Clearing the fog over misconception, confusion around need for periodontal maintenance

April 1, 2020

Knowing when periodontal maintenance is needed versus prophy will help deliver the best oral care for your patients.

Clearing the fog hanging around the topic of Periodontal Maintenance vs. a Prophy clears away confusion and misinformation about when to use periodontal maintenance. This will also provide optimal oral health for your patients.

This information is also intended to help dental professionals communicate the value of oral disease and inflammation which can contribute to other systemic diseases.

Dentistry has changed a lot during the 21st century. Dental hygienists are no longer in the business of simply “cleaning teeth.” Dentistry is about total health. It’s no longer about preventing dental decay and cleaning teeth. Dental professionals have information at their fingertips to help patients save money on preventable systemic and oral diseases. We can help our patients live a longer and healthier life.

What is the definition of Periodontal Maintenance?

According to the American Dental Association (ADA), “Periodontal maintenance is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.”

As you read the above statement, notice three specific descriptions about when this service is indicated:

1.     Instituted following periodontal therapy

2.     For the life of the dentition

3.     If new or recurring periodontal disease appears, additional diagnostic and treatment must be considered.

Some insurance companies may not cover periodontal maintenance and this service becomes devalued by many dental clinicians who want to help patients receive reimbursement for hygiene services. We should avoid falling into the trap of offering patients what their insurance will pay for.

Let’s look at when a Prophylaxis (Prophy) is indicated:

According to the ADA, Prophylaxis includes the following, “Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.”

As you read the above two descriptions, Periodontal Maintenance and Prophylaxis, notice the clear distinctions between these two dental hygiene services.

  • Periodontal Maintenance is after periodontal therapy. 

  • Prophylaxis is intended to control irritational factors.

[ Editor’s Note: The author, Debbie Seidel-Bittke, RDH, BS, is hosting a Webinar Series called: Accelerate Your Dental Practice Recovery After COVID-19. For more information and to register, click here. ]

Periodontal Maintenance includes site-specific scaling where indicated and Prophylaxis is intended for irritational factors.

When a dental office offers adjunctive services such as localized antimicrobial antibiotics and/or soft-tissue diode laser treatment, these can be included in the Periodontal Maintenance service. Having said that, Prophylaxis is indicated for a healthy patient and these adjunctive services are not necessary for treating a healthy patient.

From the patients’ perspective

From your patients’ perspective, they may only think the Periodontal Maintenance service is more expensive. In their mind, they prefer to only pay for a Prophylaxis, especially if not covered by their insurance company.

What must happen is that when active disease, pocket depths of 5 mm or more, radiographic bone loss, recession, furcation involvement, mobility, BOP, etc, are involved, hygienists and all dental clinicians must show patients what is occurring in their mouth. 

Engage with your patient during the exam process. Explain to them what you will be doing. Ask them to listen and participate during the exam process. Once you have collected all of the important information and can make a diagnosis, show your patients what is happening in their mouth. Include your patient during the exam process as well as the treatment planning phase. Help your patients to take ownership of their disease.

Once patients truly understand the disease process and the cascade of events that can occur with their systemic health when active gum disease is left untreated, you will find it much easier for them to pay and schedule treatment for preventive maintenance (AKA: Periodontal Maintenance).

As you are explaining “active gum disease” or “routine maintenance” to your patient, sit with them knee-to-knee and eye-to-eye, showing them what you see. Ask your patient questions as you look together at their X-rays, their comprehensive periodontal exam (CPE) and intra-oral pictures, etc. 

Explain to your patient that during Periodontal Maintenance (AKA: “gum maintenance” or “preventive maintenance”) you will remove bacteria, soft and hardened plaque buildup below the gumline (AKA: Hard and soft deposits. Plaque and calculus). 

Educate your patient about inflammation and how this relates to other systemic diseases such as high blood pressure, diabetes, rheumatoid arthritis, Alzheimer’s, etc. Explain that you will use special instruments to remove the bacteria. Also brief them on the use of lasers if you have lasers in your office. This includes discussing the role of lasers in reducing inflammation. Tell your patients that inflammation in the mouth also relates to inflammation in the body. Explain that inflammation in the body is what contributes to these other systemic diseases.   

Let your patients know that “gum disease” is episodic and at times they will need to be re-treated for active gum disease, infection and inflammation. Correlate gum disease to these other diseases such as high blood pressure, diabetes, etc. Let your patients know that just like high blood pressure and diabetes, gum disease is also silent. When a patient has high blood pressure and/or diabetes, their doctor will closely monitor their disease. In the same way gum disease must also be closely monitored.

Once your patients understand the value of periodontal maintenance (“gum maintenance” or preventive care”) and when they know that putting a halt to inflammation, infection and active gum disease will help them live a longer and healthier life, they will be more comfortable paying for the correct service.

Have you ever met a patient who did not want to live a longer and healthier life?

Neither have I! Creating a partnership with your patient is a great way to clear the fog around valuable services such as routine Periodontal Maintenance appointments. Let’s work together to conquer this disease process.