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Prophy and periodontal maintenance
By Richard H. Nagelberg, DDS
Prophy and periodontal maintenance are very different procedures for very different patient types that should be thoroughly understood so the appropriate procedure is provided. Failure to do so can prevent optimal treatment outcomes and reduce the longevity of favorable results.
What is a prophy? It is a non-therapeutic procedure for the maintenance of a healthy mouth. Prophy is only provided for patients without periodontitis. It is primarily a supragingival procedure and is provided at six-month intervals.
Periodontal maintenance (PM) is distinctly different than prophy and is most commonly utilized for patients who have had active perio treatment. It is ongoing treatment for periodontitis, which is a chronic and non-curable bacterial infection. The objective of PM is to keep the disease under control. Any type of periodontal treatment is ineffective in the long term without an effective PM regimen.* Periodontal maintenance is provided every three months.
The rationale for three-month maintenance intervals is not arbitrary; it is based on a sound bacterial rationale. When biofilm is not eliminated, or adequately disrupted, periodontal pathogens aggregate on the biofilm and become the predominant species of bacteria in three to 12 weeks. This means that at the outer limit of this time period, 12 weeks, which is obviously three months, the perio bugs are flourishing. That’s when we want to reduce their numbers, not one month later or three months later.
Research has shown that patients who undergo active perio treatment of any kind, surgical or non-surgical, and do not have periodontal maintenance at the appropriate interval lose two to three times more teeth and have active perio therapy twice as often as those having maintenance.*
Alternating periodontal maintenance and prophys at three-month intervals is inappropriate because the prophys are non-therapeutic and supragingival. This regimen has the same net clinical effect as the perio patient who presents for maintenance every six months. The longevity of favorable perio treatment outcomes is dependent on two factors: the effectiveness of daily biofilm control through home care and patients presenting for maintenance every three months. Patients treated with alternating PM and prophys will not have the same longevity of favorable therapeutic results compared to perio patients having PM every three months.
Understanding the difference between these two procedures and applying them properly will enhance the care we provide for our patients, and that is what it is always about.
Shumaker ND, et al. Periodontal and peri-implant maintenance: a critical factor in long-term treatment success. Compendium Sept. 2009; 30(7):388-406.
About the Author:
Dr. Richard Nagelberg has been practicing general dentistry in suburban Philadelphia for more than 27 years. He has international practice experience, having provided dental services in Thailand, Cambodia, and Canada. Dr. Nagelberg has served on many boards and advisory panels. He is co-founder of PerioFrogz, an information services company, and is a speaker, clinical consultant, and key opinion leader for several dental companies and organizations. He is also a recipient of Dentistry Today’s Top Clinicians in CE, 2009. A respected member of the dental community, Dr. Nagelberg lectures extensively around the country on a variety of topics centered on understanding the impact dental professionals have, beyond the oral cavity.