August 26, 2022
by Gabriele Maycher, CEO, GEM Dental Experts Inc. BSc, PID, dip DH, RDH


Q: I just started using the term “nonsurgical periodontal therapy” (NSPT) when speaking to my patients, and they often ask how NSPT is different than a “cleaning.” What is the easiest way to describe the difference without getting too technical?

A: Interestingly enough, when I consult and teach, most hygienists insist that NSPT is something they learned in school but is not done outside the learning environment, in clinical practice. So good on you for integrating nonsurgical periodontal therapy – and the term – into your practice.

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First, let’s make sure everyone understands the term. “Nonsurgical periodontal therapy” describes the many nonsurgical steps used to eliminate inflammation in the periodontium of a patient with periodontal disease.  The goal is to return the periodontium to a healthy state that can then be maintained by a combination of professional care and patient self-care.”1

To return a gingivitis patient to a state of health, they would need to demonstrate the following parameters: <3mm pocket depths and <10% bleeding on probing. And a periodontitis patient would need to demonstrate <4mm pocket depths and <10 bleeding on probing with no 4mm pockets bleeding.2 In the case of periodontitis, this would also include the stability in attachment loss.

Nonsurgical periodontal therapy can entail anywhere from one to six additional debridement appointments and local anesthetic for quadrant or sextant scaling, plus an additional post-care appointment. Adjunctive therapy, such as chemotherapeutic agents or host modulation therapy, may also be necessary.

As for the term “cleaning,” it doesn’t exist in the dental literature. Instead, we should be using the term “periodontal maintenance therapy,” which best describes what we understand to be a cleaning appointment. Periodontal maintenance therapy is a term from the literature that “refers to the continued patient care provided by members of the dental team to help a patient maintain periodontal health following the successful completion of nonsurgical or surgical periodontal therapy.”1 The operative words are “maintenance of health.” If a patient doesn’t have a healthy state and/or you have never successfully achieved a healthy state, then a patient does not require “periodontal maintenance therapy;” he or she requires “nonsurgical periodontal therapy.”

So, the easiest way to describe the difference between the need for a cleaning or NSPT to your patient, is: “A cleaning is for patients who have healthy tissues, and nonsurgical periodontal therapy is for patients who don’t have healthy tissues.” At this point, you can discuss with your patients what the parameters of health for their disease condition should be and based on their assessments where they are in comparison, plus what therapies will be needed to get them to health.

Although the term “cleaning” continues to be used by team members and patients alike, make sure the entire team understands the difference between the two terms and the best way to explain this difference to patients. Better yet, have the team delete the term “cleaning” from their vocabulary and switch to “periodontal maintenance,” and before long your patients will be referring to it the same way.

References:

  1. Foundations of Periodontics for the Dental Hygienist, Enhanced 5th Edition, jill S. Gehrig, Daniel E. Shin and Donald E. Willmann.
  2. Lang NP, Bartold PM. Periodontal health. J Periodontol. 2018;89(Suppl 1): S9–S16. https://doi.org/10.1002/JPER.16-0517

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