The mouth is not isolated from the rest of the body, so any intervention aiming at improving oral health will also have positive repercussions on other parts of the body. Hence, periodontal treatment is currently considered an appropriate tool not only to improve oral health, but also to provide important benefits to general health. 

Periodontal treatment leads to a number of benefits for the oral cavity. Among these is the elimination of gingival bleeding, a reduced risk of tooth loss and the control of halitosis, etc. In addition, according to Dr. Eduardo Montero, a researcher at the Universidad Complutense de Madrid and a collaborator of the Spanish Society of Periodontology and Osseointegration (SEPA), “periodontal treatment has a positive impact on the overall health and quality of life of patients.” 

Amongst the systemic benefits of periodontal treatment, he particularly emphasises the effect on the control of glucose levels in patients with diabetes, the prevention of cardiovascular events (including acute myocardial infarction or stroke), the prevention of pregnancy complications, and even an improvement in athletic performance. 

One example, says Dr. Montero is that “in people with diabetes, who have up to a three-fold risk of suffering from periodontitis, it has been shown that periodontal treatment contributes to improved metabolic control of glucose. Gum care during pregnancy is also important, as hormonal changes correlate with increased gingival inflammation and bleeding.” 

HOW AND WHO? 

Periodontal diseases are highly prevalent, with periodontitis being the sixth most common disease worldwide. In Spain, a recent analysis of the workforce performed by Dr. Miguel Carasol (Scientific Director of SEPA working groups) revealed a periodontitis prevalence of 38%. Although data on gingivitis are more difficult to collect, its prevalence is still greater. 

In order to deal with these diseases, once established, proper periodontal treatment - ranging from professional prophylaxis (cleaning) or scaling and root planing (generally known as non-surgical periodontal treatment) to various surgical procedures aimed at infection control, regeneration of the tooth support structure or improvement of the aesthetics of the gums - is essential. 

The different stages of periodontal disease require different, individualised treatments. Professional cleaning together with oral hygiene instruction are the appropriate treatment for gingivitis, while in periodontitis, regardless of its severity, a first phase of scaling and root planing will always be performed, and surgery may be necessary in moderate to advanced forms of the disease. 

GUARANTEEING THE BEST RESULTS 

Successful treatment depends to a large extent on prior adoption of a number of basic measures. “Before beginning periodontal treatment and with the aim of obtaining the greatest benefits, the dentist/periodontist should emphasise controling risk factors that may have a negative impact on treatment, such as deficient oral hygiene, smoking or poor glycaemic control in diabetic patients,” says Dr. Eduardo Montero. 

Periodontal treatment is primarily the responsibility of dentists. However, dental hygienists have the necessary skills to be able to perform some forms of non-surgical periodontal treatment, such as giving instructions for oral hygiene, or removing bacterial deposits. The periodontist, a dentist specialising in gum disease, is the most qualified professional to treat the most severe forms of periodontitis. 

In the diagnostic phase, the dentist/periodontist primarily uses periodontal charts (detailed analyses of the condition of the gums) and x-rays to determine the degree of bone loss around the teeth. 

In basic periodontal treatment, both ultrasonic and manual instruments are used to remove calculus from the roots of teeth. When it is necessary to perform surgery, microsurgical instruments are nowadays frequently used for greater accuracy and to shorten the postoperative period. In addition, the use of different biomaterials (such as bone and membrane substitutes) sometimes allows for regeneration of the support lost. 

Furthermore, “periodontal maintenance visits are essential to lengthen the benefits of treatment,” says Dr. Montero. The frequency of these will be based on the needs of each patient, so it is not possible to establish a single interval for all, but rather, a customised treatment will be required. As a general rule, the World Health Organization (WHO) recommends annual dental check-ups, although certain high-risk patients (such as diabetics or patients with a personal or family history of periodontitis) should have these every 4-6 months. 

FUTURE TRENDS 

Despite the current effectiveness of periodontal treatment, future trends in this area show expectations of still greater benefits for the patient. 

According to Dr. Eduardo Montero, “periodontal disease management will in the future focus on prevention, making patients aware of the importance of having a healthy mouth, even in terms of general health and quality of life. Dental hygiene and dental check-ups and maintenance visits will be key.” 

In terms of treatment, the expert predicts the future in this area “will be marked by solving the sequelae of the disease, improving the predictability of regenerative treatments and incorporating new resources such as the use of stem cells,”