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CHAPTER 22: PERIODONTAL MAINTENANCE THERAPY (COMPONENTS OF THE PERIO.…
CHAPTER 22: PERIODONTAL MAINTENANCE THERAPY
REFRACTORY PERIO. DISEASES/ RECURRENT PERIO. DISEASES
OBJECTIVE OF PERIO. MAINTENANCE
PRIMARY PREVENTION
; PERIO. MAINTENANCE IS INDICATED FOR 3 TYPES OF PT. 1. PERIODONTALLY HEALTHY PT. WHO HAVE NEVER HAD PERIO. DISEASE AS PREVENTIVE PROCEDURE
SECONDARY PREVENTION
; 2. PT WHO RESPOND FAVORABLY AFTER ACTIVE PERIO. THERAPY TO PREVENT OR MINIMIZE THE RECURRENCE & PROGRESSION OF PERIO. DISEASE & TOOTH LOSS
MEDICALLY COMPROMISED PT. OR PT. WHO MAINTAIN POOR ORAL HYGIENE & ARE NOT CONSIDERED CANDIDATES FOR PERIO. SX.
REFRACTORY= DISEASE OCCURS IN TREATED PERIO. PT WHO FAIL TO RESPOND TO PERIO. TX INCLUDING MAINTENANCE THERAPY
RECURRENT= OCCURS IN PT. WHO PREVIOUISLY RESPONDED WELL TO PERIO. THERAPY BUT LATER SHOWED SIGNS OF DISEASE REACTIVATION
PERSONAL REFLECTION: WHEN I HAVEN'T BEEN TO THE GYM IN A WHILE I HAVE A HARD TIME TO COMPLETE A BASIC WORKOUT BUT WHEN I MAINTAIN A REGULAR WORKOUT SCHEDULE I FEEL BETTER AND MY BACK PAIN IS MINIMAL
COMPONENTS OF THE PERIO. MAINT. VISIT
AN UPDATE OF MED. & DENTAL HX, 2. EOIE, 3. DENTAL EXAM., 4. RADIOGRAPHS 5. OHE, 6. REVIEW OF PT. BIOFILM-CONTROL EFFICACY
REMOVAL OF DENTAL BIOFILM FROM SUBG. & SUPRAG., ROOT DEBRIDE., TEETH POLISHING & ADJUNCTIVE CHEMOTHERAPY
MEDICAL & DENTAL UPDATE
INFORM PT. ABOUT AVAILABLE PROGRAMS FOR
SMOKING CESSATION!!!
EOIO
DENTAL EXAM.
GINGIVAL & PERIO. ASSESS.
PERIO. ASSESS.; RECESSION, CAL, PROBING, BOP, & TOOTH MOBILITY
GINGIVAL ASSESS.; VISUAL EXAM, COLOR, CONTOUR, CONSISTENCY, & SURFACE TEXTURE PLUS ANY MUCOGINGIVAL INVOLVEMENT & INFLAMMATION
RADIOGRAPHIC REVIEW
OHE
DENTAL IMPLANTS
PERSONAL REFLECTION: IN CLINIC I UNDERSTAND THAT NO MATTER THE SITUATION; FOLLOWING PROTOCOL IS IMPORTANT TO GATHER NEW OR UPDATE PT. DATA
TREATMENT: RECURRENT PERIO. DISEASE VS. WELL-MAINTAINED PERIODONTIUM
CHEMOTHERAPEUTICS
FREQUENCY OF INTERVALS
PATIENT ADHERENCE-COMPLIANCE AND COOPERATION
WELL-MAINTAINED PT. IN WHOM INFLAMMATION IS NOT PRESENT & FOR WHOM SOFT TISSUE ATTACH. LOSS OR BONE LOSS IS MINIMAL= 1. POINT OUT ANY AREAS IN THE MOUTH WHERE THE PT. IS HAVING DIFFICULTY W/ BIOFILM CONTROL, & CORRECT THE PT. TECH., IF NECESSARY; 2. DEPLAQUING MAY BE PERFOMED. IN PT WITH LITTLE OR NO SUBG. DEPOSITS, A DEPLAQUING STROKE CAN BE USED W/ A CURET OR ULTRASONIC ("FLOATING" W. THE TIP OF THE INSTRUMENT); 3. SELECTIVE TOOTH POLISHING, EXTRINSIC STAINS; 4. DETERMINE THE INTERVAL OF THE NEXT PERIO. MAINTENANCE VISIT
PERSONAL REFLECTION: IT IS IMPORTANT TO ALWAYS GO OVER OHE AND ANY DENTAL HYGIENE/ POST OP. INSTRUCTIONS WITH PT UNTIL THEY DEVELOP A ROUTINE, ADDITIONALLY, IT IS HELPFUL TO REMIND AND MAKE EACH PT. FEEL IMPORTANT
GENERAL DDS-PERIODONTIST RELATIONSHIP
PERIO. PT. CAN BE MONITORED BY BOTH THEIR GENERAL DENTIST & THEIR PERIODONTIST, BUT SHOULD BE SEEN BY THE PERIODONTIST @ LEAST ONCE A YEAR FOR A THOROUGH PERIO. EVAL.
