A Dental Hygienists Guide to Treating Oral Inflammation
September 26, 2023
Periodontal disease is a prevalent oral health issue that affects millions of people worldwide. If left untreated, it can lead to tooth loss and other systemic health problems.
In the battle to conquer this disease process, dental professionals employ various techniques and tools to provide effective treatment. One service that has revolutionized treatment of oral inflammation and one that has a significant result in our total health and well being is use of the soft tissue diode laser.
In this blog, we will explore how diode lasers are used in the treatment of periodontal disease, their effectiveness in targeting aerobic cells, and the ability to boost cellular mitochondria.
This blog will also explain the hygienist’s responsibility to determine health or disease in the oral cavity, how to sequence appointments when a patient has various levels of gingival inflammation and you will learn about the benefits of using soft tissue diode lasers.
At the end of reading this blog you will have information to help your patients better understand the importance of optimal oral health and how this will help them live a longer, healthier life!
Diagnosis of Gingivitis and Periodontitis:
The journey towards treating periodontal disease begins with a comprehensive examination of the oral cavity and a diagnosis. When your patient is seated in the chair for a dental hygiene preventive care appointment it’s imperative for the dental hygienist to evaluate for any abnormalities.
An annual comprehensive periodontal examination (CPE) must be performed at the beginning of a dental hygiene appointment to determine if the patient has active periodontal (“gum”) disease: Gingivitis or Periodontitis. Our goal is to determine optimal oral health.
When the dental hygienist recognizes generalized moderate to severe gingival inflammation, with or without radiographic bone loss, the hygienist and dentist will make a diagnosis for treatment of gingivitis or periodontitis.
When there is a diagnosis of generalized moderate to severe gingivitis or periodontitis, the clinician will properly plan a sequence of appointments to treat the disease which will also include scheduling a 4-6 week re-evaluation, to determine an end-point of the disease.
At the time of a diagnosis and when the patient has active gum disease, a sequence of appointments to treat the disease will be scheduled.
Periodontal Disease Etiology:
Bacterial plaque is the primary etiologic factor associated with periodontitis, yet there are several other variables that may place an individual at risk for developing disease. Two of these variables are clearly defined risk factors: tobacco smoking and diabetes.
Periodontitis is considered the sixth complication of diabetes. Periodontitis and diabetes (DM) have a two-way relationship. DM increases the risk of periodontitis, and severe periodontitis coexists with severe DM.
It’s mandatory for diabetic patients to receive adequate treatment for periodontitis.
The basic treatment modality for periodontitis is scaling and root planing. The conventional periodontal procedure includes scaling and root planing (SRP), which consists of debridement of contaminated root surfaces as well as the elimination of bacteria and their endotoxins from the cementum and from the adjacent periodontal tissues.
Scaling, root planing and curettage procedure creates a long junctional epithelium with no connective tissue attachment.
During the InitialAppointment, the Dental Hygienist Will:
- Conduct a comprehensive oral health assessment with comprehensive periodontal evaluation (CPE). CPE includes measuring pocket depths, assessing bleeding upon probing, recording recession, mucogingival involvement, furcation, occlusal disease, etc.
- Recent full mouth x-rays are used to determine the extent of disease.
- Identify any contributing factors such as tobacco use, medical conditions such as diabetes, high blood pressure, RA, Crohn’s disease, etc, and/or poor oral hygiene habits.
- Formulate an individualized treatment plan tailored to the patients specific needs.
The Role of Soft Tissue Diode Laser
Soft tissue diode lasers have become indispensable in modern dentistry, particularly in treating gingivitis and periodontal disease. Diode lasers emit specific wavelengths of light that are absorbed by pigmented bacteria and inflamed tissues, making them highly effective in eradicating bad cells and promoting healing.
Soft Tissue Diode Laser Therapy
Let’s delve into how the soft tissue diode laser becomes a crucial component in the treatment of oral inflammation. Use of the diode laser targets the bacteria and inflamed tissues in the periodontal pockets.
- Reduction of Inflammation: Diode lasers also promote the reduction of inflamed tissues, creating a more conducive environment for healing.
- Stimulation of Mitochondria: Research suggests that diode laser therapy may stimulate the mitochondria of cells, enhancing their energy production and overall cellular health.
