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CHAPTER 19: PROBLEM-/EVIDENCE-BASED TREATMENT PLANNING (PROBLEM LIST (RISK…
CHAPTER 19: PROBLEM-/EVIDENCE-BASED TREATMENT PLANNING
PBL: APPROACH TO TX
GOALS OF PERIO THERAPY
= ideal goal of perio. therapy is to restore the periodontium to a comfortable & functional state of health for the balance of the pt. life
PERIO THERAPY: ONGOING CARE
DIAGNOSITIC DECISION MAKING FOR PERIO. DISEASES
PERIO. SCREENING & RECORDING: FOR ALL PT.
GINGIVAL ASSESS: FOR ALL PT.
PERIO. PROBING: FOR ALL PT.
RADIOGRAPH ASSESS: FOR ALL PT.
MICROBIAL TESTING: REFRACTORY PT; HIGH-RISK PT.
LIMITATIONS: EXPENSIVE, BUT MAY BE USED TO DETERMINE PATHOGENS & ANTIBIOTIC SENSITIVITY
NONSURGICAL TX CHOICES FOR PERIO. DISEASES
PERIO. DEBRIDEMENT
ADJUNCTIVE THERAPY W/ ANTIMICROBIALS
CONTROLLED-RELEASE DRUG DELIVERY
SYSTEMIC ANTIBIOTICS
SURGICAL TX CHOICES FOR PERIO.
OPEN FLAP DEBRIDMENT
GINGIVECTOMY/GINGIVOPLASTY
GUIDED TISSUE REGENERATION (GTR)
ROOT COVERAGE
DENTAL IMPLANTS
prolem-based recording system is designed to intro. the student to a tech. for developing an individualized tx. plan for each pt.
problem-based learning initially identifies significant prob. from the pt. med./dental hx from which a differential dental hygiene diagnosis will be made for each sign/ or symptom on the prob. list
PROBLEM LIST
RISK ASSESS. FOR PERIO. DISEASES
SOFT TISSUES
HARD TISSUE
PATHOLOGY
RADIOGRAPHIC FINDINGS
The Problem list will be used a s guide to develop a tx. plan & a comanagement or a referral system
Therapeutic decision making refers to the process of the use of the decision theory, which is the study of the best possible outcomes for decisions made under varying conditions, in making decisons about tx. of individual cases
AAP, "The Parameters of Care"" are strategies to assist oral healthcare practitioners in making clinical decisions from a range of tx. options to achieve a desired outcome
PERSONAL REFLECTION: WRITING DOWN A PLAN OF ACTION IS HELPFUL SO YOU CAN ELIMINATE OR/ & CHECK OFF ANY PROBABLE CAUSE OR SOLUTION; IN ORDER TO MAKE A DECISION OF EXECUTION
Decision-making tree can be also be used to help decide on the proper tx. in each case
TX PLANNING
PROGNOSIS: A PREDICTION OF THE FUTURE COURSE OF A MALADY W/ OR W/O TX
PROGNOSIS USUALLY REPORTED USING A GRADED SCALE: GOOD, GUARDED, OR POOR OR A SCALE W/ MORE INTERVALS SUCH AS GOOD, FAIR, POOR, QUESTIONABLE, OR HOPELESS
PERSONAL REFLECTION: BEFORE I MAKE ANY DECISION I WRITE DOWN THE PROS/ CONS TO WEIGH MY OPTIONS, IT IS IMPORTANT TO HAVE AN IDEA OF WHAT TO EXPECT IN MOST CASES
PT. COMANAGEMENT & REFERRAL TO A PERIODONTIST
ANY PT. WHO HAS 1 OR MORE PERIO. SITES THAT SHOW PERSISTENT SIGNS OF INFLAMMATION SHOULD BE CONSIDERED FOR REFERRAL - PT. FIT IN 1 OR MORE OF THE FOLLOWING #1-8
CHRONIC PERIO. W/ DEEPER PROBING DEPTHS, FURCATION INVOLVEMENT, &/ OR PROBLEMATIC GINGIVAL RECESSION
AGGRESSIVE (LOCAL, GENERALIZED) PERIO.
PERIODONTITIS ASSOC. W/ SYSTEMIC DISEASES
PERIODONTITIS W/ SIGNIFICANT OR INCREASING TOOTH MOBILITY
REFRACTORY OR RECURRENT PERIO.
PERIODONTAL LESIONS ADJACENT TO NECROTIC TEETH
PT. WHO HAS AESTHETIC CONCERNS ABOUT THE INTERPLAY BETWEEN TEETH, RESTORATIONS, & THE GINGIVA OR ALVEOLAR ARCHES
PT. W/ MUCOCUTANEOUS D/O AFFECTING THE ORAL SOFT TISSUES (EX. PEMPHIGUS, LICHEN PLANUS)
GUIDELINES FOR REFERRAL & COMANAGEMENT
PHASES OF TX
PHASE I: NONSX/ INITIAL PREP
PHASE II: PERIO. SX
PHASE III: RESTORATIVE CARE
PHASE IV: MAINTAINANCE CARE
IDEAL TX. PLANNING INCORPORATES A LOGICAL INTERPLAY BETWEEN PERIODONTAL & NONPERIODONTAL PROCEDURES
INFORMED CONSENT
BEFORE EXAM. & TX., THE PT. MUST GIVE CONSENT
PERSONAL REFLECTION: MUST HAVE SIGNATURE AND DOCUMENT EVERYTHING!!! & PT. REFUSAL
TX GUIDELINES
PERIO. HEALTH
SLIGHT (MILD) CHRONIC PERIO.
MODERATE CHRONIC PERIO.
SEVERE CHRONIC PERIO.
REFRACTORY PERIO.
GINGIVAL DISEASES
DENTAL-PLAQUE-INDUCED GINGIVTIS
PERIODONTITIS
NECROTIZING PERIO. DISEASES
PERI-IMPLANTITIS
ADJUNCTIVE TX
ANTIMICROBIALS
PERSONAL REFLECTION: I HAVE AN IMPLANT, TOOTH #13, I GET CHLORHEXIDINE RINSES WHENEVER I GO TO FOR A HYGIENE TX
GERIATRIC PT.
PLAQUE CONTROL
XEROSTOMIA
MEDICATIONS TO DECREASE FLOW
AGE-RELATED FACTORS MAY LIMIT THE ABIILITY OF A PT. TO PERFORM ADEQUATE ORAL SELF-CARE
(EX: DEMENTIA)