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Chp 22: Periodontal Maintenance Therapy (7 Components of Perio Maintenance…
Chp 22: Periodontal Maintenance Therapy
Vocab
Recurrent periodontal disease: occurs in patients who preciously responded well but later showed signs of disease reactivation
Can occur in patients with great oral hygiene and regular maintenance appointments
Refractory periodontal disease: occurs in treated periodontal patients who fail to respond to perio tx (e.g. maintenance)
May require antibiotic use, medical consult/referral, may need repeated SRP or surgery in affected area
4 Objectives of Perio Maintenance
prevent/reduce tooth/implant loss via monitoring
increase probability of locating/treating other diseases in the mouth
preserve health/comfort/function of teeth
prevent/minimize periodontal disease recurrence via risk factor control
Self: similar to goals in our clinic, overall benefiting patient's oral and systemic health via dental hygiene therapy
7 Components of Perio Maintenance Appointments
Update MHX/DHX, social histories can help begin smoking/alcohol cessation conversation
EOIO exam, oral cancer screening
Dental exam, perio/gingival assessments (e.g. probing/CAL, BOP, suppuration, tooth mobility, furcation involvement)
Removal of biofilm control: supra-/subgingival, root debridement, polishing, etc.
Review radiographs: check for carious lesions, endo/perio abscesses
Oral hygiene evaluation (e.g. plaque index)
Review patient's biofilm-control: time to go over OHE and P.I. scores
Self: all 7 steps are completed in our clinic with out patients! Woohoo!
Tx for Well-Maintained Patient
Show pt areas of mouth where biofilm control is difficult for pt, help improve technique/OH
Deplaque: can be done via hand instrumentation or ultrasonic (Piezo/Cavitron)
Selective tooth polishing: extrinsic stain removal
Determine recare interval: 3 months to avoid future destruction
Self: similar to 7 steps of perio maintenance visit, overall tx to complete 7 steps/goals
Chemotherapeutics
Do not replace brushing/flossing
Those with poor OH can benefit from
Examples: irrigation, desensitizing agent, systemic antibiotics on occasion
Self: Have seen benefit patient, such as swishing with chlorhexidine for 1-2 weeks to help irrigate implant/remove bacteria from implant site
Interval Frequency
Several reliant factors:
Patient adherence/compliance
Highest patient drop-out rate at 1 year
Untreated moderate-advanced perio lost average of .33 teeth per year!!
presence of appliances (e.g. ortho, prosthetic)
disease severity
type of treatment performed
adequacy of patient self-care
Self: 3 months! To reduce chance of bacteria causing damage/more attachment loss