Periodontal Treatment Steps

Question 1

What occurs at step 1?

Answer 1

• education and explanation of the disease progress
• OHI
• control risk factors
• PMPR of accessible plaque
• arrange review

Question 2

When should you progress to step 2?

Answer 2

Upon re-evaluation

Has patient cooperated with treatment? If so then move to 2, if not repeat 1

Question 3

What occurs at Step 2?

Answer 3

Begin subgingival instrumentation

PMPR / RSD on root

Consider use of adjunctive systemic antimicrobials

Question 4

What considerations should make before moving to Step 3/4?

Answer 4

Reevaluate, if patients condition is stable then move on to step 4 directly

If unstable move to step 3

Question 5

What is step 3?

Answer 5

Manage non responding sites

• reinforce the OH, behaviour change and risk factor control
• re-perform sub gingival instrumentation on non responding pockets
• consider referral to regenerative surgery if pt is engaging with treatment
• if referral not possible, do sub gingival instrumentation and if stable then refer

Question 6

What is step 4?

Answer 6

Supportive periodontal therapy

• reinforce OHI, RF
• regular, targeted PMPR
  Maintenance recall individually tailored between 3-12 months

Question 7

Define engaging patient

Answer 7

> 50% improvement in plaque and bleeding scores

Or

Plaque levels <35%

Bleeding levels <30%

Or

Patient met targets in their personal self care plan

Question 8

What makes a non engaging patient

Answer 8

Insufficient improvement in OH, <50% improvement in plaque and bleeding scores

Or

> 20 plaque >30% bleeding

Or

Pt states preference to palliative approach