Nonsurgical periodontal disease treatment: The periodontist's point of view
For patients who present in the early stages of periodontal disease, nonsurgical periodontal therapy is often the first line of defense against further disease progression . . . and dentists have access to an entire arsenal of options at their disposal. Dr. Joan Otomo-Corgel, president of the American Academy of Periodontology, shares the periodontist’s view with respect to nonsurgical periodontal treatment, as she references the American Dental Association’s clinical practice guidelines and offers her years of experience in the comprehensive management of chronic periodontitis.
The ADA guidelines indicate that SRP remains the gold standard for nonsurgical therapy and should be considered as the initial treatment for chronic periodontitis. Most periodontists would agree with this sentiment. The guidelines also point out that SRP performed with manual instrumentation results in similar clinical outcomes as SRP using ultrasonic scaling units, but does not always lead to complete removal of subgingival calculus and biofilm. This is why some cases warrant the use of adjunctive therapies. However, the ADA guidelines found that that none of the adjunctive therapies, including systemic antimicrobials, systemic host modulators, locally delivered antimicrobials, and a variety of lasers (when used nonsurgically), resulted in a greater gain in clinical attachment loss over SRP alone. In fact, some of the adjunctive therapies, such as the diode, Nd:YAG, and Er:YAG lasers, yielded no additional benefit over SRP alone.
Clinicians may find the ADA guidelines helpful in selecting therapies for the initial phase of treating chronic periodontitis. It’s important to note that even evidence-based guidelines are not written in stone and are not intended to establish a standard of care. Instead they provide a reasonable prediction of what to expect from a certain treatment. Every patient is unique, and it is crucial that the practitioner base nonsurgical treatment decisions based on each individual case, using peer-reviewed evidence as a clinical roadmap. Treatment decisions should include careful risk assessment, creation of measurable clinical endpoints, clear communication with the patient about expected treatment outcomes and consequences of nontreatment, and consultation with a periodontist, especially when dealing with a complex case or a medically compromised patient.
Having treated thousands of patients in my career, I can tell you that comprehensive management of chronic periodontitis often requires much more than just nonsurgical treatment. Depending on the case, the overall treatment plan should include individualized oral hygiene education; in-depth medical, social, and psychiatric assessment; occlusal evaluation; post-SRP reevaluation; potential surgical therapy; and ongoing maintenance. From the point of view of a seasoned periodontist, nonsurgical therapy is just the beginning.
This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.
Joan Otomo-Corgel, DDS, MPH, is the president of the American Academy of Periodontology (AAP). In addition to maintaining a private periodontal practice in Manhattan Beach, California, Dr. Otomo-Corgel is an associate clinical professor in the Department of Periodontics at the University of California Los Angeles’ (UCLA) School of Dentistry, where she earned her dental degree in 1979. She completed a master’s degree in public health from the UCLA School of Public Health in 1980. An AAP member since 1977, Dr. Otomo-Corgel has served on the boards of trustees for the AAP and the AAP Foundation.