STEP 4: Supportive periodontal care (SPC)
Aim: Preventing periodontitis recurrence/progression after successful completion of active treatment. It must be performed in all patients, regarding their condition of being at high risk for periodontitis recurrence/progression. This step comprises specifically designed supportive periodontal care (SPC), consisting on a combination of preventive and therapeutic interventions rendered at different intervals: · NO presence of pockets > 4 mm with bleeding on probing. · NO presence of deep periodontal pockets [≥ 6 mm]. Professional care
Recommended interventions
Recommended
Suggested
Recommended
Recommended
Recommended
Adherence to supportive periodontal care is crucial for long-term periodontal stability and potential further improvements in periodontal status.
Repeated individually tailored instructions in mechanical oral hygiene, including interdental cleaning, in order to control inflammation and avoid potential damage for patients in supportive periodontal care.
Supportive periodontal care visits should be scheduled at intervals of 3 to a maximum of 12 months, and ought to be tailored according to patient´s risk profile and periodontal conditions after active therapy.
Suggested
Performing routine professional mechanical plaque removal (PMPR) , as a part of supportive periodontal care, to limit the rate of tooth loss and provide periodontal stability/improvement.
Not recommended
NOT recommended
NOT suggested
NOT suggested
NOT suggested
The use of adjunctive methods ( sub-antimicrobial dosedoxycycline, photodynamic therapy ) to professional mechanical plaque removal (PMPR) in supportive periodontal care is not suggested.
The replacement of conventional professional mechanical plaque removal (PMPR) with the use of alternative methods
( Er: YAG laser treatment ) in supportive periodontal care is not suggested.
Supragingival biofilm control by the patient
Recommended interventions
Recommended
Suggested
Recommended
Suggested
Recommended
Taking into account patients needs and preferences when choosing a toothbrush and interdental brush design .
Tooth brushing should be supplemented by the use of interdental brushes .
In interdental areas not reachable by toothbrushes, supplementing tooth brushing with the use of other interdental cleaning devices in periodontal maintenance patients is suggested.
Open recommendation
Open
Powered toothbrush may be considered as an alternative to manual tooth brushing.
Not recommended
NOT recommended
NOT suggested
NOT suggested
Flossing is not suggested as a first choice of interdental cleaning in periodontal maintenance patients.
Adjunctive measures for gingival inflammation
Recommended interventions
Recommended
Suggested
Suggested
Suggested
If an antiseptic dentifrice formulation is going to be adjunctively used, products containing chlorhexidine, triclosan-copolymer and stannous fluoride-sodium hexametaphosphate are suggested.
If an antiseptic mouth rinse formulation is going to be adjunctively used, products containing chlorhexidine, essential oils and cetylpyridinium chloride are suggested.
Open recommendation
Recommended
The use of adjunctive antiseptics may be considered in periodontitis patients in supportive periodontal care in helping to control gingival inflammation, in specific cases.
Unclear
Unclear
It is unknown if other adjunctive agents (such as probiotics, prebiotics, anti-inflammatory agents, antioxidant micronutrients ) are effective in controlling gingival inflammation in patients in supportive periodontal care.
Risk factor control
Recommended interventions
Recommended
Suggested
Recommended
Suggested
Diabetes control interventions are necessary.
Tobacco smoking cessation interventions needs to be implemented.
Unclear
Unclear
It is not known if increasing the physical activity and reducing weight through dietary and lifestyle modification has an impact in patients in supportive periodontal care.
This document is a graphic adaptation of the actual clinical practice guidelines and the reader is referred for the correct explanation to the original article: “Treatment of stage I-III periodontitis - The EFP S3-level clinical guideline” by Sanz and coworkers, J Clin Periodontology 2020 . https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13290
www.efp.org
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