Periodontal maintenance (PM) is teeth cleaning, but not the routine cleaning we’re all familiar with:  It is a super deep-cleaning procedure performed to thoroughly clean the teeth and roots of plaque and calculus/tartar, both above and below the gum line.  PM is an important dental treatment for stopping the progression of periodontal disease.

These are two very different types of dental teeth cleaning for very different types of patients:

  • Prophylaxis: Preventive teeth cleaning and polishing that focuses on the surfaces of the teeth above the gum line for patients who do not have periodontal disease.
  • Periodontal Maintenance (PM): Deep cleaning for patients who have been diagnosed with and treated for periodontitis.

Periodontitis is a chronic and non-curable bacterial infection.  The essence of why periodontal disease is not curable is this:  The only way one can get periodontitis is if there is a genetic susceptibility to it, which is true for all diseases. For example, some people smoke nonfiltered cigarettes for 40 years and never get lung cancer because they do not have the oncogenes necessary for it to develop; i.e., they are not genetically susceptible to cancer.  If you are genetically susceptible to periodontitis, you are susceptible forever.  All it takes for the disease to return is for the pathogens to be present.

The objective of PM is to keep the disease under control, much like diabetes or asthma.  Treatment is needed every three months, or will be ineffective in the long run.  The recommended three-month maintenance interval is scientific and is not arbitrary.  When plaque/biofilm is not eliminated, or adequately disrupted, bacteria accumulates on the biofilm and becomes the predominant species of bacteria in three to 12 weeks. This means that by three months, the bugs are flourishing on your teeth, and it’s essential for bone and tissue health to reduce them then — not one month later or three months later.

There are three components involved with controlling periodontal disease:

  1. Daily Plaque Control – After treatment it is imperative that the patient maintains a very high level of plaque control to prevent the harmful bacteria from reforming. Poor plaque control may lead to additional breakdown which will require professional retreatment. Brushing 2-3 times a day and flossing at least once a day has shown significant long-term benefits in most studies. However, the quality of your brushing and flossing is far more important than the frequency.
  2. Genetic Susceptibility and Disease Risk Factors – Some patients have a greater chance of additional breakdown, even with high levels of plaque control. Usually this is related to genetic makeup and risk factors. Smokers generally have the highest recurrence rates.
  3. Periodontal Maintenance Visits – Routine cleanings and evaluation every three months.  However, the maintenance frequency is customized for each patient depending on their disease level (early or advanced), oral hygiene thoroughness, risk factors, and disease susceptibility.  Localized scaling and root planing (SRP) may be necessary to control areas of active inflammation, but PM does not generally include SRP throughout the mouth.

It normally takes plaque about three months to develop into an aggressive periodontal disease infection.  During the first three months, bone loss will be minimal, but after that, there will be a dramatic increase in tissue (gum and bone) breakdown.  If the plaque is removed every three months, then bacterial aggressiveness will usually stay low.  Studies show that when regular and timely Periodontal Maintenance is lacking, patients can have 20 times the amount of tissue and bone loss as those who do, and lose two to three times as many teeth.

If you are interested in periodontal maintenance in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.