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Ch. 22 Periodontal Maintenance Therapy (Components of the Perio…
Ch. 22 Periodontal Maintenance Therapy
Key Words
Primary prevention
Action performed to preclude or prevent the development of a disease (e.g., use of fluorides to prevent caries)
Retreatment
After active periodontal therapy more treatment is needed to get the disease under control
Periodontal maintenance
Also referred to as recare or continuing care. An extension of periodontal therapy. Procedures performed at selected intervals to assist the periodontal patient in maintaining oral health.
Secondary prevention
Activities are aimed at early disease detection, thereby increasing opportunities for interventions to prevent progression of the disease and development of symptoms (e.g., removal of all calculus and dental biofilm while performing root debridement)
Patient adherence
Term used to describe how well a patient is sticking to their hygiene program; compliance
Smoking cessation
A means to quit smoking
Previously referred to as periodontal recall, AAP adopted Periodontal maintenance because it can be looked at as a branch of therapy
Refractory & Recurrent Periodontal Disease
Refractory perio disease
Pt who fail to respond to perio treatment including maintenance therapy, may be due to
systemic disease
inadequate treatment
deficient immune response
Persistence of perio pathogens
Adjunctive use of antibiotics
Recurrent perio disease
Pt who previously responded well to perio therapy but later showed signs of disease reactivation
Occur in pt with meticulous biofilm control
On a regular maintenance program
Treatment based on conventional perio therapy
Objectives of Perio maintenance
4 Objectives by the AAP
To prevent or minimize the recurrence of perio diseases in pt by controlling risk factors known to contribute to the disease process (e.g., dental biofilm, calculus)
To prevent or reduce the incidence of tooth or implant loss by monitoring the dentition and prosthetic replacements of the natural teeth
To increase the probability of locating and treating other conditions or diseases found in the mouth
To preserve the health, comfort, and function of the teeth
Important for monitoring the overall dental health of the pt
Indications for Perio maintenance
3 Types of Pt
Perio healthy pt who have never had perio disease as a preventive measure (primary prevention)
Pt who respond favorably after active perio therapy to prevent or minimize disease and tooth loss (secondary prevention)
Medically compromised pt or pt who maintain poor oral hygiene and are not considered candidates for perio surgery
Components of the Perio Maintenance visit
Standard perio maintenance procedures (AAP)
Radiographic review
Oral hygiene evaluation (amount of biofilm, calculus, and stains)
Dental examination and gingival and perio assessment
Review of pt's biofilm-control efficacy
Extraoral and intraoral examination
Removal of dental biofilm from the supragingival and subgingival areas, root debridement where indicated, teeth polishing, and adjunctive chemotherapy if necessary
An update of medical and dental histories
Performed on every pt at each perio maintenance visit but are subject to the judgement of the dentist and the dental hygenist
Compared with baseline findings
2 aspects emphasized and provided during perio maintenance are monitoring and therapy
Perio maintenance is designed to eliminate or reduce primary and secondary risk factors
Primary
Dental biofilm
Secondary
Biofilm-retentive areas
Calculus
Restorations w/ overhangs
Defective margins
Medical and Dental Update
Chief Complaint should be noted and this should be accompanied by a notation of the degree of comfort or discomfort
Pt should be informed about the availability of programs for smoking cessation in and outside the office
Extraoral / Intraoral Examination
If any suspicious lesions are found, the dentist should be informed
Dental Examination
Gingival and Perio Assessment
Gingival Assessment
The color, contour, consistency, and surface texture of the gingiva is recorded
Perio Assessment
Recording probing depths, gingival recession, clinical attachment level, furcation involvement, suppuration(pus), and tooth mobility
Disease Stability: Probing depths and CAL
Currently the most reliable way to determine perio disease stability
Measure of the CAL is made from the CEJ to the apical extent of the tip of the probe
Gingival Recession
Defined by the location of the gingival margin in relation to the CEJ
BOP
Absence of bleeding on probing is a better indicator of gingival health than its presence is of perio disease
25 grams of probing force
Tooth Mobility
Grade I, II, III, or IV
Radiographic Review
Show past bone destruction
Taken according to the ADA Guidelines
Sites with bone destruction can be evaluated at least 6 months
Oral Hygiene Evaluation and Pt's Biofilm-Control Regimen
Evaluate gross biofilm accumulation determine the quality of oral hygiene self-care procedures, and conduct OHE
A disclosing agent is used for pt education and as a basis for recording a biofilm index
Dental Implants
Periapical films are indicated at 6-month to 1-year intervals to determine the height of the bone around the implant
Accepted standard for a stable endosseous implant 1 yr after placement is vertical bone loss less than 0.2 mm per year
Treatment: Recurrent perio disease vs a well-maintained periodontium
A good rule to follow may be that when BOP or the presence of suppuration is seen 4-8 wks following the perio maintenance appt, then retreatment is plausible
1-2 mm or greater increase in probing depth or attachment loss
Well-maintained pt
Point out areas in the mouth where the pt is having difficulty with biofilm control, and correct the pt technique
Deplaqying may be performed
Selective tooth polishing can be performed
Determine the interval of the next perio maintenance visit
Chemotherapeutics
Prevent repopulation of gram-negative periodontal pathogens
Medically compromised pt or those exhibiting poor oral hygiene may benefit from such agents
Chemotherapeutic agents may be beneficial in certain pt as an adjunct to standard oral hygiene procedures but they do not replace brushing and flossing
Controlled release drugs such as Arestin, PerioChip, or Atridox may be used in selected recurrent pockets of 5mm or greater that bleed
Patient Adherence
Most pt do not comply with long-term behavioral changes, especially for conditions that are not life-threatening
3 Type of compliers: Full compliers, Irregular compliers, and Non compliers
Wilson, Glover, Schoen, Baus, and Jacobs (1984) 8 yr period
34% never returned, 16% completed the treatment
Becker, Becker, and Berg (1984) 44 pt
Pt dropout rate 43% was highest in 1st yr
Pt is more likely to remain compliant if fully compliant with the maintenance in the 1st yr
Nonadherence due to:
Belief no longer require treatment due to no sign of disease
Fear of dental treatment
Expense
Lifestyle changes
General Dentist- Periodontist Relationship
Frequency of Intervals
Perio maintenance intervals are determined on an individual basis according to:
type of treatment performed
Adequacy of oral hygiene self care
Presence of orthodontic appliance
Presence of prosthetic appliance
Systemic health
Pt adherence and cooperation
Periodontal disease severity
Pt's can return 4-8 wks after perio debridement for further observations
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After conducting these so often I have a better understanding of the importance the play in the prevention
As well as the Oral-systemic link
This is how we treat patients with a more holistic view
I can say i do not receive this at my dental office and makes me want to reconsider my provider**