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State Of The Art
Periodontal
Treatment
Why do I need treatment?
 Periodontal infection is a chronic disease that can have
periods of no signs of disease activity and periods of
disease progression.
Some factors that can speed-up your periodontal disease
are: Lack of regular dental cleanings, poor oral hygiene,
dental plaque, smoking, genetic factors, stress, pregnancy,
diet, illness and medications.
It is likely that you have been referred to Dr Hoffmeyer
because your general dentist has noticed an increase in
infection activity that needs to be addressed.
Protecting your periodontal health gives many benefits
such as keeping your dental costs down, feeling a healthy
mouth, smiling and speaking with confidence, eating with
comfort and avoiding a possible contribution to other
medical diseases (cardiovascular, diabetes, pre-term low
birth weight babies, e.t.c.)
How do I prevent periodontal disease?
Remove plaque from your teeth and gums every day by
brushing and flossing.
Regular dental visits are important (interval is commonly
3-6 months, but can vary).
Daily cleaning helps keeping plaque and calculus build-up
to a minimum, but it will not completely prevent it,
especially if the build-up is under the gum-line or in areas
difficult to access.
Therefore you need to have your teeth
cleaned professionally.
 A regular periodontal evaluation is very important. This
is done using a small measuring instrument (probe) gently
placed between your tooth and gum to measure the depth of
the pocket. Several other measurements may be necessary as
well.
Dr. Hoffmeyer will be very gentle when performing this
evaluation.
Please feel free to ask questions at your
visits.
Dr. Hoffmeyer finds great professional satisfaction in
helping you, but keep in mind that the results depend on
your optimal participation and corporation.
Is Periodontal
Disease Treatable?
Yes! Periodontal disease is treatable. Periodontal disease
will not go away by itself.
Periodontal health should be
achieved in the least invasive and most cost-effective
manner.
The mild stage is often treated through
non-surgical treatments (“deep cleaning”).
The advanced stage is often treated with a
combination of non-surgical and surgical treatment. The
purpose of surgery is to gain visible access to deep
pockets, remove calculus, shrink the pockets and repair
tooth and bone defects if possible. This makes future
maintenance and prognosis better.
The extremely advanced stage with severely loose
teeth is treated with extraction and placement of implants
or other restorative solutions.
A periodontist is trained to deal with many varieties of
gum disease.
The goal is to help you achieve a good oral
health and help you maintain it.
Periodontal examination
 Dr. Hoffmeyer will discuss your chief complaint, review
your medical and dental history, perform a comprehensive
clinical examination, a digital x-ray evaluation and propose
treatment options. In some cases additional diagnostic tests
may be performed.
It is very important that you fill out your medical history
form as accurately as possible, prior to your consultation.
Prophylaxis • professional cleaning
A prophylaxis is a scaling and polishing procedure
performed to remove plaque, calculus and stains by various
foods, beverages and tobacco.
Scaling and Root planing • “Deep-Cleaning”
This is a cleaning of the root surfaces to remove plaque
and calculus from deep pockets and to smooth the tooth root
to remove bacterial toxins.
It is done with ultrasonics and
hand-scalers.
It is a “deeper cleaning” than the routine
prophylaxis cleaning.
The procedure requires more time and
often more than one visit.
A local anesthetic will be
offered to reduce any discomfort.
This treatment reduces
gingival inflammation.
Patients with mild disease
most often do not require a following surgical therapy.
After this therapy Dr. Hoffmeyer will perform a
re-evaluation exam and discuss the outcome, prognosis and
possible need for further treatment.
When pockets are
greater than 3-4 mm additional treatment may be needed.
Systemic antibiotics
It has been difficult to reach high enough levels of
antibiotic by pill or injection to kill all periodontal
microbes without undesirable side effects.
In very few
cases, antibiotic pills are prescribed at the time of
scaling and root planning.
This is never given routinely
since you increase your chance of developing drug resistant
bacteria.
Local delivery antimicrobials • host modulators
 In general these drugs do not lead to antibiotic
resistance.
Local delivery antimicrobials are antibiotic agents
(Tetracycline, Minocycline or Metronidazole) that are
released into the pocket over time.
This produces a very
high level of medicine for the affected area but an
extremely low dose for the rest of the body, clearly
eliminating the risk of side effects.
Host modulators are pills containing anti-inflammatory
drugs (NSAID) or sub-antimicrobial antibiotics (do not
contain a high-enough concentration to kill the bacteria,
but helps offset the body’s response to the bacteria).
They
can fight the breakdown of gum and bone caused by
periodontal microbes before reaching the dosage level
required to kill the same microbes.
Enzymes causing the bone
breakdown are controlled.
This allows long term use of the
pills without the side effects seen at the higher dosages.
Checking your occlusion • jaw relationship • bite
 When upper and lower teeth are not in harmony, this may
participate in causing damage to your teeth and supporting
bone.
A slight adjustment of your teeth or an occlusal night
guard may be recommended and performed by Dr. Hoffmeyer.
PERIODONTAL SURGERY
Around 4-6 weeks after your first scaling and root
planing, your re-evaluation exam will determine the outcome
of initial treatment.
If there are still pathological (deep)
pockets that need further treatment, local surgery can
remove any remaining infection and decrease pocket depths to
reduce your risk for disease in the future.
Periodontal Maintenance Procedure • Supportive Periodontal
Therapy
When re-evaluation exam reveals non-pathological or
non-treatable pockets you will enter into a maintenance
phase.
This is a thorough cleaning about every 3 months
(varies from 1-6 months) in order to help you protect your
teeth and gums from relapse of periodontal disease.
Depending on the prognosis of your periodontal condition,
this maintenance phase may be performed alternating between
Dr. Hoffmeyer and your referring dentist or hygienist (a
licensed professional who performs professional cleaning in
the dental office and provides education in proper care of
the teeth and gums).
This treatment with Dr. Hoffmeyer is
different from traditional six-month dental exams with you
general dentist, who helps you check and maintain your
teeth.
Please notify Dr. Hoffmeyer of any medical and dental
changes since your last visit.
 At this visit you will receive a comprehensive assessment of
your pocket depths, attachment of your teeth, bone and gums,
oral cancer screening and possible x-rays to evaluate the
bone.
Bacterial plaque and calculus are removed and if
necessary non-surgical root planning is performed to smooth
infected root surfaces.
Your oral hygiene routine is
reviewed and possibly modified to fit your current
periodontal condition.
Any new or recurring periodontal
disease will be treated or treatment planned with you.
Remember periodontal disease is a chronic disease and
early diagnosis and immediate treatment is preferable for a
god prognosis.
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