Claudia Kinnander

I. Periodontal disease

a. Periodontium is all of the hard and soft tissues that surround all of the teeth. This

would include gum tissue, alveolar bone, and the periodontal ligament. Periodontitis

occurs when these structures are weakened by bacteria and start to recede. First the

infection caused by the bacteria will affect the gingiva which causes inflammation, which

is called gingivitis. Then the disease progresses to periodontal disease which means there

is gingival attachment loss and alveolar bone loss. Gingivitis is reversible, however

periodontal disease is not.

b. Periodontal disease is caused by a bacteria biofilm that builds up on the teeth. In

order to prevent this disease frequent plaque removal is required to disrupt the bacteria.

The plaque has to be removed using mechanical forces like brushing and flossing. Patients

cannot remove adequate amounts of plaque by swishing alone. Studies have shown that

poor dental hygiene can increase the severity of periodontal disease.

c. There are many factors that can predispose people for periodontal disease. Some

of these factors are gender, education level, race, age, socioeconomic status, and tobacco

use. Men have a higher chance of developing periodontal disease then women do.

Socioeconomic status has been shown to have an effect on the chances of someone

developing periodontal disease. Patrons in lower income classes tend to have greater

chances of developing periodontal disease because of little or no insurance coverage. If

people do not have insurance, then they are more likely to not go to the dentist and do not

get the proper oral hygiene education. A low level of education can cause an increase the

chances of getting periodontal disease. People who smoke have a greater chance of getting

periodontal disease. The chances of getting periodontal disease increase as people get
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older especially in senior adults that are over the age of 65. There are some systemic

diseases that can cause an increase in periodontal disease. One of these diseases is diabetes

especially insulin dependent diabetics.

d. The main and most important contributor of periodontal disease is P. gingivalis.

Other bacteria that have been known to play a role in periodontal disease are: P.

intermedia, T. denticola, A. acinomcetemcomitans, and Campylobacter species.

Researchers have found this out by taking samples of plaque, staining them, and looking

at them under a microscope to determine what bacteria are in the plaque involved with

periodontal disease.

II. Common treatment methods

a. There are several different types of treatments for periodontal disease. Periodontal

disease cannot be cured but it can be slowed down and managed. Bone and tissue cannot

be grown back, however with some good homecare and professionally applied

chemotherapeutics some tissue attachment may be able to be regained. Perio chips are one

of these treatments. They are flat chip that is laced in a periodontal pocket of 5mm or

more. The patient is not able to floss around the teeth with the chips for 10 days so that

they are not dislodged. If a chip is dislodged the patient should contact their office. The

most common treatment at the Dental Hygiene Clinic and the University of Iowa College

of Dentistry is Arestin. Arestin is a powder that is placed in a pocket and is dissolved over

the course of 14 to 21 days. This treatment has been shown to reduce a pocket depth of

7mm or more by 2mm.

b. There was a study that was done on Arestin. In the study there were two different

groups. Group A only received SRP while group B received SRP and Arestin. Throughout
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the duration of this study the plaque index, gingival bleeding index, gingival index, and

the pocket depths of group B improved significantly. Group A showed very little changes.

c. It is very important that the hygienist discuses home care with the patient once the

appointments over. If only SRP is done the patient should be instructed to take whatever

they take for a headache and swish with a arm salt water rinse if there is any sensitivity.

The hygienist should go over OHI with the patient and improve their brushing and

flossing techniques. If a professionally applied chemotherapeutic agent is applied there are

some extra home care instructions to go along with the ones for only SRP. If Arestin is

applied the patient should be instructed not to brush for 12 hours, no interproximal

cleaning for 12 days, avoid foods that can harm the tissue. Post op instructions should

always be given based off the manufacturer’s recommendations.

III. Preferred method of treatment

a. My preferred choice of treatment would be SRP with Arestin to improve gingival

attachment levels. SRP would be done to remove the majority of the bacteria and plaque.

Once the bacteria and plaque are removed the gum tissue can start to heal and reattach.

Arestin is a antibacterial that would help kill or stop the growth of bacteria that is

remaining in the pocket. The Arestin will help promote the reattachment of the gingiva.

