Perio PP10/11

• dentist
• dentist and dental hygienist

• 1.Does the clinical assessment indicate health or disease
• 2.Is it gingivitis or periodontitis
• 3.What type of gingivitis or periodontitis

• Based on signs of inflammation
• –Overt signs: changes in color, contour, or consistency
• –Hidden signs:bone loss, exudate, bleeding
• Symptoms of periodontal disease
• –Bad taste, bleeding when chewing/brushing
• –NONE – silent disease, there may be no symptoms recognized by the patient at all

• –I = gingivitis only
• –II = slight/mild periodontitis
• –III = moderate periodontitis
• –IV = severe periodontitis

1-2mm

3-4mm

5mm or more

• Phase I–Assessment phase and preliminary therapy
• Phase II–Nonsurgical periodontal therapy and re-evaluation
• Phase III–Surgical therapy
• Phase IV–Restorative therapy
• Phase V–Periodontal maintenance

• eliminate immediate problems
• –Treatment of emergencies
• Dental or periapical
• Periodontal–Extraction of hopeless teeth and provisional tooth or teeth replacement(s)
• –Assessment of the periodontal situation
• –Assessment of systemic risk factors which may affect treatment
• –Diabetes, smoking, age, genetic predisposition, stress, pregnancy
• –Elimination of risk factors which may contribute to chronic periodontitis (consult with MD)

• –Instruction, reinforcement and evaluation of the patient’s plaque control
• –Supra- and subgingival calculus removal and root planing (initial treatment/non-surgical treatment)
• –Correction of local contributing factors (restorative and prosthetic irritants and caries)
• –Antimicrobial therapy may be used +/-
• –Occlusal therapy (occlusal adjustment)–Minor orthodontics
• –Provisional splinting (temporarily splint mobile teeth)

–Re-evaluation of pocket depths and inflammation

• –Periodontal surgery
• –Implant placement
• –Root canal therapy

• –Permanent splinting of teeth
• –Restorations
• –Replacement of teeth by fixed or removable prostheses

–Periodic recall visits to check home care, gingival health, occlusion and other pathology along with removal of plaque and calculus in order to keep periodontitis under control and prevent recurrence of disease

3 month

• –Often completed in one, 1-hour visit
• Assessment, patient education and OHI
• Scaling
• Disruption of all subgingival plaque
• Establish appropriate maintenance schedule
• Re-evaluation at subsequent appointments–At first maintenance appointment
• –Goal
• To eliminate all clinical inflammation
• To eliminate all increased probing depths

• –Often requires multiple visits
• Assessment of the periodontal situation
• Assessment of systemic risk factors which may affect treatment
• Patient education and OHI
• Supra- and subgingival scaling (disruption of all subgingival plaque) and root planing, possibly requiring anesthetic, possibly completed in multiple appointments
• –2 to 4 one-hour appointments
• Establish appropriate maintenance schedule
• Re-evaluation at subsequent appointments***
• –Possibly first periodontal maintenance visit

• Significant reduction in clinical inflammation
• Reduction of pocket depth
• Stabilization or gain of clinical attachment
• Reduction of clinically detectable plaque to a level compatible with gingival health

• Assessment of the periodontal situation
• Assessment of systemic risk factors which may affect treatment (evaluate for referral to periodontist)
• Patient education and OHI
• Supra- and subgingival scaling (and disruption of all subgingival plaque) and root planing, by quadrant, often requiring anesthetic in four 1-hour appointments (or 2 two-hour appointments)
• Establish appropriate maintenance schedule
• Re-evaluation at subsequent appointments**

• –Often treated by quadrants
• Assessment with referral to periodontist
• Patient education and OHI
• Scaling (and disruption of all subgingival plaque) and root planing by quadrant with local anesthetic
• Establish appropriate maintenance schedule
• Re-evaluation at subsequent appointments**

• –May be treated in single or multiple visits depending on number and depth of pockets
• Assessment WITH referral to periodontist
• Patient education and OHI
• Scaling (and disruption of all subgingival plaque) and root planingEvaluation for systemic/local antibiotics
• Possible referral to physician
• Establish appropriate maintenance schedule, probably more frequent as in 2 to 3 months
• Re-evaluation at subsequent appointments**

• Chronic periodontitis with deeper probing depths, furcation involvement and/or problematic gingival recession (mucogingival problems)
• Aggressive (localized or generalized) periodontitis
• Periodontitis associated with systemic diseases
• Periodontitis with significant or increasing mobility
• Refractory or recurrent periodontitis
• Patients with esthetic concerns

• Verbal or implied
• Written

• –Overall prognosis
• –Individual prognosis for each tooth

• –Age
• –Systemic health
• –Attitude (education, IQ, motivation, cooperation)
• –Finances
• –Inflammation
• –Bone remaining

• –Based first on overall prognosis
• Pocket depth
• Bone remaining
• Mobility
• Furcation involvement
• Mucogingival problems
• Ability to modify local factors
• Prognosis of other teeth

–Conditions may worsen at some time in the future

–Efforts to save the teeth/tooth may be unsuccessful

–The condition may not be treatable and the tooth/teeth more predictably will be lost

with furcation involvements

Bacteria

multifactorial

• Poor Self-care
• Faulty Dentistry
• Smoking
• Nutrition +/-
• Medications
• –Medical consult
• Diabetes
• –Poorly controlled – medical consult
• –Well controlled – monitor
• Hormonal variations
• –Good daily self-care
• Heredity
• –Good daily self-care
• Immunocompromised
• – good daily self-care

• pathogenic bacteria and the host’s inflammatory and immune responses
• local and/or systemic

does not

• –Systemic illness
• –Certain Medications
• –Smoking
• –Poor diet
• –Stress

periodontal instrumentation

increasing home care and professional care

• –Age
• –Gender (male is higher risk)
• –Dental awareness
• –Socioeconomic status

Identify risk factors to determine which patients are more likely to prevent or control their dental disease