GINGIVITIS OR MILD CHRONIC PERIO. PT. CAN RECEIVE TOTAL CARE, INCLUDING CHRONIC PERIO. MAINT. BY THE GENERAL DENTIST
MODERATE CHRONIC PERIO. PT. SHOULD ALTERNATE PERIO. MAINT. VISITS BETWEEN THE GENERAL DENTIST & PERIODONTIST ONCE ACTIVE TX IS COMPLETE
SEVERE CHRONIC PERIO. PT. SHOULD BE SEEN PRIMARILY BY PERIODONTIST W/ ANNUAL APPTS. W/ THE GENERAL DENTIST FOR GENERAL CARE
REFRACTORY PERIO. & AGGRESSIVE PERIO. PT. SHOULD BE SEEN EXCLUSIVELY BY THE PERIODONTIST FOR ALL ACTIVE PERIO. TX.
PERSONAL REFLECTION: DENTISTRY IS A MULTIDIMENSIONAL PRACTICE, DEVELOPING AND MAINTAING A HEALTHY RELATIONSHIP WITH ALL DOCTORS/ DENTIST EQUALS THE BEST RESULTS FOR THE PT.
PATIENT ADHERENCE
3 TYPES OF COMPLIERS
: 1. FULL COMPLIERS, 2. IRREGULAR COMPLIERS, 3. NONCOMPLIERS
BETTER COMMUNICATION MAY CONTRIBUTE TO MORE SUCCESSFUL OUTCOMES; OTHER METHODS= PROVIDING POSITIVE REINFORCEMENT & ATTEMPTING TO BETTER ACCOMMODATE PT. NEEDS; FURTHERMORE, THE SEVERITY OF THE PERIO. PROBLEM SHOULD BE STRESSED BC THE MORE THERATENING A PT PERCEIVES A DISEASE, THE HIGHER IS THE ADHERENCE
1984, SOME COMMON REASONS FOR PT. NONADHERENCE W. OFFICE VISITS INCLUDE THE EXPENSE, THE BELIEF BY PT. THAT THEY NO LONGER REQUIRE TX. BC THEY NO LONGER HAVE ANY SIGNS OF DISEASE, FEAR OF DENTAL TX., OR LIFESTYLE CHANGES
PROVIDING PT. W/ MOTIVATIONAL STRATEGIES; 1. GIVING PT. PRINTED SELF-CARE INSTRUCTIONS @ EVERY PERIO. MAINT. VISIT, 2. NOTING THE NEXT PERIO. MAINT. APPT. ON THE INSTRUCTIONS, 3. COUNSELING PT. ABOUT THEIR CONDITION & THE BENEFIT-TO-RISK RATIO OF HAVING PERIO. MAINT., 4. SEEKING OUT PT. CONCERNS & RESPONDING TO THEM, 5. SENDING REMINDERS OR CALLING PT. ABOUT THEIR NEXT PERIO. APPT.