Periodontal maintenance: keeping results over time

Why is maintenance part of treatment?

Periodontitis is a chronic disease. Active treatment reduces inflammation and pocket depth, but the tendency to react strongly to plaque remains. Bacteria recolonise cleaned areas within a few weeks, above all where residual pockets, furcations or hard-to-reach spaces persist.

The EFP European guideline makes supportive periodontal care the fourth step of treatment in its own right ^[1]. Long-term studies offer some indications: in a retrospective cohort of 168 patients followed for a median of five years, those attending regularly (every 2 to 4 months) lost an average of 0.14 teeth per year, against 0.21 for those who spaced their visits further apart; the gap was not statistically significant, and in the highest-risk patients tooth loss remained notable even with three-monthly follow-up ^[3]. This is an observational study: it shows an association, and other differences between regular and irregular attenders may weigh in.

How often?

The EFP guideline asks for visits to be scheduled at intervals of 3 months to a maximum of 12 months, adjusted to the patient's risk profile and periodontal condition ^[1]. The Scottish guidance (SDCEP) suggests that frequent recalls, every three months for instance, are often beneficial at the start of maintenance, with later adjustment according to progress ^[2].

At Dr Hazout's practice the rhythm is as follows: a first follow-up one month after the treatment session, which serves as the re-evaluation, then six-monthly long-term follow-up. This six-month interval sits within the European range; it is reviewed at every visit: it is shortened if bleeding returns or if your risk is high, and may be lengthened if everything stays stable over time.

What happens at a visit?

• updating your medical history, medication, smoking status and, if relevant, diabetes control;
• examining the gums: plaque, bleeding, inflammation;
• targeted X-rays if needed, at sensible intervals;
• checking your technique, particularly the choice and size of interdental brushes;
• professional cleaning above the gum line, then fine tips passed below the gum to remove the biofilm where it re-forms: no longer root planing, still less curettage, but mechanical upkeep that respects a root already cleaned; sites that bleed or deepen are instrumented more thoroughly;
• deciding the interval until the next visit.

This matches the content described in professional guidance ^[2]. A maintenance visit costs €280 to €320; indicative amounts are listed on the Fees page.

Your role between visits

Daily cleaning matters more than the visit itself. The EFP guideline specifies that toothbrushing should be supplemented with interdental brushes, and that floss is not suggested as the first choice where the spaces let a brush through ^[1].

• One interdental brush per space, the largest size that passes without forcing.
• Once a day, ideally in the evening, before brushing.
• A soft toothbrush, manual or electric, twice a day.

Loose teeth: stabilising with a splint

After advanced periodontitis, some teeth stay loose even once inflammation is under control: they have lost part of their support. They may also have moved, drifted apart or forward, which further weakens their balance.

A bonded splint joins these teeth with a fine wire set on their inner surface. It improves chewing comfort and spreads the load, but it does not rebuild bone: gum health still rests on maintenance, and cleaning around the wire with suitable interdental brushes calls for particular care. How it is placed, cared for and where it fits in treatment are explained on the page Splinting loose teeth. When teeth have moved, orthodontic treatment can be considered once the disease is stable.

Smoking and diabetes: two factors that change the outlook

Smoking. Smoking is associated with a markedly higher risk of developing and worsening periodontitis ^[4], and it weakens the response to treatment: in smokers, pockets close less often and relapse is more frequent. Stopping smoking is among the measures recommended from the very start of treatment ^[1]; the practice can point you towards stop-smoking support. The figures on smoking and the other risk factors are presented in the article Understanding periodontitis.

Diabetes. Diabetes and periodontitis influence each other in both directions ^[5]: poorly controlled diabetes undermines the results of maintenance, and periodontal treatment modestly improves HbA1c, by about 0.4 percentage points at 3–4 months in randomised trials ^[6]. It helps to let the practice know your latest HbA1c and any change in your medication. The link between the two diseases is detailed in the article Diabetes and periodontitis.

The limits of maintenance

It reduces the risk of relapse; it does not remove it. Even with regular attendance, periodontitis can return at a few sites: a pocket that deepens again, bleeding that comes back. That is precisely why the gums are re-examined at every visit. A localised relapse is usually treated by re-instrumenting the site; a widespread relapse means returning to active treatment, then to maintenance.

Some teeth keep a guarded prognosis. A tooth that has lost much of its support, a molar with furcation involvement or a very loose tooth may be lost despite diligent follow-up. In the study cited above, tooth loss remained notable in the highest-risk patients even with three-monthly visits ^[3]. These teeth are identified at the assessment; whether to keep them is a shared decision, reviewed as the visits go on.

Adherence fades over time. In the first years motivation runs high; then visits grow less frequent, especially when all is well and nothing hurts. Yet the return of the disease is silent. Cohort studies show that irregular attenders lose more teeth than regular ones, even though other differences between them may play a part ^[3]. The interval proposed takes this reality into account: a slightly longer interval that is kept beats a short one that is abandoned.

Frequently asked questions