Of all the topics in Periodontics, Supportive Periodontal Therapy (SPT) is by far and away my favorite.
I know this seems odd.
In fact I personally don’t know any other periodontist who shares my level of passion about this topic. Hopefully, if you continue reading what I write here (and this will be over a number of posts planned for the near future), I would like to try and convince you that Supportive Periodontal Therapy is not only extremely interesting but of incredible value to patients.
I remember as a dental student and then a general dentist that treating periodontitis was like nailing Jell-O to the wall. Unlike a filling or a crown where the procedure is pretty much the sum of treatment needed to eradicate dental caries (aka. tooth decay), periodontal therapy doesn’t seem to have a similar definitive endpoint. I say it doesn’t seem to have, because in fact, it actually does. In periodontal therapy, moving a patient from the active treatment phase to SPT is like the final cementation of the last crown in a restorative treatment plan.
It’s that big a deal.
Now, instead of dealing with the problems of an uncontrollable condition causing the progressive loss of alveolar bone and the loosening and eventual loss of teeth, the patient has moved to a new form of care intended to keep them healthy.
So keep this in mind:
When you move periodontal patients from Active Therapy to SPT you are essentially declaring them stable and healthy.
Another way to put this is to define SPT this way:
SPT is the management of healthy, stable patients who have a history of periodontal disease.
SPT patients are not the same as patients who have never had periodontitis. Because they have shown a susceptibility to periodontal pathogens in the past, they are at greater risk for disease recurrence compared with the practice’s general patient population – even including those with miserable plaque control. When dentists and hygienists fail to appreciate this and therefore treat former periodontitis patients in the same manner as all other patients in their practice (perhaps only adjusting the cleaning intervals slightly), disease recurrence is inevitable. On the other hand, when general dentists and their teams understand how to effectively run an SPT program, it is reasonable for periodontists to allow them to take on the majority of patient care in this area.
So here’s the question: Are general dentists willing to create and manage effective SPT programs that keep periodontal patients healthy long-term? If the answer (by the actions of the practice) is no, then these patients should predominantly remain with the periodontist. Personally, if I were the general dentist, I would want to manage the care of these patients, but being that I am a periodontist, I am also aware of the problems that occur when the general practice SPT program is deficient. My solution to this problem is maintaining a line of communication between general dentists and periodontists on this topic. With a little effort, the creation and management of an effective SPT program is very easy to do. Stay tuned, and I will show you how.
Next time I will get into the parameters of SPT.
So do you think this is an important topic? Let me know.