In the realm of dentistry, periodontal practices play a pivotal role in not only bestowing patients with bright smiles but also safeguarding their overall oral health.

Effective periodontal care is an ongoing journey, intricately woven through distinct phases. I have found that sequencing these phases of care is essential to ensure predictable success – namely dental health, excellent esthetics, and patients who are raving fans. I have identified 5 essential phases of care. Let’s dive in.

Phase 1: Elimination of Pain

At the outset of periodontal therapy, the primary objective is to eliminate any prevailing pain the patient might be experiencing. This is crucial. The elimination of pain is not a comprehensive treatment. It is emergency care. However, it is a necessary beginning to establish a trusting relationship with our patients. The elimination of pain serves as a significant positive emotional event for our patients. There can be no greater gift than eliminating a patient’s discomfort, especially when they are fearful and anxious. This positive first step mitigates fear and helps to establish trust. 

Phase 2: Disease Control

Following the relief from pain, the focal point shifts towards eliminating active disease. This involves a comprehensive evaluation of the patient's oral health, identifying the underlying issues, and formulating a tailored treatment plan. A myriad of ailments such as caries, periodontal disease, endodontic abscesses, and bone infections need to be addressed before we embark upon comprehensive treatment. The objective is to halt the progression of the disease through interventions such as caries control, scaling and root planning, antibiotic therapy, or endodontics, thereby creating a stable foundation for subsequent treatments. Following this phase of care, general oral health has been achieved and the patient is ready to embark upon the next phase.

Phase 3: Functional Rehabilitation

Once disease is under control, we focus on functional rehabilitation - a segment that often echoes as the quintessence of dentistry for many. Encompassing a spectrum of treatments, from the installation of new crowns to bone regeneration, orthodontic care, and the placement of dental implants, this phase manifests as the rejuvenation period for overall oral health. It is a comprehensive multidisciplinary venture where both restorative dentistry and regeneration of hard and soft tissue take center stage, all aiming to restore optimum function.

Phase 4: Esthetics

Following the restoration of functionality, the spotlight turns towards esthetics. While the desire for esthetics improvement is understood, it is vital to underline that this phase takes precedence only after establishing a sound healthy baseline, thus ensuring that beauty and health go hand in hand. Additional treatments in this phase may include teeth whitening, veneers, esthetic crown lengthening, and various other procedures designed to improve the patient’s esthetics resulting in an increased self-esteem.

Phase 5: Maintenance

The final and the most critical phase is maintenance. The maintenance phase is where the periodontal practice ensures the longevity of the treatments rendered in the previous stages. Instituted to safeguard the gains achieved, this phase promises long-term health and wellness. I strongly recommend that all our patients practice excellent plaque control and commit to a routine maintenance schedule, usually every 3-4 months depending upon their propensity to disease. Maintenance is a collaborative effort, where patients need to adopt a stringent home-care regimen, coupled with regular hygiene visits to ensure continued health and prevent a recurrence... Unfortunately, less than 20% of our patients follow our advice, which oftentimes leads to a recurrence of disease.

Following these sequential goals of therapy serves as a template for ideal care. I review all five of these goals with each patient at their initial examination. I stress the importance of long-term maintenance if they are to maintain their healthy beautiful smiles. Despite my strong recommendations, few patients follow my advice. I am not discouraged. I do not lose hope. I continue to encourage the people I serve to do the things that will prevent them from returning to my surgical chair. To paraphrase, Coach Tom Landry, of the Dallas Cowboys, “The job of a dental coach is to make our patients do what they don't want to do in order to achieve the health they always wanted to have.”