Summary

Periodontal therapy involves many factors and events, including probing, radiographs, diagnosis, case typing, treatment planning, scaling, irrigating, surgery, prescribing, re-evaluating, and perio maintenance, among others. Some or all of these activities are necessary to arrive at a successful clinical outcome; however, only one of them determines the longevity of our successful treatment results. It’s all about perio maintenance.

Perio maintenance is every three months for life – the life of the patient or life of the dentition. This is not an arbitrary interval. When a biofilm is forming, the early colonizing bacteria are not pathogenic; they cannot cause perio disease. If this biofilm is not eliminated or adequately dismantled, the later colonizing perio pathogens come onboard the biofilm. They become the predominant species in three to 12 weeks, and 12 weeks is obviously three months. That’s when we want to get them, not one or three months later. The timing of biofilm development provides a sound bacterial rationale for maintenance every three months.

Patients can only get periodontitis if they are genetically susceptible to it, which is true for all diseases. Some people smoke nonfiltered cigarettes for 40 years and never get cancer because they do not have the oncogenes necessary for it to develop; i.e., they are not genetically susceptible to cancer.

Dental professionals have the primary role in diagnosis and treatment, but the patient has the primary role in maximizing the longevity of successful treatment results. It is critically important that patients understand their role. Without patient compliance we will never be able to achieve long-lasting, favorable results. Appropriate, effective treatment will achieve disease resolution, but only appropriate maintenance and home care will perpetuate the favorable results. Without it, the disease will recur every time.

Research shows that perio patients who do not receive proper maintenance lose two to three times more teeth and need active therapy twice as often as those having proper perio maintenance. Successful perio therapy requires considerable attention to the patient’s dental, medical, and family histories, clinical presentation, risk factors, and underlying biological processes. Proper perio maintenance to enhance the longevity of the favorable results we achieve is simple: every three months for life. It’s all about perio maintenance.

Dr. Richard Nagelberg has practiced general dentistry in suburban Philadelphia for more than 27 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations. He lectures extensively on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity. Contact him at gr82th@aol.com.