Non- surgical periodontal therapy and phases of care

Question 1

Define non-surgical periodontal therapy

Answer 1

Control of plaque-induced gingivitis or periodontitis through
• Periodontal instrumentation
• Supported by patient’s daily self-care measures
• Use of chemical agents (adjunctive therapy)

Question 2

Describe the indications of non-surgical periodontal therapy

Answer 2

Non-surgical periodontal therapy is required for patients with plaque-associated gingivitis or periodontitis
• Usually controls plaque-induced gingivitis
• Usually controls mild to moderate periodontal disease (Stages 1 & 2)
• Usually precedes periodontal surgery in those patients with severe periodontitis

• Surgery is indicated for patients with more advanced periodontitis AFTER non-surgical periodontal therapy is completed
• Non-surgical periodontal therapy may minimize the extent of surgery that is needed

Question 3

Explain the goals of non-surgical periodontal therapy

Answer 3

• Return the periodontium to health
• Maintain health with professional care and daily patient self-care
• Eliminate inflammatory disease in the periodontium
  
  • Minimize bacterial challenges to the patient
  • Eliminate or control local risk factors for periodontal disease
  • Minimize impact of systemic risk factors for periodontal disease
  • Stabilize attachment level

Question 4

Describe the role of periodontal instrumentation

Answer 4

• Objectives
• Subgingival plaque bioflim within pockets cannot be reached with a toothbrush or floss
○ Physical removal of bacterial plaque biofilm, and their volative by- products, is the most effective mechanism of control

Role:
○ To arrest progress of periodontal disease
○ To induce positive changes in subgingival bacterial flora
○ To eliminate inflammation in the periodontium
○ To increase effectiveness of patient self-care
○ To prevent recurrence of periodontal disease during periodontal maintenance

Question 5

Describe the steps required to develop a treatment plan for non-surgical periodontal therapy

Answer 5

Plan treatment that controls or eliminates
• Primary etiologic factors
• Local risk factors
• Systemic risk factors

• Selected procedures should meet the individual needs of the patient

• Depending on risk factors, patient needs and severity of disease treatment may require several appointments
  
  • Sextants
  • Quadrants
  • Half mouth

Question 6

List the phases of care

Answer 6

Systemic

Control

Conservation

Corrective

Maintenance

Question 7

Describe the systemic phase of care

Answer 7

Known as the information required to proceed with treatment

• Health history
• Precautions (take vital signs)

Question 8

Describe the control phase of care

Answer 8

Relief of pain, possibly leading to the consultation, referral

• Addressing chief complaint, including special tests, radiographs, etc.
• Stabilise infection or oral disease prior to making further decisions on treatment
• Consult or referral

Question 9

Describe the conservation phase of care

Answer 9

Treatment (beginning with initial assessment through non-surgical perio tx up to, but not including review)

6 week review
• Assess response to care
• Re-treat as required (no perio probing)
• Assess & review OH

3 month review
• Periodontal Re-assessment
• Re-evaluate individual tooth and overall prognoses
• Results will determine:
○ Recall based on risk assessment,
○ Referral to Periodontist (surgical therapy may be required), or
○ Second course of non-surgical treatment

Question 10

Describe the corrective phase of care

Answer 10

Additional corrective measures (restorative, surgical perio therapy)

Question 11

Describe the maintenance phase of care

Answer 11

Oral / perio health maintained through recall

• Recall appointments include the following:
• Review and update medical and smoking history
• Extra- and intra- oral examinations
• Periodontal chart (minimum of once yearly)
• Supra- and sub- gingival exploration
• Re-instrumentation of bleeding sites
• Polishing and application of fluoride, as required