Periodontitis
Also known as: gum disease · periodontal disease
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Evidence-Based Clinical Practice Guideline on the Nonsurgical Treatment of Chronic Periodontitis by Means of Scaling and Root Planing With or Without Adjuncts
American Dental Association (ADA) Council on Scientific Affairs · 2015 · 2015 guideline
The ADA guideline on nonsurgical periodontal therapy, centred on scaling and root planing and on whether various adjuncts add benefit. It grades adjuncts such as systemic and locally delivered antimicrobials, chlorhexidine chips, photodynamic therapy and lasers, and remains the ADA's listed guideline for this topic. It predates the 2018 staging and grading classification, so its terminology refers to chronic periodontitis.
- Scaling and root planing is treated as the core nonsurgical intervention, with benefits judged to outweigh potential harms. source
- Adjunctive therapies are graded separately, with several receiving only weak or expert-opinion-level support. source
- Laser use as an adjunct to scaling and root planing was not recommended on the basis of insufficient evidence of clinical benefit. source
Treatment of Stage I-III Periodontitis - The EFP S3 Level Clinical Practice Guideline
European Federation of Periodontology (EFP) · 2020 · S3-level clinical practice guideline
The EFP's flagship S3-level guideline for periodontitis, structured as a stepwise treatment pathway aligned with the 2018 classification of periodontal and peri-implant diseases. It sets out dozens of graded recommendations spanning behaviour change and risk factor control, supragingival and subgingival instrumentation with or without adjuncts, surgical options, and long-term supportive care. A companion EFP S3 guideline published in 2022 covers stage IV periodontitis and its rehabilitative aspects.
- Contains 62 graded recommendations organised around a stepwise therapy model and mapped to the 2018 periodontal classification. source
- It was developed from the EFP Perio Workshop 2019, drawing on 15 commissioned systematic reviews reviewed by experts from 19 countries. source
- A separate 2022 EFP S3 guideline extends the pathway to stage IV periodontitis, emphasising multidisciplinary rehabilitation with orthodontists and prosthodontists. source
US vs EU key differences
- Disease terminology differs by vintage: the ADA guideline addresses 'chronic periodontitis' and predates the 2018 classification, while the EFP guideline is built on the 2018 staging and grading system and is framed around stage I-III disease. source
- Scope differs: the ADA document covers only nonsurgical scaling and root planing with or without adjuncts, whereas the EFP guideline sets out a four-step incremental pathway (behaviour and risk-factor control, subgingival instrumentation, surgical retreatment, then supportive periodontal care) across 62 recommendations. source
- Adjunct stance differs: the ADA guideline rates adjunctive systemic subantimicrobial-dose doxycycline in favour and gives weak in-favour ratings to systemic antimicrobials, chlorhexidine chips and diode-laser photodynamic therapy, while the EFP recommends against routine systemic antibiotics with subgingival instrumentation, reserving them for selected cases such as young adults with generalised stage III disease. source
- Both agree on the core intervention: mechanical subgingival instrumentation (scaling and root planing) is the foundation of nonsurgical treatment, with adjuncts treated as optional rather than standard. source
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