Periodontics is the specialized field of dentistry focused on the health of the periodontium, which includes the hard and soft tissues that support the teeth. The dental hygienist plays a foundational role in this specialty, acting as the primary provider for non-surgical periodontal care. This involves a systematic approach to identifying, treating, and managing inflammatory diseases like gingivitis and periodontitis.
Patient Data Collection and Assessment
Accurate data collection forms the basis of all periodontal care, providing the necessary evidence to establish a diagnosis and treatment plan. A comprehensive periodontal examination (CPE) must be performed annually, involving a detailed assessment of the tissues surrounding every tooth. This process begins with full-mouth periodontal charting, which involves measuring probing depths—the distance from the gingival margin to the base of the periodontal pocket. These measurements are combined with any gingival recession to determine the clinical attachment loss (CAL), which is the most reliable measure of true periodontal destruction.
Inflammatory markers are recorded, most notably bleeding on probing (BOP), which indicates an active inflammatory lesion. The presence of suppuration, or pus, extruded from the pocket, is also noted as a sign of active infection. The assessment includes evaluating local factors, such as bacterial plaque and calculus deposits, which serve as reservoirs for disease-causing microorganisms.
Radiographic interpretation provides visualization of the underlying alveolar bone structure, showing patterns of bone loss, either horizontal or vertical, that correspond to clinical findings. Evaluation also incorporates systemic and behavioral risk factors that modify disease expression and progression. For instance, uncontrolled diabetes and tobacco use are significant factors.
Periodontal Disease Classification Frameworks
Once clinical and radiographic data are collected, classification involves assigning a formal diagnosis using a standardized framework. The current system, established in 2017 by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP), utilizes a multi-dimensional approach. This framework moved away from older terms like “chronic” and “aggressive” periodontitis to provide a more tailored understanding of the disease. The classification is divided into two parts: staging and grading.
Staging classifies the severity and extent of the periodontal disease based on the amount of destroyed tissue. This is determined primarily by measured clinical attachment loss and evidence of radiographic bone loss. Staging ranges from Stage I (initial periodontitis) to Stage IV (advanced periodontitis with potential tooth loss). Complexity factors, such as deep probing depths, furcation involvement, and tooth mobility, can modify the assigned stage.
Grading provides information regarding the rate of disease progression and the influence of systemic risk factors. Grades are classified as Grade A (slow rate), Grade B (moderate rate), or Grade C (rapid rate) of progression. Modifiers like smoking status and the presence of diabetes significantly influence the assigned grade, reflecting the systemic burden on periodontal health.
Non-Surgical Treatment Modalities
The primary therapeutic intervention for established periodontitis is non-surgical treatment, focusing on controlling the infection and promoting tissue healing. This therapy aims to remove the bacterial biofilm and calculus from both supragingival and subgingival tooth surfaces. The modern approach emphasizes periodontal debridement, which targets the mechanical disruption of the subgingival biofilm and the removal of calculus. This is distinct from the historical concept of scaling and root planing (SRP), where the intention was often to aggressively remove infected cementum.
Current protocols focus on root surface debridement with the goal of conserving the root cementum. The procedure aims to create a biologically compatible root surface that facilitates the reduction of inflammation and pocket depths. Successful non-surgical therapy is defined by a reduction in probing depths, the disappearance of bleeding on probing, and a stabilization of attachment levels.
Adjunctive therapies are incorporated to enhance the effects of mechanical debridement. Localized delivery of antimicrobial agents can be placed directly into residual deep pockets following instrumentation to suppress persistent pathogenic bacteria. Some patients may also benefit from host modulation agents, which are medications used to alter the body’s inflammatory response rather than directly targeting the bacteria.
Supportive Periodontal Therapy
Following active non-surgical treatment, the core principle shifts to long-term disease management, known as Supportive Periodontal Therapy (SPT) or Periodontal Maintenance. Since periodontitis is a chronic inflammatory disease, SPT is a continuous phase of care required to prevent its recurrence and progression.
The SPT appointment involves ongoing monitoring, including a full or partial periodontal reassessment at every visit to check for signs of disease relapse. Site-specific professional mechanical plaque removal and localized instrumentation are performed on any areas showing renewed inflammation or residual pocket depths. This professional debridement is essential because pathogenic bacteria can repopulate deep pockets within a matter of months.
A major component of SPT is determining the appropriate recall interval, which is highly individualized based on the patient’s risk profile and disease stability. While a common starting interval is three months, this can be adjusted based on patient needs. Patients with systemic risk factors or persistent inflammation require more frequent visits, ranging from three to twelve months. Adherence to this personalized recall schedule and consistent patient compliance are paramount to achieving long-term success.