What is it?
This consists of four main stages:
- Reassessment – This involves assessments of the periodontal status, including repeat measurements of pockets, bleeding, recession, mobility and oral hygiene levels.
- Diagnosis – based on the measurements taken, we can diagnose the disease that may have relapsed, or detect new disease. By complying with recommended maintenance intervals, this can be found early, thereby avoiding the need for extensive repeat treatment.
- Treatment – any remaining pockets (either existing or relapsed) are rescaled, sometimes with the use of local anaesthetic. Occasionally, medicaments are placed in the pockets to help them heal. General scaling of the whole mouth is also carried out. Oral hygiene is re-instructed and reinforced to help keep you motivated. Occasionally, it may be found that a site is still getting worse and just scaling and maintenance are not enough to control it – so alternative treatments may be suggested.
- Risk Evaluation – based on the measurements taken and assessments carried out, risk evaluation is performed in order to provide you with a recommendation of how long a gap should be left before the next maintenance visit.
Why is it needed?
Imagine your tooth support (gum, bone and ligament) are like a car or a house – they need constant servicing and looking after in order to run smoothly and prevent breakdown.
All research shows that without maintenance, also known as supportive periodontal therapy (SPT), you have a much greater chance of relapse. This would, therefore, lead to the need for repeat intensive treatment and the risk of further tooth loss in that time.
Despite your best efforts with oral hygiene, there is always a risk of relapse of the condition. Remember, gum disease is not usually painful, so you are unlikely to notice this yourself. SPT allows for early detection and treatment, thereby helping to maintain teeth for as long as possible, and avoid the need for repeat treatments.
If you had pockets remaining after treatment was completed, no matter how well you clean, there will still be some areas that will accumulate plaque (you can only clean up to 3mm below the gum line). Therefore, these pockets need to be scaled regularly in order to prevent them from deteriorating. If they do get worse, you run the risk of further bone and tooth loss, the decay of the root surfaces and loss of tooth vitality (the tooth may die).
Who does it?
In most cases, evidence shows that SPT carried out or at least led by a periodontist is the most effective in being successful. Frequently, we will advise the dentist or their hygienist to carry out some maintenance at intervals with the need for a further assessment with the periodontist in between so that we can make to appropriate diagnoses and risk assessments.
How often is it needed?
This is very prescriptive to individual cases. Typically it starts off at 3 months and gradually extends to every 4, then 6, then 12 months depending on how stable the condition remains between these visits. Likewise, if the condition deteriorates again, maintenance visits can be brought closer together in order to achieve and maintain periodontal stability.
What happens if I don’t comply?
You stand a very high chance of needing to have extensive treatment carried out again, and you may not always respond as well as the first time. This is because each time you re-start a program of periodontal treatment, you have been losing bone around the teeth. This means each time you don’t see a periodontist, the chances are the disease is worse than the first time and therefore the overall prognosis is poorer because the disease is more advanced to start with.
What can I do if I have already lapsed?
Just contact the periodontist and start again – it may not be too late yet!