perio in the maintenance phase Flashcards
What is the sequence of tx of periodontitis?
Step 1- behavioural change and risk factor control
Step 2- subgingival PMPR
Step 3- management of non-responding sites
Step 4- supportive perio care (maintenance)
What is periodontal stability?
Bleeding of probing <10%
PPD 4mm or less
No BOP at 4mm sites
May not be achievable in severe stage III/IV
What is the aim of periodontal supportive care?
Maintain perio stability in all treated perio pts
Combine step 1 and 2 at regular intervals
If recurrent disease, new assessment and tx plan
Why do pts need supportive periodontal care?
Successfully treated pts remain at high risk of perio recurrence/progression
Need to control plaque, risk factors and to disrupt biofilm
Regular compliance limits progression and tooth loss
Needs to be strongly promoted
What does the maintenance appt involve?
Assessment and monitoring
Changes to systemic health/lifestyle
Reinforce OHI
Pt motivation of risk factors
PMPR supra and sub
45-60 mins- personalised
How can you structure the maintenance appt?
1. Interview
2. Assessment
3. Evaluate intervention needs
4. Communication
5. Practical interventions
6. Planning next interval
What are important factors of the history?
Changes to med history
-esp meds
Diabetes? Controlled?
Pregnancy- hormonal changes
Stress- career/family
Smoking- regression?
Oral hygiene regime- any changes?
Do we take radiographs?
Case by case basis
Secondary to clinical exam when they have the potential to change pt management
What oral hygiene instructions should be given?
Individual and repeated
Interdental cleaning
Powered can be considered
What are adjunctive therapies that could be recommended?
Antiseptic mouth rinses can be considered in specific cases
Containing chlorhexidine, essential oils or cetylpyridinium chloride
Short term use
How often should recall visits occur for engaging pts?
Stage I, Grade A- maintain according to risk
Stage II/III/IV- maintain 3 monthly
How compliant are pts with SPC?
25% don’t return
Smokers have lower compliance rate
Successfully tx pts w compliance have better prognosis
What is an engaging pt?
Plaque levels 20% or less
Bleeding levels 30% or less
OR
50% or more improvements in plaque and bleeding scores
What if the pt isn’t engaging?
Step 1-
1 month- reinforce OHI and risk factor control
3 month- re evaluate
If not engaging-
Repeat step 1
3 month reevaluation
If still not engaging-
PALLIATIVE PERIO CARE
What is palliative perio care?
Brief step 1
Every 6 months for stage I/II
Every 3 months for stage III/IV
If they start to engage- can move on to step 2
