Periodontitis
Patients with a diagnosis of periodontitis
In patients with a diagnosis of periodontitis who have completed a course of active therapy, long-term care (also known as the Fourth step of therapy and Maintenance) involves supportive periodontal care provided in the dental clinic, along with the patient’s ongoing homecare regime and control of risk factors. It aims to maintain periodontal stability, prevent disease recurrence and, if disease does recur, recognise it early and intervene to limit tissue damage (see figure: Long-term care). It combines aspects of monitoring, prevention and treatment and is an active process of re-assessment and re-treatment, where required.
Before entering a maintenance programme, it is important that patients with periodontitis understand the nature and purpose of maintenance and are aware of the signs and symptoms of gingivitis or periodontitis which might indicate the need for further active treatment.
Images taken A: at baseline and B: at 5 years for a patient with Stage IV periodontitis and an extensively restored dentition on a programme of regular maintenance. While the periodontal disease was not completely stable at 5 years, bone infill had occurred around the lower anterior teeth, and inflammation was controlled.
Sufficient time is required at each recall appointment to carry out examination and supportive care effectively, and patients who have previously received active treatment for periodontitis will likely require longer and more frequent appointments than those receiving care focussing on primary prevention of disease.