rationale for periodontal treatment Flashcards
What is the host bacterial interaction theory?
Biofilm +inflammation = tissue loss –> tooth loss
Any treatment that will MINIMIZE or PREVENT the * Accumulation, * Adherence * Maturation of biofilm will be beneficial.
Any treatment that will IMPEDE the SPREAD of inflammation will be beneficial.
generally the diagnosis of gingivitis is based on what? periodontitis is based on what?
Generally, the diagnosis of GINGIVITIS is based on the presence and extent of gingival inflammation, frequently measured as BOP, and PERIODONTITIS is based on the presence and extent PD, CAL, MOBILITY, and the pattern and extent of alveolar BONE LOSS assessed radiographically. In addition, consideration may be given to age, gingival recession, medical and dental histories, previous treatment, and signs and symptoms, including pain, ulceration, and microbial deposits.
why can the definition of periodontitis be confusing?
The definition of periodontitis can be confusing.
Some definitions use a combination of PD and CAL, whereas others are based on PD or CAL alone. No consensus has been reached on the threshold values for PD and CAL or on the numbers of sites or teeth that must be affected to constitute disease.
how do you tell if it is mild, moderate, or advanced periodontitis?
Mild chronic periodontitis was defined as as >2 interproximal sites with CAL > 3 mm and > 2
interproximal sites with PD > 4 mm (not on the same tooth) or one site with PD > 5 mm
Moderate Chronic periodontitis defined as localized or generalized loss of up to 1/3 of the supporting periodontal tissues, including Class I furcations, with PD measuring up to 6 mm and CAL up to 4 mm.
Advanced chronic periodontitis was defined as localized or generalized loss of more than one-third of the supporting periodontal tissues with furcation involvement higher than Class I, PD >6 mm, and CAL >4 mm.
what distinctive criteria are recommended for the case definition of aggressive periodontitis (AP)?
Criteria for the diagnosis of AP
An early age of onset, usually<25 years of age.
The age of onset may be a predictor of the severity of AP, so the younger the age of onset, the more severe the disease that may develop.
- Loss of periodontal tissue occurs at multiple permanent teeth and detectable clinically and radiographically. (vertical bone loss at the proximal surfaces of posterior teeth) The pattern of bone loss is usually similar bilaterally. In advanced cases the lesions may be depicted radiographically as a horizontal loss of the alveolar bone.
- Progresses rapidly.
- The primary teeth may also be affected.
- The patients are systemically healthy.
what are the steps in periodontal management?
The steps in periodontal management ..
Examination –> Diagnosis –> Prognosis –> Treatment plan-> Tx
The 1st part of the treatment is known as INITIAL THERAPY (phase 1)
Recall the patient in 4-6 weeks – this appt is called: EVALUATION OF INITIAL THERAPY.
If some or all sites did not respond after initial Tx, re-evaluate local/behavioral/systemic factors and re-do initial therapy. If patient is maintaining good PC and there are no obvious aggravating factors, you may treat the unresponsive sites with PERIODONTAL SURGERY OR SOME OF THE NEWER HOST-MODULATION PRODUCTS. (this is phase 2)
what’s the first part of the periodontal treatment called? what is the rationale?
In the management of chronic periodontal diseases, the first part of the treatment is called [1] INITIAL THERAPY. (Phase 1)Rationale: * To control the biofilm (etiologic factor) and local/behavioral/systemic factors.
You control biofilm by initiating a plaque control program
Local management involved thorough debridement (SRP). . scaling and root planing.
in primary therapy or initial therapy what are local aggravating factors and how can biofilm and calculus be removed?
Biofilm and calculus could be eliminated by providing appropriate PCI & SRP
Local aggravating factors [e.g. caries, defective restorations] etc. may be eliminated by an appropriate method.
how do you control behavioral factors?
Controlling BEHAVIORAL FACTORS e.g.: SMOKING, STRESS INVOLVES A GOOD MEASURE OF PATIENT COUNSELLING
how do you manage certain systemic conditions?
Managing certain SYSTEMIC CONDITIONS.e.g.; Diabetes involves consulting with a physician AND/OR byIntervening systemically (antibiotics)e.g.; Aggressive perio, systemic manifestations, prevent bacteremia, after certain perio surgery, acute gingival lesions, AIDS etc.
after completing intial treatment how long do you wait and then what do you do? what is this called?
Evaluate the patient after about 4-6 weeks.
Evaluate the patient after about 4-6 weeks.
EVALUATION OF INITIAL THERAPY
IT IS STILL UNDER THE PHASE ONE UMBRELLA.
How do you evaluate the intial therapy?
Tissue response: Re-exam periodontal tissues and compare findings with baseline data.
Attitude response: If PC is not satisfactory, have the pt demonstrate PC techniques – reiterate/reinforce, if needed.
if the general conditions has not improved what do you do?
The steps in periodontal management ..
Examination –> Diagnosis –> Prognosis –> Treatment plan-> Tx
The 1st part of the treatment is known as INITIAL THERAPY (phase 1)
Recall the patient in 4-6 weeks – this appt is called: EVALUATION OF INITIAL THERAPY.
If some or all sites did not respond after initial Tx, re-evaluate local/behavioral/systemic factors and re-do initial therapy. If patient is maintaining good PC and there are no obvious aggravating factors, you may treat the unresponsive sites with PERIODONTAL SURGERY OR SOME OF THE NEWER HOST-MODULATION PRODUCTS. (this is phase 2)
(or perhaps non-surgical/host modulation treatment) (e.g.; topical AB, Periostat, periowave)
During evaluation of initial Tx, some sites may have responded well and others may not have. Re-evaluate all possible Local and systemic aggravating factors. May need to go back to SRP. OR… these sites may require,
SURGICAL INTERVENTION (provided the patient can demonstrate good PC) or NON-SURGICAL/ Host- MODULATION Tx (Periowave. Periostat). Also called PHASE 2 treatment.
Surgical Tx may include… GINGIVECTOMY FLAP SURGERY
MUCO GINGIVAL SURGERY
[more info on surgery will be provided in yr 3]
what do you do after seeing the patient one week after surgery?
After seeing your patient one week after surgery (post op evaluation), recall patient in about 3 months.
Evaluate surgical site and the rest of the periodontium.
If tissues are clinically healthy (including surgical site), if all local risk factors have been controlled (all active Tx is done)..
Then place the patient on a 3/6/8/12 month….MAINTENANCE Program.
what is phase 3?
If, during the phase 1 or 2, you notice that your patient has unmet caries, defective restorations/ partial dentures etc, you must attend to these needs as early as possible. (i.e.: once you have had most of the inflammation under control and the patient is able to demonstrate good PC. This phase (restorative therapy) is known as PHASE 3. (if such needs are not evident then MT is called Phase 3 instead of 4).
