Nonsurgical Periodontal Therapy: a Review of Current Standards of Care and Innovations to Improve Gingival and Periodontal Health
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Purpose of Review
Regular home care delivered by patients as well as professional mechanical debridement is a cornerstone of periodontal and peri-implant health. This report will examine current therapies for nonsurgical periodontal and peri-implant diseases, including oral hygiene measures and behavioral modification, scaling and root planing, adjunctive systemic and local antibiotic therapy, and novel pharmacologic and physical adjunctive treatments.
Periodontitis is a highly prevalent, destructive disease and has been estimated to result in $54 billion of lost productivity yearly worldwide. Additionally, it is estimated that up to 5 million dental implants are placed each year and, with the increasing number of implants comes increasing numbers of cases of peri-implant mucositis and peri-implantitis. Nonsurgical therapy is the first line of treatment and long-term prevention for both of these conditions. Mechanical therapy requires a high level of operator skill and an understanding of expected results and the modifiers which may affect treatment outcomes. Proper patient selection, patient compliance, and assessment of optimal treatment options are required for successful results of therapy. Adjunctive therapy in high-risk patients, for example, smokers, may improve treatment outcomes, and care should be taken to select adjunctive therapies based upon their mechanisms of action and the deficits in host defense noted in patients with additional risk factors. Furthermore, long-term maintenance and surveillance of disease recurrence are necessary in the management of these chronic diseases.
Nonsurgical therapy is a cost-effective intervention to address periodontal diseases, and patients with select risk factors may receive additional benefit when adjunctive therapies are employed during this phase of treatment.
KeywordsPeriodontal diseases Periodontitis Oral health Oral hygiene Gingivitis Nonsurgical therapy
The authors would like to thank Ms. Elizabeth Bolton for her assistance with this manuscript.
Compliance with Ethical Standards
Conflict of Interest
Dr. Geisinger reports her role as Vice Chair of the American Dental Association’s Council on Scientific Affairs and Chair of the ADA Seal Subcommittee, reviewing the safety and efficacy of over-the-counter patient-delivered products for dental health and oral hygiene.
Maninder Kaur and Hussein Basma each declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.• Eke PI, Thorton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National Health and Nutrition Examination Survey 2009–2014. J Dent Res. 2018;149(7):576–88. This work describes the updated prevalence data for periodontitis and periodontal findings in adults based upon the NHANES III data from 2009 to 2014. As periodontitis is the most common oral disease in the US adult population, readers should be aware of its most recent prevalence numbers. Google Scholar
- 2.• Mombelli A. Microbial colonization of the periodontal pocket and its significance for periodontal therapy. Periodontol 2000. 2018;76(1):85–96. This work reviews the microbial etiology of periodontitis and the over 700 bacterial species and 1500 putative periodontal pathogens present in the oral cavity that may contribute to periodontal disease. The complex microbial interactions described in this review article are of critical importance as a rationale for all nonsurgical therapy to treat periodontal diseases. CrossRefPubMedGoogle Scholar
- 9.Straub AM, Salvi GE, Lang NP: Supragingival plaque formation in the human dentition. Lang NP, Attstrom R, Loe H. Proceedings of the European workshop on Mechanical Plaque Control. 1998; Quintessence, Chicago.Google Scholar
- 10.American Dental Association: Brushing your Teeth. Available at: https://www.mouthhealthy.org/en/az-topics/b/brushing-your-teeth Accessed April 12, 2019.
- 21.• Woelber JP, Spann-Algoe N, Hanna G, et al. Training of dental professionals in motivational interviewing can heighten interdental cleaning self-efficacy in periodontal patients. Fron Psychol. 2016;7:254. Behavior modification and improved patient-delivered oral home care are critical to the success of periodontal therapy and the long-term maintenance of results. This report discusses strategies that dental professionals can employ to improve patient outcomes and increase motivation for oral hygiene measures. Google Scholar
- 24.Kazmierczak M, Mather M, Ciancio S, et al. A clinical evaluation of anticalculus dentifrices. J Clin Prev Dent. 1990;12:13.Google Scholar
- 25.Department of Health and Human Services. Food and Drug Administration. Federal Register. May 23, 2009 www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Over-the-CounterOTCDrugs/StatusofOTCRulemakings/ucm096081.pdf Accessed April 12, 2019.
- 27.Centers for Disease Control and Prevention. National Biomonitoring Program. Factsheet: Triclosan. www.cdc.gov/biomonitoring/Triclosan_FactSheet.html Accessed April 12, 2019.
- 28.United States Environmental Protection Agency. Report of the Cancer Assessment Review Committee (CARC). Triclosan. January 8, 2008. www3.epa.gov/pesticides/chem_search/cleared_reviews/csr_PC-054901_4-Jan-08_a.pdf Accessed April 12, 2019.
