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Steps in the BOST treatment

1. Initial consultation
   Once the periodontal disease is detected, patients are advised to take the DNA test and fill out a health questionnaire.  To administer the DNA test, four tiny paper points are placed under the gums for a period of 15 seconds to collect bacteria. Once they are removed, the paper points are packaged and sent to the laboratory where the bacterial DNA are analyzed to reveal which types of bacteria are present.  The test results are then e-mailed back to the dentist in about 10 days.  The patient then schedules a second consultation to discuss the results of the DNA test and review treatment options.
2. Second consultation
   Most tests show an infection with anaerobic bacteria, supporting the need for further treatment.  The bacterial DNA test serves three purposes: it objectively confirms the dentist's clinical and radiographic diagnoses, it helps the patient to better understand the disease and the treatment, and it allows the dentist to prescribe the correct antibiotics--if necessary. After the results of the test are shared with the patient, the treatment plan is presented.  The treatment plan usually involves the BOST treatment as well as treatment for other complications such as loose teeth, aesthetic problems, and bite imbalances.  Recommendations are also given based on the health questionnaire.  If necessary, suggestions are made addressing the patient’s diet, exercise, and lifestyle.  Lastly, the specifics of the hygiene treatment are shared with the patient.
3. Treatment
   Historically, patients return for treatment within two to three weeks of the second consultation.  Preparatory general dental procedures are usually performed within this time period.  Examples include treating decay, root canals, and unavoidable extractions. Ideally, the treatment is performed in a single session.  A custom treatment bed provides added comfort for the patient.  This is important given the length of the treatment, which can last up to five hours.  The treatment itself employs far fewer instruments than a surgical procedure.  Typically, one universal curette is used along with two Gracey curettes.
4. Post Treatment
   Once the treatment is complete, the patients receive a BOST oral hygiene kit and instructions.  They also schedule their next appointment.  Most patients are given a recommendation for a mild analgesic.  In many cases, the patients opt not to take any pain medication.  All BOST patients have been able to resume normal activities the following day. During the first few days after the treatment, patients usually prefer a more liquid type of diet.  Patients are also encouraged to stay away from nuts and seeds as well as any foods containing particles.
5. Oral Hygiene and follow-up sessions
   Oral hygiene starts the day following the treatment.  Performed with a perio-aid instrument, the oral hygiene helps stop biofilm reformation and keeps the pockets open.  This inhibits the epithelial attachment from forming and keeps the pockets aerated, which discourages anaerobic bacteria. The follow-up session usually takes place two to three days later.  At this time, the dentist goes over the entire mouth with the perio-aid.  This serves the purpose of giving the patient a demonstration again with no anesthetic present on proper use of the perio-aid as well as ensuring that the healing is progressing in all areas of the mouth. By their eighth day after the initial treatment, patients are usually able to resume eating normally.  At the one-month mark, most of the pockets are healed and the teeth have tightened, an initial sign of bone healing.  From this point, continued check-ups every three months ensure that complete healing is taking place and that the patient continues to perform adequate oral hygiene. Because of the rapid healing, restorative treatment can begin sooner with more confidence in prognosis. At 9 months a follow up x-ray can show evidence of bone regeneration.