Exam 3 Tx & Prognosis Flashcards
Except for _________ no dental TX should be initiated until a TX plan is established and accepted by patient
Emergencies
After a diagnosis and prognosis have been determined the __________ and ___________ is planed
- treatment
- sequence
Treatment plan may require the following types of decisions
1) Extract/retain teeth
2) Pocket therapy techniques that will be used (surgical or non-surgical)
3) Need for occlusal therapy- before, during or after pocket therapy
4) Use of dental implants
5) Temp restorations/provisional crowns
6) Final restorations that will be needed after therapy, teeth serve as abutments for prosthesis.
7) Ortho consult
8) endo therapy
9) esthetic considerations
10) sequence of therapy
11) medical consult
The urgent phase of care begins with a through review of the patients ________ condition and history.
This initial emergency appointment is to establish patient comfort, it includes:
1______________
2______________
-Medical
1) Eliminate pain and /or abscess
2) Address emergency concern
Control phase includes what ? (6)
1) Control of active pathological lesions (apical, perio abscess, primary occlusal trauma)
2) Control caries an dinital tooth prep and provisonal (operative dentistry)
3) Provisional restoration for esthetic and/or functional reason
4) Control plaque & intial perio therapy
5) Oral surgery procedures
6) Initiation of endodontic treatment
Re-evaluation phase is to determine what?
The response to our initial therapy BEFORE our definitive phase.
What may the Re-evaluation phase include?
1) Completion of endo TX (post and core)
2) Reeval of occlusal adj
3) reveal of provisional restoration
4) reevaluation of response after initial perio therapy and plaque control
5) definitive perio surgery (osseous re-contour/mucogingival defect)
6) Re-prep of teeth after perio surgery
7) Healing time after oral/perio surgery
8) Establishing design for fixed and removable pros
9) Final eval of esthetics
Anything that needs a lab slip is __________ phase
Definitive
After reassessing the initial TX, the patient entrees the ____________ or __________ phase of TX.
This phase includes all therapies that _______ function after the patients disease has been __________
- Corrective
- Definitive
- Restore
- Controlled
Examples of the definitive phase include ?
1) Fixed and removable prosthodontics
2) Implant restoration
3) ortho
What are the regular re-care examinations for the maintenance phase?
1) Reassessment of occlusion
2) Reassessment of maintenance for any completed treatment
3) Reassessment of patient’s home care
What is gingivitis?
1) Inflammation soft tissue (superficial)
2) Bleeding on provocation
3) PD 1-4 mm and present as psuedopocket
4) No loss of attachment or radiographic evidence of bone loss
5) No tooth mobility
6) No furcation involvement
What is the initial therapy Phase I of gingivitis?
1) Medical consult
2) OHI
3) Full-mouth scale and polish
4) Re-evaliation 4-6 weeks
5) Prophylaxis every 6 months if disease resolved
What is the clinical presentation of Mild Chronic Perio?
1) Inflammation extending to bone
2) Bleeding on provocation
3) Attachment loss of 1-2 mm from CEJ
4) Probing depths of 3-4 mm
5) Radiographic bone loss of LESS than 20%
What is the initial therapy- Phase I for Mild Chronic Perio?
1) Medical consult
2) OHI
3) Quadrant or half-mouth scaling and root planning w/ anesthesia
4) Requires 2-4 appointments
5) Re-evaluation (4-6 weeks)
6) 3-4 month maintain interval
What is the clinical presentation of MODERATE Chronic Perio?
1) Inflammation extending to bone
2) Bleeding on provocation
3) CAL of 3-4 mm from CEJ
4) PD 5-6 mm
5) Radiographic bone loss of 20%-40%
6) Class I and II furcation involvement
7) Class I and II tooth mobility
What is the initial therapy- Phase I for MODERATE Chronic Perio?
1) Medical consult
2) OHI
3) Quadrant or half-mouth scaling and root planing w/ anesthesia
4) Requires 2-4 appointments
5) Re-eval (4-6 wks)
6) Locally delivered antimicrobials in 5-6 mm residual pockets
7) Referral to periodontist
What is the clinical presentation of ADVANCED Chronic Perio?
1) Inflammation extending to bone
2) bleeding on provocation
3) CAL of greater than 5 mm from CEJ
4) PD of greater than 7 mm
5) Radiographic bone loss greater than 40%
6) Class I, II , or III furcation involvement
7) Class I, II, or III tooth mobility
What is the initial therapy- Phase I for ADVANCED Chronic Perio?
1) Medical consult
2) OHI
3) Quadrant or half-mouth scaling and root planing w/ anesthesia
4) Requires 2-4 appointments
5) Re-eval (4-6 wks)
* *6) Locally delivered antimicrobials in 5-6 mm residual pockets
* *7) Referral to periodontist
What are the sequence of thought when determine prognosis?
1) Diagnostic
2) Therapeutic
3) Prosthetic
4) Provisional
What is diagnostic prognosis?
Prognosis without treatment
What is therapeutic prognosis?
What effect will periodontal TX have on course of disease?
What is prosthetic prognosis?
Given the anticipated result of perio TX, what is the forces for the success of the prosthetic restoration?
What is provisional prognosis?
The prognosis given prior initial phase of TX. It may change according to the patient/tooth response
Prognosis is divided into what 2 groups?
1) Overall prognosis
2) Individual tooth
Systemic Background (overall prognosis):
Sometimes the patient life expectancy is _________ than the tooth life expectancy. Seen in _________________ and _________________
- SHORTER
- AIDS
- Terminal stages of cancer
Systemic habits that affect prognosis ______________, _____________, and ______________.
1) Smoking
2) High refined sugar intake
3) Methamphetamine abuse
Overall prognosis is affected by what factors?
1) Systemic background ( smoking, AIDS (not HIV), Diabetes)
2) Pt attitude toward TX (compliance)
3) Availably of maintenance care
4) Vertical or horizontal bone loss
5) Furcation involvements (access for OH)
6) Pt history (Perio destruction, rate of disease, caries history (root especially)
7) Skill and interest of operator
8) Finances
____________ is the single most important risk factor
Smoking
Cigarette smokers are ___________ more likely than non-smokers to develop severe periodontitis.
5-8 times
- Smoking affects _______ and ______ in cross-section studies.
- Smoking has a ___________ incidence in longitudinal studies.
- Statistically there is significant association even after _________ for other risk factors
- prevalent
- severity
- HIGHER
- controlling
_______ inhibits ___________ healing following perio therapy.
- Smoking
- wound
Smoking ________ the quality of ___________ in shallow and deep pockets.
- Alters
- microbiota
Smoking _____________ NEUTS, Chemotaxis, Phagocytosis and oxidative burst.
DECREASES