Perio treatment planning/charting extra info Flashcards
What are the 5 treatment planning phases
- Initial examination and pain relief
- Cause related (non-surgical) therapy
- re-examination
- definitive treatment plan
- maintenance
What do we do in phase 1 of treatment planning
Initial examination and pain relief:
- pain relief is a priority
then
- a full and thorough examination should be completed
- perio diagnosis which allows INITIAL tp
What is the GOAL of Cause Related therapy (phase 2) NSPT:
the objectives of cause related therapy are
- to resolve the disease process
- to create conditions that will MITIGATE AGAINST THE RECURRENCE OF THE DISEASE
- INVOLVES CONTROLLING DENTAL PLAQUE SUPRA/SUB
What clinical considerations are there (what can we take into account) for cause related therapy(6)
suggested by clinical examinations and radio reports:
- caries
- restoration overhangs etc
- furcation involvement
- sensitivity testing
- occlusal trauma
- mobility
what ADVICE can we give within stage 2 (cause related therapy) to our patients? - THIS IS THE HYGIENE PHASE (6)
OHI
denture hygiene
smoking cessation
alcohol reduction
dietary advice
dentine hypersensitivity
What is the point of cause related therapy
Designed to identify and control risk factors for perio disease and begin active therapy.
INDIVIDUALISED FOR EACH PATIENT
what is involved with phase 3 - the re-examination
this is necessary to determine the patients RESPONSE to treatment
what ocurrs if the treatment provided is a sucess
if stability is achieved the patient should progress DIRECTLY to maintenance therapy (phase 5!!!!) or supportive therapy. pt is NOT cured and recurrence is likely if plaque levels rise above the disease threshold. hence why maintenance is so important
what occurs if tx is a failure
ESTABLISH the cause of failure - there are many causes but the most likely is inadequate OH/pt compliance. if the cause can be corrected, further treatment may be given with the intent of achieving treatment success
if the cause CANNOT be corrected the patient goes to palliative care
what is palliative care?
this is NOT the same as maintenance
maintenance is a recall system for patients once their disease is established and stabilised!
it is designed to try and maintain disease stability - MAIN AIM IS TO SLOW DISEASE DOWN WHILE ATTEMPTING TO KEEP PATIENT COMFORTABLE WITH FUNCTIONING DENTITION - because the pt cannot maintain plaque control - physical disability etc
what is involved in phase 4 (definitive treatment)
may include:
- rsd (second time round? - due to unresponsive patient)
- perio surgery - dependant on findings at the re-examination stage
- endo tx
- definitive rests and prosthetic treatment
PATIENTS CAN ONLY PROGRESS ONTO PHASE 5 ONCE THE PERIODONTIUM IS STABLE
what is involved in phase 5 - MAINTENANCE
recall system which attempts to maintain periodontal stability - tailored to each individual it terms of how often they are seen.
What does susceptibility to disease mean
this describes an INDIVIDUALS HOST RESPONSE TO PLAQUE
can be determined by the level of disease relative to patients age and OH
What is involved in a simple perio assessment/review
BOP - present or absent?
PPDs - measured in mms using a CP12 probe
LOA - measured using the CP12. Base of the pocket to the ACJ
Furcation - probe can be inserted into the space between multi-rooted teeth
Mobility - movement out-with norm
What can radiographs identify
- overhangs/ledges
- calculus
- impacted teeth
- suggestion of furcation (arrow head lesions)
- pathology PA
list the different aspects of 2017 classification of perio
HEALTHY, GINGIVITIS OR PERIO - ID recession or radiographic bone loss?
DISEASE PATTERN - MI pattern, localised or generalised
STAGING - based on HOW MUCH bone loss
GRADING - proportion of bone loss against the patients age
STABLE - BOP is less than 10% overall and no bop at 4mm sites and no pocketing over 4mm
REMISSION - BOP is more than 10%, no bleeding at 4mm sites
UNSTABLE - pockets of 5mm or more OR bleeding at sites of 4mm or deeper
RISK FACTORS - eg uncontrolled type 1 db or smoker, stress
What is the definition of a diagnosis
this gives concise description of presenting disease in a particular mouth at a particular time
useful on its own and helps indicate any change over a perio of time
should always be recorded in the patients notes
IN terms of diagnosis, what is the criteria for clinical gingival health?
- less than 10% BOP
- no ID recession
- pt able to maintain low plaque scores
in terms of dx, what is the criteria for localised gingivitis
- no obvs signs of id recession
- redness, sweeling
- 10-30% bop
- ? false pocketing
- reversible
in terms of diagnosis, what is the criteria for generalised gingivitis
- no obvious ID recession
- redness, swelling
- more than 30% bop
- ?false pocketing
- reversible
what % of teeth affected to get a localised perio dx
up to 30% of teeth affected
What % of teeth affected do we need for gen perio
more than 30% of teeth affected
When is staging and grading of perio performed?
this is performed once periodontitis has been diagnosed - this will help to assess severity and extent of disease
what does staging reflect?
- this reflects the SEVERITY of disease at presentation.
- it is based on radiographic bone loss assessment alone
- based on the % of bone loss in relation to the root length
- BASED ON THE MOST SEVERE SITE IN THE MOUTH
- staged 1-4
