who also teaches at the UCL Eastman Dental Institute, mentoring the final-year Masters students and general dentists.
Ong, C., Ivanovski, S., Needleman, I., Moles, D., Retzepi, M., Tonetti, M. and Donos, N. (2008) ‘Systematic review of implant outcomes in treated periodontitis subjects’, Journal of Clinical Periodontology, May; 35 (5) 438-62.