The Periodontists at Georgia Periodontics and your dentist want what is best for you!!!
We understand that most people are looking for a quick and easy solution to any health problem, and treating periodontal disease certainly falls under this category. There are numerous claims of curing gum disease with a new drug, mouthwash, or pill. Unfortunately, these "cures" are not successfull, and by the time the patient discovers this, much more periodontal destruction has occurred. Patients can't even trust most medical "studies", which seem to show fantastic results. Often the company selling the new product funds these studies, and that same company is paying the dentists who are touting these results. Anecdotal results, or short-term studies, are simply not a sound basis upon which to base treatment.
Most researchers believe there must be at least two "blind" human studies of 6 months or longer to warrant credability, and longer-term studies (years) to dictate therapy. Also beware of claims that periodontists don't want to use a product because it would do away with the need for surgery, and thereby reduce their income. Any ethical dentist looks for the best health solution for his or her patients, regardless of profit margin.
The following treatments often generate claims of cures that are either highly exaggerated or just plain false.
Mouthwashes - The gold standard for mouthwashes is chlorhexidene, commonly sold as the prescription mouthwash Peridex. It is extremely effective in reducing plaque, and we prescribe it frequently after active therapy. It is safe, but will stain teeth over time, which is of concern to most patients. (The stain is removed by tooth polishing). Certainly we would rarely discourage its use by a patient. However, no mouthwash is able to penetrate to the bottom of a pocket, and even when an irrigator is used, a pocket will still contain plaque that produces more disease.
Mouthwashes are good adjuncts to therapy, particularly when flossing and brushing are limited, but they do not cure periodontal disease. Other mouthwashes that are useful include PerioMed, a stannous flouride mouthwash, and Listerine, a well-studied rinse that helps reduce plaque.
Vitamins and Supplements - For years, researchers have studied the effects of diet on periodontal disease. While there are numerous studies that indicate one supplement or another reduces or cures gum problems, none have been reproducible by objective researchers. Our current thinking is that those with normal, healthy diets do not improve their periodontal health with supplements.
Antibiotics - While it seems logical to think that taking antibiotics would be helpful in treating an infection, with periodontal disease the problems tend to return as soon as the antibiotic is discontinued. Also, good scaling and root planing seem just as effective as antibiotics without the risks of side effects or the formation of resistant strains. In general, antibiotics are used only for specific cases (see Antibiotics).
Low Dose Antibiotics - It has been known for many years that the antibiotic doxycycline not only kills bacteria, but also reduces collagenase, an enzyme that causes breakdown of periodontal tissues. It was found that in low doses, when the antibiotic effect is no longer available, collagenase reduction still occurs. Because of the low dose, it is thought that the problems with side effects and bacterial resistance are greatly reduced, and the drug can be used on a long-term basis. This attempt to increase patient resistance is the first step of what promises to be an important approach in maintaining periodontal health. Unfortunately the research on this specific product (Periostat) is extremely limited, and the results non-conclusive. In the only human study the difference between the control and the product was less than 1 mm change in pocket depth, which is not clinically significant. We use Periostat with certain cases that are resistant to conventional care, but it is not recommended at this time for every case.
Local Delivery Products – (Please see our full section under maintenance)In the last decade there has been an attempt to place antibiotics (Actisite and Atridox)or antimicrobials ( PerioChip) directly into the pocket. As new techniques surface, it is possible to have the product time-release over several days, which helps kill the bacteria in the pocket. These products seem to help in certain cases, although the most recent research indicates that over a 5 year period, no difference is seen with or without the product. We currently use these local delivery antimicrobials in the maintenance (recall) phase of treatment, when specific areas don't seem to be doing well. They are not used in the original treatment phase.
The Patient's Role in Therapy
No matter how successful the periodontal treatment has been, the patient is the most important part in maintaining periodontal health. For maximum results, the patient must accept this role as a "co-therapist" .
The first responsibility of the patient is to eliminate factors that increase susceptibility to periodontal disease. The prime culprit is smoking, which increases the odds of losing teeth 1000%! Diabetic patients are also more susceptible, although this effect is negligible if the blood sugar remains stable. Healthy diets promote healing, but don't be misled by vitamin claims. Periodontal disease is NOT affected by high doses of Vitamin C or calcium supplements, if the patient has a normal diet.
The second responsibility of the patient is to maintain daily plaque control, with brushing and flossing . Brushing is easy for most of us, but flossing is more demanding. Most periodontal disease, however, starts between the teeth, where the brush can not reach. "Floss is the Boss", and the time spent in learning proper technique will pay large dividends. (See Oral Hygiene)
Lastly, the patient is responsible for scheduling regular periodontal maintenance appointments. The frequency is determined by your periodontist and dentist, and is critical! Most patients with moderate and advanced cases should have periodontal maintenance appointments every three months for their lifetime, and staying faithful to this schedule is very important.
Periodontal Maintenance
Following therapy, regular Hygiene visits are vital to maintaining periodontal health. Maintenance, along with good oral hygiene, are the keys to good oral health. Studies have shown people who do not maintain regularly have 20 times the amount of bone loss as those who do.
For cases where there are some residual pockets deeper than 3mm, or where the patient has shown a high susceptibility to breakdown, three month (or more frequent) recalls are critical. In these cases where the patient cannot reach all areas with oral hygiene techniques, bacteria form colonies (plaque) immediately after treatment.
Normally, however, it takes plaque about three months to develop into an aggressive infection. The first three months there is minimal bone loss, but after ninety days the breakdown dramatically increases. If the plaque is removed every three months, the plaque aggressiveness will stay low.