- 35.• Brooks JK, Bashirelahi N, Reynolds MA. Charcoal and charcoal-based dentifrices: a literature review. J Am Dent Assoc. 2017;148:661–7. Charcoal is currently a very common additional ingredient in dentifrice. This systematic review assesses the current evidence regarding the safety and efficacy of such charcoal-containing dentifrices and finds that they may have high levels of abrasivity and the inclusion of charcoal may limit the availability of fluoride in such dentifrices.CrossRefPubMedGoogle Scholar
- 44.• Yaacob M, Worthington HV, Deacon SA, et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014;6:CD002281. This systematic review and meta-analysis reports updated information summarizing randomized controlled trial findings that mechanical toothbrushing reduces plaque and gingival bleeding in short (0–3 months) and long-term (> 6 months) use intervals. For patients who are unable to achieve adequate plaque control with a manual toothbrush, use of a powered toothbrush may aid them in successful oral hygiene measures and reduce periodontal inflammation and disease progression. Google Scholar
- 49.Stambaugh RV, Dragoo M, Smith DM, Carasali L. The limits of subgingival scaling. Int J Periodont Res Dent. 1981;1(5):30–41.Google Scholar
- 55.• Fang H, Han M, Li Q-L. et al.Comparison of full-mouth disinfection and quadrant-wise scaling in the treatment of adult chronic periodontitis: a systematic review and meta-analysis. J Periodont Res. 2016;51:417–30. This meta-analysis assessed the advantages of full-mouth disinfection versus quadrant-wise ScRP. While statistically significant reduction in periodontal clinical parameters was seen, these reductions may not be clinically significant for all patients. In patients with more rapid periodontal destruction and/or more virulent periodontal pathogens, full-mouth disinfection may offer an advantage. Google Scholar
- 61.Kurggan S, Önder C, Blaci N, Fentoglu Ö, Eser F, Balseven M, et al. Gingival crevicular fluid tissue/blood vessel-type plasminogen activator and plasminogen activator inhibitor-2 levels in patients with rheumatoid arthritis: effects of nonsurgical periodontal therapy. J Periodontal Res. 2017;52(3):574–81.CrossRefGoogle Scholar
- 62.Heitz-Mayfield LJA, Lang NP. Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts. Periodontol 2000. 2019;79:218–31.Google Scholar
- 64.• Sabharwal A, Gomes-Filho IS, Stellrecht E, Scannapieco FA. Role of periodontal therapy in management of common complex systemic diseases and conditions; an update. Periodontol 2000. 2018;78:212–26. This work describes a systematic review of literature from 2010 to 2018 evaluating current strength of evidence of periodontal treatment and its effects on various systemic conditions and diseases. There is moderate evidence in patients with diabetes mellitus and respiratory diseases that periodontal therapy may improve long-term medical outcomes. CrossRefPubMedGoogle Scholar
- 66.Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: consensus report of workgroup 2 of the 2107 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.Google Scholar
- 86.Umrania VV, Rao Deepika PC, Kulkarni M. Evaluation of dietary supplementation of omega-3 polyunsaturated fatty acids as an adjunct to scaling and root planing on salivary interleukin-1β levels in patients with chronic periodontitis: a clinico-immunological study. J Indian Soc Periodontol. 2017;21(5):386–90.PubMedPubMedCentralGoogle Scholar
- 87.Nevins M, Kim S-W, Camelo M, Martin IS, Kim D, Nevins M. A prospective 9-month human clinical evaluation of laser-assisted new attachment procedure (LANAP) therapy. Int J Periodont Res Dent. 2014;34(1):20–7.Google Scholar
- 88.Nevins M, Camelo M, Schupbach P, Kim S-W, Kim DM, Nevins M. Human clinical and histological evaluation of laser-assisted new attachment procedure. Int J Periodont Res Dent. 2012;32(5):496–507.Google Scholar
- 89.Harris DM, Nicholson DM, McCarthy D, Yukna RA, et al. Change in clinical indices following laser or scalpel treatment for periodontitis: a split-mouth, randomized, multi-center trial. SPIE BiOS, 2014, Proceedings in Lasers in Dentistry Vol 8929: 8929OG(2014).Google Scholar
- 94.De Melo Soares MS, D’Almeida Borges C, de Mendonca Invernici M, et al. Antimicrobial photodynamic therapy as adjunct to non-surgical periodontal treatment in smokers: a randomized clinical trial. Clin Oral Investig 2018 Nov 3. [Epub ahead of print] https://doi.org/10.1007/s00784-018-2740-3.
- 98.Sgolastra F, Petrucci A, Gatto R, Monaco A. Effectiveness of systemic amoxicillin/metronidazole as an adjunctive therapy to full-mouth scaling and root planing in the treatment of aggressive periodontitis: a systematic review and meta-analysis. J Periodontol. 2012;83:731–43.CrossRefPubMedGoogle Scholar
- 101.Cosgarea R, Heumann C, Juncar R, Tristiu R, Lascu L, Salvi GE, et al. One year results of a randomized controlled clinical study evaluating the effects of non-surgical periodontal therapy of chronic periodontitis in conjunction with three or seven days systemic administration of amoxicillin/metronidazole. PLoS One. 2017;12(6):e0179592.CrossRefPubMedPubMedCentralGoogle Scholar
- 104.• Smiley CJ, Tracy SL, Abt E, et al. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc. 2015;146(7):525–35. This work outlines practice guidelines for the most effective use of adjunctive therapies with scaling and root planing.CrossRefPubMedGoogle Scholar
- 114.Petit C, Batol F, Bugueno IM, Schwinte P, Benkirane-Jessel N, Huck O. Contribution of Statins towards periodontal treatment: a review. Med Inflamm 2019; 27; 2019: 6367402 doi: https://doi.org/10.1155/2019/6367402. eCollection 2019.