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PerioFrogz: Research Summaries and Implementation Strategies

The objective of PerioFrogz is to help dental professionals stay current with on-going research; facilitate integration of research findings into daily practice, ultimately elevating the level of patient care.

“Risk Factors for Periodontal Disease and the Management of those Risk Factors”

PerioFrogz Issue No.: 0609

April Edition 1

The focus of this issue of PerioFrogz is risk factors for periodontal disease and the management of them by dental providers and patients is. The information was compiled from a variety of sources rather than a single journal article, including interviews and published works by leading clinicians, researchers and dental educators including; Dr. Larry Sweeting, Dr. Maria Ryan, Dr. Laura Minsk and the JP Institute.

Summary of research:

Heredity
Smoking
Diabetes
Stress
Medication
Nutrition
Poor Oral Hygiene
Faulty Dentistry
Hormonal Variations
Immunocompromise
Connective tissue diseases
Previous history of active perio disease

Summary:

Risk factors such as diabetes and smoking are far more potent than others such as faulty dental work and missed hygiene appointments.
All risk factors are not created equal.
More risk factors increase likelihood and severity of periodontal disease exponentially.
Risk assessment and modification is essential prior to and throughout active periodontal therapy and during periodontal maintenance.

Key take-away

The primary role of all dental providers is risk reduction!
As dentists and hygienists, we are identifying and modifying risk factors for periodontal disease even if we don’t recognize it as such. For example, home care instructions are an attempt to modify the risk factor and behavior of poor oral hygiene for the development of perio disease. Smoking cessation and dietary counseling we routinely provide also constitutes risk factor & behavior modification.

A significant risk factor for periodontal disease can be faulty dentistry. The RDH and the RDA have an exceptional opportunity with each patient, restorative or recare, to determine the patient’s level of risk relative to their existing dentistry. This discussion can take place prior to the doctor exam in order to plant seeds for potential restorative needs.
All risk factors are not created equal.
Diabetes and smoking are the biggest risk factors for gum disease development, increased severity and the speed at which it occurs. The #1 systemic condition increasing susceptibility to periodontal disease is diabetes.
Multiple risk factors do not increase the risk in an additive manner, but rather in an exponential manner.
A patient with 3 risk factors such as diabetes, poor oral hygiene and smoking is not 3 times more likely to develop gum disease than a patient without these risk factors; they are approximately 27 times more likely for gum disease to occur or worsen rapidly. When we provide perio treatment and behavior modification, we reduce the risks for gum disease in an exponential manner as well.
Identifying and modifying risk factors prior to and throughout active periodontal therapy and during periodontal maintenance will be critical to successful treatment outcomes and maintaining long term periodontal health.
Ongoing management of risk factors and behavior management should be part of every therapy and maintenance appointment. Clinicians should engage in open dialogue with their patients to facilitate appropriate referrals to other health care providers, such as nutritionists, heart specialists & smoking cessation.

Implementation strategies:

During patient education, health history & risk assessment the clinician should be sure to include:

The concept that when known risk factors for gum disease are reduced the risk of gum disease is also reduced. For example if the patient has 3 risk factors as noted above and one is eliminated, the risk of gum disease goes from 27 times more likely to 9 times more likely to develop or worsen.
Consideration of using the Periodontal Susceptibility Test (PST), to determine if the patient is genotype positive for periodontal disease. This is significant especially for those patients with a family history of gum disease and dentures.
The fact that nutritional considerations and increased stress are risk factors which have a suppressive effect on the immune system.
The importance of noting medication changes potentially increasing the patients’ perio disease risk due to xerostomia.

The clinician should modify treatment recommendations:

Regarding Perio Maintenance, PM-4910, the suggested frequency to maintain disease remission is 2-3 months, essentially, 8-12 weeks. The JP Institute has recognized that there is increased patient compliance when the interval between PM visits is in weeks rather than months. As the patient sustains their disease remission, the interval can be extended one week at a time so as not to bypass the balance point or biofilm threshold.
Regarding Adult Prophylaxis or Continuing Care, CC-1110, the suggested frequency is typically 6 months as long as disease is being prevented. However, those CC patients ‘at risk’ for gum disease due to genetics or medical/systemic issues should be seen somewhere between 12 and 16 weeks, once again to ensure disease prevention.