In the world of periodontal care, it's crucial that we take a step back and reevaluate our strategies for helping patients combat periodontal disease. Despite our best efforts with probing, scaling, cleaning, grafting, and education, we're witnessing more patients losing teeth, turning to implants, neglecting oral health, and questioning the effectiveness of our treatments.

Periodontal disease is undoubtedly a complex issue involving biofilm, microbiome balance, immune system health, cardiovascular factors, and more. However, it's also closely tied to dysfunction in the chewing system, resulting in force imbalances that exacerbate the condition. Here are a few effective approaches to periodontal healing.

Take a Long-Term View

• Understand that resetting the microbiome is a lengthy process, spanning 12-24 months.
• A single scaling and root planing (SRP) followed by a 6-week post-op check may not be sufficient.
• Implement bacterial testing and follow-up assessments over two years.

Support Connective Tissue Healing

• Remove granulation chronic fibrotic tissues to create an acute wound for healing, using techniques like curettage and laser treatment.
• Supplement with daily Vitamin C (around 1000mg) and ensure adequate hydration (2 liters of water daily).
• Pay attention to other vitamin needs, especially Vit D and B vitamins, and promote a diet rich in green vegetables.

Reduce High-Force Outliers

• Address systemic issues that can slow healing times, including managing insulin levels, reducing high-carb intake, and controlling blood pressure and stress.
• Be mindful of the impact of other diseases or chronic disorders on the patient's immune system.
• Monitor and manage sleep issues, aiming for 25% REM sleep and 7-9 hours of nightly sleep.
• Consider and treat airway obstruction issues, both pharyngeal and nasal, as they can affect arterial tone and capillary perfusion.

Focus on Breathing

• Encourage nasal breathing and provide patients with a nasal rinsing process.
• Promote lips-together breathing in most cases to improve oral health.

Address Tooth Alignment

• Recognize that malpositioned teeth can complicate force management and hinder home care effectiveness.
• Address alignment issues, and consider clear aligner therapy to aid in healing and patient comfort.

Comprehensive Periodontal Therapy Appointments

• Adopt a systematic approach to care, including guided biofilm therapy, laser photobiomodulation, curettage, repetitive appointments over 1-2 years, bacterial testing, and monitoring of relevant biomarkers.
• Utilize local anesthetics, sedatives, and anti-anxiety medications when necessary.
• Consider localized surgery to create opportunities for healing.

Provide Home Self-Care Equipment

• Offer patients all the tools they need for effective self-care, with associated costs included in the overall treatment plan.
• Package home self-care gear in a way that encourages daily access and use.

The aim of periodontal care should not be to administer a series of isolated procedures but to provide comprehensive and individualized care to each patient. By adopting a two-year plan that includes clear aligner therapy, force management, and a biofilm control system, we can offer patients a more thoughtful and effective approach to managing this chronic disease. Always remember to ask your patients if they want to get well, as their choice for health is often the first step toward successful periodontal healing.