Ultrasonic Periodontal Therapy - Benefits for the Patient and the Practice

The prevention of periodontal disease is a key factor in oral health. It has also become evident that periodontal health is associated with systemic health. Nonsurgical scaling and root planing is the standard of care for periodontitis. Supragingival plaque removal influences the bacterial environment in pockets up to 3 mm in depth, while subgingival scaling and root planing is essential in pockets 4 mm or more with attachment loss to remove and reduce the levels of periodontal bacteria. The thorough removal of both supragingival and subgingival deposits is important to remove niches for microbes, prevent inflammation, and prevent future growth of a mature subgingival biofilm. Ultrasonic scaling offers practical and practicebuilding advantages over manual scaling. Consideration of the advantages, safety and technique-sensitivity of method of scaling is required in selecting one. Given the oral-systemic link, periodontal treatment is important to help systemic health and the patient’s quality of life. Introduction/Overview The prevention of periodontal disease is a key factor in oral health. Over the last decade, as research into the oral-systemic link has continued, it has also become evident that periodontal health is associated with systemic health, and conversely that periodontal disease is associated with systemic disease. Periodontal disease is an inflammatory process involving the periodontal soft tissues and alveolar bone. The initiation of periodontal disease depends on the presence of a mature subgingival biofilm (plaque) rich in gram-negative periodontal bacteria. The inflammatory process begins with reversible gingivitis. Over a period of several weeks, the nature of the biofilm changes and the disease changes to one that is irreversible without clinical intervention. The progression of periodontal disease relies on host susceptibility and response. As periodontal disease progresses, clinical attachment loss (CAL) and bone loss occur, resulting in periodontal pockets of increasing depth and complexity if left untreated, ultimately leading to tooth loss. Periodontal disease progresses episodically. The inflammatory process is associated with the release of immune modulators and chemical mediators. Their release occurs when oral bacteria and lipopolysaccharides bind to macrophages and monocytes. Neutrophils, lymphocytes, and macrophages all play a role.1 Chemical mediators involved in the disease process include prostaglandins and cytokines, including interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF), and interleukin-6 (IL-6).2 These chemicals also act as stimulators for liver production of C-reactive protein (CRP). While chemical mediators are part of a protective function, they also result in destruction. The oral-systemic link Periodontal disease is linked to specific systemic diseases including cardiovascular disease (CVD), respiratory disease, renal disease, osteoporosis, and pulmonary disease. In CVD, the same chemical mediators associated with periodontal disease influence CVD. Elevated levels of CRP result in an increased risk of heart attack.3 Interleukin produces fibrinogen — also associated with thrombus formation;4 TNFis associated with triglyceride production, high levels of which are also associated with CVD; IL-1 receptor antagonist has been found inside atherosclerotic plaques5; oral bacteria are also found in the bloodstream as well as in cardiac plaques. Patients with severe periodontitis may have twice the risk for CVD, and an increased risk for stroke.7 CRP has also been linked to reduced renal function,8 and antibodies to periodontopathogens have been found to be linked to kidney disease and have been identified in the bloodstream.9 Preterm lowbirth-weight babies are also associated with the presence of periodontal bacteria in expectant mothers.10 Clinical treatment of periodontal disease is essential for oral and systemic health. Treating periodontal disease has been found to result in improvements in systemic health markers and conditions. Following periodontal treatment, while CRP levels initially increase they later decline;11 endothelial function may improve six months after periodontal therapy.12 In addition, performing scaling and root planing in pregnant women may reduce the number of preterm births,13 and treating periodontal disease helps improve glycemic control in diabetics.14 Given the oral-systemic link and the associations of periodontal disease and health with systemic disease and health, appropriate treatment of periodontal disease is doubly important. Reducing the presence of periodontopathic bacteria is essential for health. Scaling and Root Planing Nonsurgical scaling and root planing is the standard of care for periodontitis. Its goals are to remove the biofilm, periodontal bacteria, toxins, calculus, and debris from the full circumference of exposed surfaces of the teeth supraand subgingivally. It is important that the bases of pockets be debrided, particularly since periodontal bacteria concentrate more in the depths of pockets.15 Furcations must be thoroughly debrided — furcation involvement is a factor in poor periodontal treatment outcomes, making their thorough debridement and treatment imperative. If calculus remains on the root surface, this acts as a site on to which bacteria can adhere and a mature