maintenance for periodontal patient - periodontics Flashcards
list four goals of periodontal maintenance therapy
to minimise the recurrence and progression of periodontal disease
to reduce the incidence of tooth loss
increase the probability of detecting and treating other oral conditions
the expected outcomes of achieving these goals is to maintain the dentition throughout the life
list the typical steps performed during a periodontal maintenance an appointment
update medical status
clinical assessment: intra - oral examination, radiographic exam, periodontal exams.
evaluate of effectiveness of patient self care: plaque scores after API and SBI. patients need to be motivated to practice good self care . inform of their progress. disclosing solution is helpful for patients to see areas they are missing
identification of treatments needs: outine part of PMT is to perform through periodontal instrumentation. local delivery of antimicrobials . restorative therapy . prophylaxis
periodontal instrumentation: to create an environment biologically acceptable to the tissues of the periodontist. main adverse effect; disturbance of epithelial attachment, irreversible root substance removal and gingival recession. if no plaque/ calculus detected, no instrument
patients counselling: motivation biofilm removal, smoking cessation, counselling for other risk factors that may effect periodontal health, nutritional counselling.
application of fluorides: determine by the risk status, can promote remineralisation, high concentration may have antimicrobial effect. aids in prevention of root caries and control of dentinal hypersensitivity
describe how to establish an appropriate interval between maintenance appointments
frequency of visits is determine on an individuals basis
factors to consider when making determination include severity of disease, patients self care effectiveness and host responses - systemic or genetic factors
sub gingival pathogens return to pre- debridements levels in 9-11 weeks
periodontal maintenance should be performed every 3 months or fewer for removal and disruption of periodontal pathogen
describe the clinician signs of recurrent periodontitis
progressive attachment loss
pockets that bleed upon probing or exhibit exudate
pockets that get deeper over time
radiographic evidence of progression bone loss
increasing tooth mobility
list the reasons for recurrence of periodontitis
inadequate self care by the patients
incomplete professional treatment
failure to control systemic factors
inadequate control of occlusal contributing factors
improper periodontal surgical techniques
attempting to treat teeth with a poor prognosis
explain the term root caries and list recommendation to prevention of root caries
root caries refers to tooth decay that occurs on the root surface of the teeth. periodontal maintenance are at risk for root caries because of the exposed tooth surfaces. recommendations;
root caries can be arrested by remineralisation
fluoridated drinking water lowers risk
used dentifrice with 1100ppm NaF lower risk
mouth rinse containing 0.05% NaF lower risk
application of fluoride varnish every 3 months lower risk
silver diamine fluoride
what is periodontal maintenance therapy?
continuing patient care provided by members of dental team. intervals selected to meet the need of the individual patient. this phase includes measures used to keep the patient under control. essential elements of successful periodontal therapy.
what is the importance of PMT
maintained in a state of health
with good maintenance, patients can retain teeth or implants in function and comfort throughout their lives
what is the considerable effort on the part of the dental team for?
professional care at regular intervals
renewal of patients motivations
instructions in self care techniques
eliminate or reduction of risk factors
what is the office guidelines for planning PMT
can provide in general practice if previously treated for mild chronic periodontitis but with current stable periodontist. can alternate 3-6 month appointments between 2 practice with each seeing patient every 6 months
ideally pt should receive PMT in periodontal office if patient have severe chronic periodontitis, and aggressive periodontitis.
what is disease recurrence ?
the return of disease in a patient who has been previously successfully treated for periodontitis.
option for managing disease recurrence
be alert for need re-treat when performing PMT
if self care is inadequate, then complete NSPT followed by the reevaluation
if failure to complete PMT schedule, complete NSPT. stress need for PMT schedule and follow with reevaluation
if patient self care is adequate and appears locally, complete localise periodontal instrumentation, local delivery antimicrobial agents and localise surgical therapy
if generalise attachment has occurred, erases for contributing systemic factors and consider referral to a periodontist
what is compliance for PMT
the extent to which a person’s behaviour coincides with medical or health advice
patients do not follow recommendation for daily self care is non compliant
patient who meet regularly schedule periodontal maintenance appt is compliant
what is the reasons for non compliance for PMT
different for each patient
fear of dental treatment
the expense of dental treatment
low priority for the patient
competing demands on the patient’s time or financial resources
patients want to deny having a problem
failure to understand the implication of non compliance
perceived indifference on the part of dental health care workers
strategies for improving compliance
printed self care instruction
appt reminders - contact regarding missed appt
vary your approach
appt reminders
seek out patients concerns - open-ended questions
positive feedback - compliment patients
simplify self care - limit number of aids and consider alternative to floss
occurrence of root caries (PMT)
if the tooth root surface is exposed to the oral environment because of loss attachment.
new root caries are often seen shallow, softened area that is yellow and light brown
older lesions appear brown to black
risk factors associated with root caries incidence
history of past root caries
number of surface at risk
poor oral hygiene
gender
age
periodontal disease
attachment loss
inadequate oral hygiene
cariogenic diet
infrequent dental visits
inadequate saliva flow
lack of fluoride exposure
removable partial denture
anti microbial and supplemental therapist for caries (PMT)
chlorhexidin: effective reducing caries
xylitol: containing gums and lozanges - 6-10g of xylitol
casein phosphopeptide: calcium phosphate paste are recommended for extreme caries
caries risk management
protocol for clinician management of caries risk factor level. first step in managing the disease process. four risk levels - low moderate, high, and extreme
recommendation for levels of risk
ow risk: fluoridate toothpaste twice daily. optional professional fluoride.
moderate risk: fluoride toothpaste twice daily with 0.05% mouth rinse. fluoride varnish application at maintenance appointments. salivary tests are optional.
high risk: 5000ppm fl toothpaste twice daily. fluoride varnish application at 3 month intervals. salivary test are recommended
extreme risk: 5000ppm fl toothpaste twice daily, fluoride varnish application at 3 months intervals. salivary test recommended and backing soda rinses, 0.5%Naf rinses, calcium/phosphate paste may be recommended
