Dr. Paul H. Keyes - The Non-Surgical Solution to Oral Health

The Keyes Method
The Non-Surgical Solution to Oral Health

Here is the “Keyes 7 Step System to Periodontal Health,” as described by the International Dental Health Foundation.

The Keyes Seven-Step System

Diagnosis
Patient Education
Treatment
Patient Instruction
Monitoring the Progress
Modulation of Therapy
Maintenance

Step 1 - Clinical Examination & Microbiological Diagnosis

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Evaluations of tissue damage are supplemented with microscopic assessments of periodontal disease associated microorganisms (PDAM) and the presence of white blood cells (WBC). Complete samplings of PDAM are important to distinguish the “SPECIFIC SITE” nature of THE DISEASE PROCESS. THE “INFECTION” is very subtle, cunning, and difficult to “CLEAR.” The GOAL of therapy is BACTERIAL CONVERSION to HEALTH. The INFECTION is both INSIDE and OUTSIDE the body.

Step 2 - Patient Education

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Patients are informed about the nature of periodontal infections, specific bacterial risk factors, how tissue damage occurs, and the possibility of transmission of organisms from person to person. (Developments in research and conceptual approaches in treating THE DISEASE PROCESS are continually updated by close contact with ORATEC CORPORATION, IDHF, AND RESEARCH.) Significant factors are MICROBIAL 1) Types , 2) Numbers, 3) Activity, and 4) Organizational patterns, as well as 5) White blood cell (WBC) counts.

Step 3 - Professional Treatment

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Treatment includes meticulous debridement of root surfaces (1-10 hours) and irrigations with antiseptic AGENTS to the depths of all pockets. (Piezoelectric ultrasonic units have recently been adapted for subgingival instrumentation and are proving to be excellent additions to the periodontal armamentarium). For the first time in dentistry QUALITY of HOMECARE IS MEASUREABLE BY USING A MICROSCOPE. The word CLEAN NOW HAS A NEW DEFINITION. “QUALITY CONTROL” with a “MICROSCOPE” can finally now be achieved (CLEARING THE INFECTION), and the therapist and patient know “THE THERAPEUTIC END POINT” is reached.

Step 4 - Patient Instruction

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Patients are instructed in an EFFECTIVE self-care program using INSTRUMENTS and AGENTS that combat PDAM. The inorganic salts, baking soda, epsom salts, peroxides, fluorides, and other AGENTS are excellent anti-microbials. The IRRIGATOR is probably the most EFFICIENT INSTRUMENT today because it DELIVERS the AGENTS TO THE LOCALIZED SITE of infection most EFFECTIVELY. We suggest the toothbrush be used with 10-12 brushfuls of BAKING SODA and PEROXYL. COMPLIANCE in homecare is an absolute must in attaining and maintaining control of the PDAM and END POINTS of therapy.

Step 5 - Monitoring

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After an appropriate interval the patient’s progress is assessed by MONITORING SUBGINGIVAL microorganisms and the prevalence of white blood cells (WBC). Complete and repeated localized MONITORING is essential in establishing the END POINTS of treatment as well as assessing the corroborating CLINICAL SIGNS and SYMPTOMS of HEALTH (pockets, bleeding, color, pain, shape, etc.). In this way “FALSE NEGATIVE” readings are held to a minimum. Use of “MULTIPLE AGENTS” is an essential “CONCEPT” in controlling these “MIXED INFECTIONS”.

Step 6 - Modulation of Therapy

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If disease related microbial complexes have not been converted to ones associated with health (BACTERIAL CONVERSION), and if white blood cell levels remain high, IN-OFFICE TREATMENTS and SELF-CARE PROGRAMS need to be MODULATED. Additional AGENTS and DELIVERY SYSTEMS should be considered (CUSTOM-FIT DELIVERY TRAYS). Systemic antibiotics are usually necessary to “CLEAR THE INFECTION” from the body and COMPLIANCE is very important. Antibiotics will not “CLEAR THE INFECTION” outside the body. Specific surgical techniques are other alternatives.

Step 7 - Maintenance

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The frequency of maintenance or recall visits will depend on such factors as: patient’s age, immune system response, diet, smoking, general health, COMPLIANCE with homecare, dexterity, chances of reinfection, the extent of prior tissue damage, etc. Theoretically, patients can be maintained by professional therapy alone. The length of time between visits will be influenced by the levels of control attained by both professional and self-care measures after initial therapy. THE DISEASE PROCESS HAS HISTORICALLY BEEN PROGRESSIVE but can now be CONTROLLED by treating it like an INFECTION.