Mainstream Treatment

What is the mainstream treatment protocol?

There are several approaches, but generally speaking, one can divide these treatments into:

1. Non surgical (also called closed field curettage, or root scaling and planning, or ‘deep cleaning’)

2. Surgical (open field) - creating a ‘flap’ by cutting the gum and peeling it loose.

The main problem with the mainstream approach is that the treatment is done in sessions (usually 4).

When the bacterial DNA tests became available, we were curious to know how many bacteria we can remove. We performed a DNA test immediately before and after treatment. The results showed we had removed 99% of the bacteria.

This is very good, even impressive, but think about it, if you only treat one fourth of the mouth in a session, you actually leave 75% of the bacteria, even if you remove all bacteria in that one sector!

The bacteria move around with our saliva, and re-infect the area we have just treated. This means that if the other sectors which were not treated have very high bacterial counts, it will not be long before the one sector, which has been treated, is re-infected.

This has been demonstrated over a ten year period at the university of Leuven (Belgium) by the team of professor Quirynen. They took a group of patients who needed periodontal treatment because of bleeding gums, pockets, bone loss etc. This group was split into two groups, one group was treated in four sessions, each session about a week apart. The second group had the whole mouth treated within a 24 hour period. The group who had the full mouth treated within 24 hours, had much better results than the standard protocol ‘four weekly sessions’ group.

So this is a major factor, regardless if the treatment was surgical or not.

Now let us take a closer look at the surgical treatment: it involves cutting the gum, ‘flapping’ it (this means peeling it loose), root scaling, planning, osteoplasty (remodelling the bone where needed), removal of excessive wound healing tissue (also called granulation tissue).

A major drawback of any surgery is obviously the post operative pain and discomfort. With surgery, there is no way the whole mouth can be treated in one session. So the re-infection happens again. Also few people have the courage te endure four weeks in pain.

On top of all this, the gums, which are usually already retracted to begin with, retract even more as a result of the surgery. As the gums retract, obviously the pockets get shallower, but the aesthetics are impaired. The extra exposure of the root can also give extra sensitivity.

A major problem with all these treatments is that there is a high rate of relapse. The main reason for this may be that after the deep cleaning of the pockets (with re-infection from opposite sides later on) the gums re-adhere at the margin first, locking in the remaining bacteria lower down. This creates a hidden chronic infection lower down, waiting for a dip in the immune system to flare up. When this dip comes, because of stress or any other factors, this flare-up means a new acute phase, so the gum is again detached, and a new pocket opened.