Periodontics is a specialized field of dentistry focused on the health of the structures that support the teeth, including the gums and underlying bone. The dental hygienist’s role is expanding beyond routine cleanings to include comprehensive periodontal care, making them a primary force in managing these diseases. This overview covers the core concepts in periodontics, highlighting the knowledge base required for dental hygienists to effectively manage patient health.
The Hygienist’s Role in Periodontal Assessment
A dental hygienist’s primary responsibility in periodontal care is collecting and analyzing patient data. This process begins with periodontal charting, which involves measuring probing depths and clinical attachment levels (CAL) to determine if there has been a loss of the fibers that hold teeth in place. This charting includes noting bleeding on probing (BOP), which indicates inflammation, and identifying furcation involvement where bone loss has occurred between the roots of multi-rooted teeth.
The assessment continues with a visual and tactile examination of the gingival tissues for changes in color, contour, and consistency. Hygienists document the presence of plaque biofilm and calculus, and interpret radiographs to evaluate the underlying bone structure. They also identify and record risk factors that influence disease progression, such as smoking, diabetes, certain medications, and genetic predisposition. This comprehensive data collection is the basis for diagnosis and treatment planning.
Periodontal Disease Etiology and Classification
Periodontal disease is caused by microbial dental plaque, a biofilm that forms on teeth. However, the body’s immune and inflammatory response to these bacteria leads to the destruction of gum tissue and bone. The composition of this biofilm is complex, but certain species of bacteria are more strongly associated with disease progression.
Periodontal diseases are categorized using a classification system to standardize diagnosis and treatment planning. The 2017 American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP) classification is the current standard. This system helps distinguish between conditions like gingivitis, which is reversible inflammation, and periodontitis, which involves irreversible bone loss. Periodontitis is further classified by stages and grades to describe its severity, extent, and rate of progression, which informs the therapeutic approach.
Principles of Non-Surgical Periodontal Therapy
The goal of non-surgical periodontal therapy (NSPT) is to control the microbial infection and halt disease progression. This is accomplished through scaling and root planing (SRP), where the hygienist removes plaque biofilm and calculus from above and below the gumline. The root surfaces are then smoothed to create a surface more resistant to plaque accumulation and promote healing.
Hygienists use a combination of manual and ultrasonic instruments for SRP. Manual scalers allow for tactile feedback and precise removal of deposits, while ultrasonic scalers use high-frequency vibrations to break up calculus and disrupt biofilm. The choice of instruments is tailored to the patient’s needs and the nature of the deposits. The objective is to thoroughly debride the tooth and root surfaces without causing undue damage.
In some cases, chemotherapeutic agents are used as an adjunct to SRP to reduce the bacterial load in deep periodontal pockets. These agents are applied locally by the hygienist and can include chlorhexidine chips, minocycline spheres, or doxycycline hyclate gel. NSPT also includes comprehensive patient education, with personalized oral hygiene instructions to help patients manage their dental health at home.
Effective Periodontal Maintenance Protocols
Following active periodontal therapy, patients enter a phase of ongoing care known as periodontal maintenance or supportive periodontal therapy (SPT). Because periodontitis is a chronic condition, this long-term program is for patients with a history of the disease to prevent its recurrence and maintain treatment results.
A periodontal maintenance appointment begins with a reassessment of the patient’s periodontal status. This includes updating the periodontal chart and comparing it to previous records to monitor for changes. The hygienist then performs targeted removal of new plaque and calculus. Site-specific instrumentation may be required for areas that show signs of recurrent inflammation.
The interval between maintenance visits is customized for each patient based on their risk profile, including the severity of their disease, response to treatment, and home care effectiveness. Common intervals are every three, four, or six months. During these visits, the hygienist also reinforces oral hygiene techniques and provides motivation to help the patient adhere to the care plan.
Managing Advanced Periodontal Conditions and Collaboration
When non-surgical periodontal therapy alone is not sufficient to control disease progression, more advanced treatment is needed. Dental hygienists recognize the signs indicating this need, which include:
- Periodontal pockets that remain deep after NSPT
- Advanced bone loss
- Complex furcation involvements
- Certain types of vertical bone defects
In these cases, a referral to a periodontist, a specialist in gum disease, is necessary.
A periodontist can perform a range of surgical procedures to treat advanced conditions. These may include flap surgery for deep cleaning, osseous recontouring to reshape bone, or guided tissue regeneration to encourage regrowth of lost tissue. Mucogingival surgeries may also be performed to address gum recession. Understanding these treatments allows the hygienist to educate the patient about what to expect after a referral.
The hygienist plays a role in both pre- and post-surgical care. This includes providing thorough plaque control before the procedure and assisting with post-operative care, such as suture removal and providing specific home care instructions. Effective communication and collaboration between the general dentist, dental hygienist, and periodontist are necessary to achieve the best outcomes. This team-based approach ensures all aspects of the patient’s health are considered in the treatment plan.