What are the desired endpoints after periodontal treatment?
PD Dr. Kristina Bertl, PhD MSc MBA
In addition to evaluating treatment methods, the following topic was also discussed at the Perio Workshop 2019: ‘What are we actually trying to achieve with periodontal treatment – from a practitioner’s perspective, but above all from a patient’s perspective?’
Bruno Loos (ACTA, University in Amsterdam, the Netherlands) and Ian Needleman (Eastman Dental Institute, University in London, England) have addressed this topic and have published a review based on data from 94 publications that is very interesting and worth reading.
Periodontal treatment involves educating patients about oral hygiene, removing biofilm and tartar (if necessary by using adjunctive treatments – see also: Adjunctive therapies in non-surgical periodontal treatment – Part I, Part II, Part III) and/or surgical periodontal treatment. In addition, however, lifestyle factors (e.g. smoking, unhealthy diet, etc.) should be addressed and, if possible, the patient should be encouraged to make positive changes.
But what exactly is the goal of periodontal treatment? We would like to enable the patient to retain their own teeth with no further periodontal loss of attachment. In detail this means:
- Avoiding further episodes of periodontal inflammation
- Reducing and avoiding gingival inflammation
- Reducing and avoiding increased pocket probing depths
- Regaining periodontal attachment
- Preventing tooth loss
- Retaining function of dentition
To express it in numbers: After active periodontal treatment, we would like small pocket probing depths (≤ 4 mm) that do not bleed. The total bleeding index should be < 30%. If this goal is achieved, the evidence tells us that the patient has a very high chance of long-term stability and only a very small risk of tooth loss due to periodontitis.
But what is important from the point of view of our patients? What goals can we use to motivate them? Because, as a rule, patients are not very motivated by things such as low bleeding indices and/or probing depths. Instead, they are motivated by the following:
- Increased quality of life
- Improved appearance/aesthetics
- Less tooth loss
- Improved chewing ability
- Prevention of systemic diseases
- Avoidance of tooth pain
- Avoidance of further active periodontal treatment
In short, even if we have the same objective as our patients, we often define it in different ways – and we should take this into account in our patient communication.
You can find other articles on this topic in the Prophy Community:
- Bruno G Loos, Ian Needleman. Endpoints of Active Periodontal Therapy. J Clin Periodontol. 2020. doi: 10.1111/jcpe.13253.