The non-surgical treatment of patients with periodontal disease:
Walter J. Loesche, DMD, PhD
In a previous study involving patients at the dental clinic
of the
Detroit Receiving Hospital,87% of teeth that initially had
been
recommended for surgery or extraction were spared either treatment
through a combination of debridement and short-term usage of
antimicrobial agents. The object of the present study was to
determine what changes occurred to these teeth after 6.4 years
in the
maintenance phase of treatment.
Patients were scheduled for maintenance therapy at three-month
intervals over a period of 6.4 years. They were evaluated "
annually" (that is, the patients were scheduled for annual
visits)
for surgical needs by a clinician who was not aware of the
treatment
received by the patients. Multivariate statistical models were
used to
determine which variables predicted subsequent surgical needs.
The initial treatment benefits were sustained, as the majority
of
patients showed no increase in surgical needs after 6.4 years.
When
relapse occurred, those who were smoking when the study began
and an
increased number of sessions of debridement were predictors.
Surgical
needs were reduced when metronidazole was dispensed after the
first
and second annual examinations.
Aggressive home care and maintenance CAN keep advanced periodontal
cases under control. We have more than a few cases that
have had minimal breakdown going well into a second decade
of monitoring. It requires a consistent effort at home
care, and going with recommended clinical care. We have
had cases where teeth had been considered "unsalvageable" by
specialists and are still functioning 14 years later.- DFB