Arestin is a powder that is placed in a periodontal pocket and slowly releases the antibiotic

overtime.

b. An ideal candidate would be a perio patient who has a perio pocket. The pocket

depth has been shown to reduce by 2mm for a pocket that is 7 mm or greater. This method

will only work if there is a patient that is willing to comply to all of the POI. The patient
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will also need to make some changes in their OHI routines for this method to work. If the

patient does not comply the disease may progress.

c. The cost of SPR in a private practice would be around $185 for 1-3 teeth and

$230 for full mouth SRP. If a patient needs Arestin the price would increase.

d. The Hygienist would perform the SRP for a patient and they would also apply all

the chemotherapeutic agent if necessary. The Hygienist must obtain an AAS degree and a

license for the state where they would like to work in.

IV. Benefits

a. SRP is the treatment of choice because the bacteria and plaque must be removed

for the pocket in order to promote healing. I feel like Arestin treatment is a good treatment

because there is a possibility for 2mm of reattachment for deeper perio pockets.

b. There have been studies that show that SRP can help with plaque indexes,

bleeding and periodontal pockets. Arestin with SRP has shown to improve the same things

that SRP does, however the results are much better.

V. Insufficiencies

a. The downfall to this periodontal treatment is the cost. Some patients may not want

to commit to the costs of this treatment. Usually with SRP patients will need to come in

for maintenance appointments every 3 months. There are also several home care changes

that the patient will need to make in order to see any changes. Some of these changes can

include having the patient stop smoking.

b. There are many variables that can increase the risk of failure for periodontal

disease treatment. Getting a patient to stop smoking can be very hard and this greatly

effects the success of the treatment. Encouraging patients to come in for three month recall
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appointments is very difficult because a lot of times they have to take off work and their

insurance may not pay for more than two appointments a year. It is very hard to judge

failure of perio treatment on just one thing because there are so many different variables

that can have an effect on the success.

VI. RDH and patient responsibility

a. The patient must follow the instructions that the hygienist and doctor give to the

patients. There are some things that will need to change in order to improve the health of

the patient’s oral cavity. The patient must stop smoking in order for the treatment to work

the best. The patient also has to change their brushing and flossing habits to improve their

oral hygiene.

b. The hygienist is expected to explain the disease and who they got it so the patient

can understand. The hygienist also needs to walk the patient though the treatment plan and

make the plan for that specific patient. They are expected to give the patient all the

information that they will need in order to produce the best results.

c. The patient should be scheduled for an SRP for the proper number of quadrants

that is needed. Once the SRP treatment is complete the patient should be scheduled for 3

month recalls for perio maintenance. The maintenance appointments will help to keep the

disease from progressing if the patient also complies to the changes in their home care.

d. The patient needs to have their brushing technique adjusted. The hygienist should

suggest an electric toothbrush. They need to encourage the patient to brush at a 45-degree

angle toward the gumline for two minuets twice a day. The patient should also be

persuaded to floss by using normal string floss or different flossing aids like a water

flosser, soft picks, interdental brushes, or floss picks. This should be done once a day.
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e. A patient may not want to comply due to the price of SRP treatments. Their

insurance may not cover three or four appointments in a year. If a patient has to make

some major life changes like stop smoking or using other tobacco products they maybe

reluctant to do the treatments.

Sources

Boyd, L., Wilkins, E., Wyche, C. (2017). Clinical practice of the dental hygienist. Philadelphia, PA:

Wolters Kluwer.

Clark, S. History of Periodontology and the Dental Hygienist. Kirkwood Community College.

Gopinath, V., Ramakrishnan, T., Emmadi, P., Ambalavanan, N., Mammen, B., Vijayalakshmi. (2009).

Effect of a Controlled Release Device Containing Minocycline Microspheres on the Treatment of

Chronic Periodontitis: A Comprehensive Study. Journal of Indian Society of Periodontology.

Hebl, L. Dental Hygiene IV, Chemotherapeutics unit 102 professionally applied chemotherapeutics.

Kirkwood Community College.

Perry,D., Beemsterboer, P., Essex, G., (2014). Periodontology for the Dental Hygienist, St. Louis, MO:

Elsevier