Perio treatment step 3 and 4 Flashcards
what is step 1 for the BSP treatment of perio diseases?
number I
building foundations for optimal treatment outcomes
I: explain disease, risk factors and tx alternatives, risk and benefits including no treatment
what is step 1 for the BSP treatment of perio diseases?
number II
building foundations for optimal treatment outcomes
II: explain importance of OHI, encourage and support behaviour change for OH improvement
what is step 1 for the BSP treatment of perio diseases?
number III
building foundations for optimal treatment outcomes
III: reduce risk factors including plaque retentive features , smoking cessation and diabetes control interventions
what is step 1 for the BSP treatment of perio diseases?
number IV
building foundations for optimal treatment outcomes
IV: provide individually tailored OH advice including interdental cleaning.
+/- adjunctive efficacious toothpaste and mouthwash,
+/- professional mechanical plaque removal (PMPR) including supra and subgingival scaling of clinical crown
what is step 1 for the BSP treatment of perio diseases?
number V
building foundations for optimal treatment outcomes
V: select recall period following published guidance and considering risk factors such as smoking diabetes
what is step 1 for the BSP treatment of perio diseases?
number VI
building foundations for optimal treatment outcomes
VI: oral health educator (I,II), hygienist therapist (I-IV), dentist, practitioner accredited for level 2 and 3 care (I-V)
what do you do after step 1 for bsp guidelines of perio?
re-evaluate
non engaging patient repeat step 1
engaging patient move to step 2
consider referral
what is step 2 of bsp guidelines for perio?
Number 1
subgingival instrumentation (root surface debridement/ PMPR on root)
I: reinforce OH, risk factor control, behaviour change
what is step 2 of bsp guidelines for perio?
Number 2
subgingival instrumentation (root surface debridement/ PMPR on root)
II: subgingival instrumentation, hand or powered (sonic/ ultrasonic) either alone or in combination
what is step 2 of bsp guidelines for perio?
Number 3
subgingival instrumentation (root surface debridement/ PMPR on root)
III: use of adjunctive systemic antimicrobials determined by practitioner accredited for level 2 and 3 care
if step unstable and you go to step 3 for bsp perio guidelines what do you do?
Number I
managing non-repsonding sites:
I: reinforce OH, risk factor control, behaviour chnage
what do you do after step 2 of bsp perio guidelines?
re-evaluate after 3 months
unstable -> step 3
stable -> step 4
if step unstable and you go to step 3 for bsp perio guidelines what do you do?
number II
managing non-repsonding sites:
II: moderate (4-5mm) residual pockets - re-preform subgingival instrumentation
if step unstable and you go to step 3 for bsp perio guidelines what do you do?
number III
managing non-repsonding sites:
III: deep residual pocketing (6>=mm) consider alternative causes
if step unstable and you go to step 3 for bsp perio guidelines what do you do?
number IV
managing non-repsonding sites:
IV: consider referral for pocket management or regenerative surgery
if step unstable and you go to step 3 for bsp perio guidelines what do you do?
number V
managing non-repsonding sites:
V: if referral not possible, re-perform subgingival instrumentation (if all sites stable after step 3 proceed to step 4)
if stable and you to step 4. what step 4 for the bsp perio guidelines?
Number I
maintenance
I: supportive periodontal care strongly recommended
if stable and you to step 4. what step 4 for the bsp perio guidelines?
Number II
maintenance
II: Reinforce OH, risk factor control, behaviour change
if stable and you to step 4. what step 4 for the bsp perio guidelines?
Number III
maintenance
III: regular targeted PMPR as required to limit tooth loss
if stable and you to step 4. what step 4 for the bsp perio guidelines?
Number IV
maintenance
IV: consider evidence based adjunctive efficacious tooth paste and or mouthwash to control gingival inflammation
after step 4 of bsp perio guidelines?
maintenance recall individually tailored intervals from 3 -12 months
how do you define if a pt is engaging?
engaging - plaque levels <= 20 percent and bleeding levels <30 percent or 50 percent improvement
what to do for decision making at re-evaluation? If he has Poor OH, persistent inflammation
identify reason for poor OH, then supportive care or repeat cause-related therapy
what to do for decision making for this perio lecture? Good OH, inflammation resolved?
supportive care & proceed with treatment plan
what to do for decision making for this perio lecture? Good OH, persistent deep pockets with BOP?
consider surgical access or repeat RSD, then re-evaluate
what is the ideal endpoint?
No pockets > 4mm
No pockets = 4mm with BOP
BOP < 10%
Functional and comfortable dentition
Plaque scores < 20% (or target for patient)
But not all patients will reach these….but they can still maintain a functional dentition…
why supportive peridontal care?
Patients who are not maintained in a supervised recall program subsequent to active treatment show obvious signs of recurrent periodontitis
The more often patients present for recommended supportive periodontal treatment (SPT), the less likely they are to lose teeth.
Treated patients who do not return for regular recall are at 5.6 times greater risk for tooth loss than compliant patients.
how is supportive periodontal car done?
3 separate parts.
Part I – exam
- MH changes
- oral pathologic examination oral hygiene status (plaque chart)-
- gingival changed
- pocket depth changes
- mobility changes
- occlusal changes
- dental caries
- restorative, prosthetic and implant status
Part II – treatment
- oral hygiene reinforcement
- supra gingival scaling
- root surface debridement
- polishing
Part III: report, cleanup and scheduling
- write report in chart
- discuss report with pt
- schedule next recall visit
- schedule further periodontal tx
- schedule or refer for restorative or prosthetic tx
what is part 1 exam of the supportive periodontal care?
- Similar to the initial evaluation of the patient
- Updating medical history
- Oral mucosa inspected for pathologic conditions
- Evaluation of restorations, caries, prostheses, occlusion, tooth mobility, bleeding on probing, and periodontal and periimplant probing depths
- Analysis of the current oral hygiene status of the patient is essential.
- The dentist primarily looks for changes that have occurred since the last evaluation
what is part II treatment of supportive periodontal care?
- Required scaling and root surface debridement (supra and subgingival PMPR) are performed, (based on pocket chart/plaque chart).
- don’t instrument sites non-deep sites with no calculus as could create attachment loss
causes for recurrence of perio disease?
- Often can be traced to inadequate plaque control on the part of the patient or failure to comply with recommended SPT schedules.
- Inadequate or insufficient treatment that has failed to remove all the potential factors favoring plaque accumulation.
- Incomplete calculus removal in areas of difficult access.
- Inadequate restorations placed after the periodontal treatment was completed.
- Failure of the patient to return for periodic checkups. This may be a result of the patient’s conscious or unconscious decision not to continue treatment or the failure of the dentist and staff to emphasize the need for periodic examinations.
- Presence of some systemic diseases that may affect host resistance to previously acceptable levels of plaque.
