Establishing New Treatment Objectives for Periodontal Disease

The principles of leadership that drive achievement have the practitioner state the objectives prior to initiating an action plan. Success is more certain and predictable, while any short falls become measurable and remedies are tied to the metrics of the initial objectives.

The traditional treatment objectives for periodontal therapy have revolved around certain soft and hard tissue architectural end points and bleeding on probing. These standards have been in place for about 100 years and are still embraced by the majority of mainstream dentistry. New evidence in the past decade and the availability of DNA based pathogen testing are reshaping how periodontal disease can be more effectively managed and treated, including the systemic ramifications of its high-risk pathogens. The older methodology will never be irrelevant, but more recent knowledge may in fact now be more relevant and have a higher priority as practitioners develop treatment plans to mitigate periodontitis.

Periodontal disease is a polymicrobial infectious systemic inflammatory disease with specific genetic expressions. This local and systemic bacterial disease is best managed utilizing the medical model for treating an infectious bacterial disorder. Targeting and mitigating specific microbes found in the host that are perpetuating the progression of the disease, and breakdown and dysfunction of all susceptible tissues that attract its causal pathogens.

Treatment plan objectives can be established that reflect current evidence, stabilize local tissues, and mitigate the systemic impact of high-risk pathogens. The following is a list of periodontal disease treatment objectives that are all essential to take into consideration as dentistry works to better take action against the most prolific bacterial based disease in America:

  • Stop the local breakdown of soft and hard tissues by specific pathogen reduction or elimination
  • Create a local environment that will facilitate regeneration
  • Reduce or mitigate systemic high-risk periodontal pathogens
  • Reduce local and systemic levels of inflammation
  • Create a local and systemic environment for the host immune system to function more optimally
  • Account for and consider high-risk pathogens in translocated microbiomes and biofilms
  • Account for and consider persistent high-risk pathogens in the dormant microbiome
  • Create a simplified post therapy compliance model for each patient

Practicing dentistry from an oral-systemic perspective with newly aligned treatment objectives, allows caregivers the ability to envision new standards of care, and patients to experience new degrees of wellness.

Extraordinary Practice expands on this course objective. Even though, this is a simple but relevant perspective on ‘treating periodontitis’. We take time in our training process to have the audience rethink the traditional objectives we have taken for granted over the years and re-articulate new objectives based on the evidence we have just reviewed.

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John Kempton DDS