Diagnosis: Following clinical and radiographic examination, I have been advised that I have periodontal disease. Periodontal disease is an infection of the gums that gradually destroys the bone and gingival tissue around your natural teeth and also can affect dental implants. Bacteria found in dental plaque is the primary cause of gum disease. Bacteria produce toxins that irritate the gums. They may cause the gums to turn red, swell, and bleed easily. If this irritation is prolonged, the gums separate from the teeth causing pockets (spaces) to form. Plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line. As periodontal disease progresses, the supporting gum tissue and bone that holds teeth/implants in place deteriorate. If left untreated, this leads to teeth/implant loss. 

We will provide your general dentist with a comprehensive report of our findings and will update yourself and them as we proceed with the recommended treatment. 

Recommended treatment: The initial stage of treatment is treated with non-surgical periodontal therapy called scaling and root debridement, and may be performed over 1-4 visits, if need be, this can include Perioscopy. This procedure involves removal of plaque and tartar deposits beneath the gum line. The tooth roots may also be debrided to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. Local anaesthetic may be administered as part of the treatment to numb your gums and teeth, providing more comfort during the procedure. Antibiotics or irrigation with antimicrobials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontal disease. At these sessions, your current home care practice will be reviewed and you will be provided with information to assist with brushing and interdental care. 

Expected benefits: The purpose of this first phase of treatment is to reduce the bacterial deposits and biofilm which will assist with the healing of the gums and reduce and slow the progression of periodontal disease. Eliminating or decreasing pocket depths will enable better access for you and dental professionals to adequately maintain gum health. The success of this treatment is dependent on your compliance with home care and attending routine maintenance appointments.

Primary risks and complications: It has been explained that following this phase of treatment, my gums may shrink as I have bone loss which may result in receding gums and spaces between my teeth. Root exposure can lead to root sensitivity which will be managed with certain products that contain fluoride. With excellent oral hygiene and fluoride containing products the sensitivity should settle down. Sometimes the gums can also ulcerate and become inflamed after root planing procedures. 

Old or compromised, defective fillings may loosen during debridement. We will inform your dentist if any fillings need repair or replacement. 

I understand that if I smoke I have an increased risk of the above complications, and my response to the nonsurgical treatment will not be as effective. The exact duration of any complication(s) can not be determined, and they may be irreversible.

I understand the importance of regular hygiene maintenance appointments. Studies have shown people who do not maintain good oral hygiene regularly have much more bone loss than those who do.

Re-evaluation and Maintenance Schedule: Following the completion of the initial phase therapy, I understand that a re-evaluation appointment is necessary about 8 -10 weeks following treatment. At this appointment, a comprehensive examination will be completed and compared to the initial records that were taken. The prognosis of teeth, replacement options and the need for further non-surgical or surgical periodontal treatment will be discussed. My home care methods will be assessed and suggestions to assist me to improve my home care regime will be discussed. 

At this appointment, a maintenance schedule will be suggested. The suggested maintenance schedule will vary depending on how your gums have responded to the first phase of treatment. It can be 3, 4 or 6 monthly at the Periocentre or an alternating care-share arrangement with your dentist. Maintenance, along with good oral hygiene, are the keys to good oral health. Both adherence to this maintenance programme as well as strict home oral care will give you an excellent chance of keeping your gums healthy and extending the life of your teeth. There may be areas that require further non-surgical or surgical intervention. 

Maintenance and supportive periodontal care visits may include the following: 

• Update your Medical and Dental history.

• Clinical periodontal examination which includes the measurements of the depth of the pockets around your teeth and a soft tissue assessment.

• If there are areas of concern e.g. obvious dental decay or any other dental concerns we will refer you to your general dentist for further investigation and treatment.

• Update radiographs (a referral will be provided for a full mouth OPG radiograph every 3 years and intra-oral radiographs will be taken at our practice every 2 years or as deemed required by the clinician - the costs of the intra-oral radiographs will be charged accordingly).

• Review of your current home oral care procedures.

• Removal of bacterial plaque and tartar, root debridement under the gum as needed with local anaesthetic.

• Administration of medications to reduce tooth sensitivity.

• Confirmation of recall frequency and scheduling of next appointment

• As you attend your ongoing maintenance appointments we will update your dentist on your condition every 12 months.

Further Treatment Options: After the re-evaluation appointment, further non-surgical or surgical treatment of certain areas may be required: This may include: 

1) Non-surgical intervention using Perioscopy: The Perioscope features a miniaturised digital video technology that enables the clinician to diagnose and treat areas below the gum line without the discomfort and inconvenience of surgery.

2) Surgical phase of Periodontal Therapy: There may be certain areas that require surgical intervention. Your Periodontist may be required to reshape the tissues and bone. This procedure decreases the pocket depth and creates an environment for you to be able to keep clean on a daily basis. Sometimes it may be possible to place regenerative material that can reverse some damage caused by periodontal disease. These procedures and materials will be discussed prior to the surgical procedure. 

No warranty or guarantee: I hereby acknowledge that no guarantee, warranty or assurance has been given to me that the proposed treatment will be successful due to individual patient differences, a periodontist cannot predict certainty of success. There exists the risk of failure, relapse, additional treatment, or worsening of my present condition including the possible loss of teeth or implants despite the best care. It has been explained to me that long term success of treatment requires my cooperation and performance of effective plaque control (home care) on a daily basis and periodic periodontal maintenance visits with a dental professional. 

Sedation:  Please speak to your treatment coordinator if this is something you wish to discuss further as this requires to be arranged prior to your procedure date, with a minumum of 24 hours notice.

I understand that if I take oral sedation, I will need a driver to and from my appointment and that I should not operate any heavy equipment/machinery for 24 hours following the use of oral sedation.

Payment Terms: I understand the proposed treatment plan estimation which has been presented to me as a written treatment plan outlining the required appointments, time frames, item codes and the fees associated with my treatment. 

I understand all appointments are to be paid in full on the day of the procedure, and I will be mindful of any daily bank card limits I may have, thus ensuring full payment can be made. 

I understand that if I wish to make payment via direct deposit that I will contact my treatment coordinator at least two days prior to my appointment, ensuring the funds have cleared before the commencement of my appointment. 

I am aware that a HICAPS terminal is not available on site and I will claim any benefits that I may be entitled to directly from my health fund.

Patient Consent: The treatment options have been explained to me as well as the importance of ongoing maintenance. I have been fully informed of the nature of the periodontal therapy, the risks and benefits, the alternative treatments available and the necessity for follow-up care. I have had an opportunity to ask any questions I may have in connection with the treatment and discuss my concerns with my clinician. I hereby consent to the suggested periodontal therapy and the maintenance program as presented to me during consultation and in the treatment plan presented. I understand that during the procedure, conditions may become apparent which warrant additional or alternative treatment for my best interest, which I will be informed of. This may involve additional costs that may not have been outlined in the provided treatment plan.

I Understand the success of periodontal procedures can be affected by medical conditions, dietary and nutritional problems, smoking, alcohol consumption, clenching and grinding of teeth, adequate oral hygiene, and medications that I may be taking. To my knowledge I have reported to my periodontist/periodontal hygienist any prior drug reactions, allergies, diseases, symptoms, habits or conditions that in any way relate to this treatment procedure.

I have agreed to follow the post-operative instructions and to report to all follow-up appointments.

By providing my signature, I certify that I have read and fully understand this document and that all my questions have been answered to my satisfaction.