Practice Management/Communication Tip: “What happens inside the mouth transfers through the saliva and blood stream and eventually happens inside the body. Year after year of bleeding gums year after year, can create various systemic diseases such as: heart attack, stroke, high cholesterol, Crohn’s Disease, Parkinson’s Disease, Low Birth Weight Babies, and even Alzheimer’s Disease, etc.”
The enhanced reduction of inflammation induced by laser therapy is also due to the effective bacterial reduction property of diode lasers. In previous research it was demonstrated that diode laser light at 805 nm eliminated Aggregatibacter actinomycetumcomitans and Porphyromonas gingivalis in periodontal pockets.
Lin et al, demonstrated that subgingival treatment with the diode laser effectively inhibited recolonization of A. actinomycetumcomitans for up to 28 days than in root planing.
Note. Read below about the end-point and re-evaluation appointment for more information on the importance of this 4-6 weeks re-evaluation appointment.
Pick et al. showed that diode laser light not only eliminates bacteria but also inactivates bacterial toxins diffused within root cementum. A study by Moritz et al. showed that Gram-negative species showed immediate structural damage when exposed to the laser. Diode laser at 810 nm causes bacterial damage without injury to periodontal tissues.
Soft Tissue Diode Laser Therapy Advantages:
- Minimally invasive: It requires no incisions, minimizing patient discomfort and reducing the need for sutures.
- Precision: The laser can precisely target infected areas, leaving healthy tissues unaffected.
- Reduced healing time: Patients typically experience faster recovery compared to traditional methods.
- Improved outcomes: Laser therapy can lead to better results and long-term periodontal health.
Re-Evaluation, Periodontal Maintenance, and End-Point
The final phase of Phase I therapy involves 4-6 weeks re-evaluation. This is also known as (in the case of using a CDT code) the patient’s 1st periodontal maintenance appointment.
This appointment is essential for long-term success in managing periodontal disease. The 4-6 week re-evaluation is very important because we must identify an end-point of the disease process.
When we see a physician for treatment of a disease there is always a re-evaluation appointment to be certain the disease process has ended.
In terms of treating dental patients, we will have the same sequence of appointments: re-evaluate to determine an end to the disease process. Only when you have a patient return after treatment of active disease can you can clearly determine the next interval for preventive care (Periodontal Maintenance).
Never do we treat disease and hope for a positive outcome. We must always have patients return for an evaluation to determine the state of the disease.
Our goal is to halt bleeding gums and gingival inflammation. Only when we know there is an end point to active gingival disease can we truly help our patients live a longer, healthier life!
The Dental Hygienist Will:
1. Complete the CPE
2. Determine if there is a halt of the disease process or if the patients will need referral to a periodontist, etc,
3. If periodontal disease is no longer in an active stage the hygienist will:
- Complete LBR full mouth
- Scale any new calculus
- Polish
- Re-cap mouth-body connection, perio process (episodic and cyclic, etc.), review homecare and
- schedule regular follow-up preventive care appointments, typically every 3-4 months, to monitor periodontal (“gum”) health.
Conclusion
Periodontal disease is a chronic gingival disease in populations around the world. Treatment of this disease requires meticulous care and attention.
Soft tissue diode lasers have emerged as powerful tools in the battle against gingivitis and periodontal disease, offering precision, reduced invasiveness, and the potential to stimulate cellular mitochondria.
By following a comprehensive treatment plan that includes diagnosis, gross debridement, soft tissue diode laser therapy, scaling and root planing, end-point re-evaluation and ongoing maintenance, patients can achieve optimal total health.
Our overarching message to patients is that optimal oral health will help us live a longer, healthier life.
Do you have questions about this?
Would you like to learn more about treating gingivitis and periodontitis patients?
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Resources.
- Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16:329–34. Accessed September 21, 2023.
- Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: A two-way relationship. Diabetologia. 2012;55:21–31. Accessed September 21, 2023.
- Adriaens PA, Edwards CA, De Boever JA, Loesche WJ. Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol. 1988;59:493–503. Accessed September 21, 2023.
- J Pharm Bioallied Sci2015 Aug; 7(Suppl 2): S636–S642. doi https://tinyurl.com/LBRPTRDIODE . Accessed September 21, 2023.
- Laser curettage as adjunct to SRP, compared to SRP alone, in patients with periodontitis and controlled type 2 diabetes mellitus: A comparative clinical study. Accessed September 21, 2023.
