what are the final steps in providing evidence based dental and dental hygiene care?
evaluation of tx outcomes and oral health education interventions
______ ________ at the end of a sequence of dh interventions determines whether or not the goals in the pts care have been met
summative evaluation
when can info regarding the need for modifications of the original pt care plan be evaluated?
during the ongoing evaluation of tissue changes and pt sel care ability during multi-appt tx
a plan for evaluation of a pt care outcome includes: (3) during each appt
informal monitoring
feedback
modifications
at the beginning of tx, methods for evaluating the success of dh tx include what?
re-collection of same clinical data (i.e. probing depths, bleeding)
what are the overall purposes of tx during maintenance? (4)
arrest disease
provide oral health
function
comfort for pt
maintenance = ________ ______
continuing care
oral diseases do or do not recur? what is possible through combined personal and professional effort?
DO RECUR
CONTROL IS POSSIBLE
t/f lifelong preservation of teeth and their supporting structures is a realistic goal
true
success of the maintenance program depends on the _________ by the pt of the maintenance procedure
understanding
a way to help the pt become aware of the concept of the maintenance phase is in the _______ ______ ______
initial care plan
t/f a fixed schedule is used for all pt's in oral health because the frequency is similar for each pt
FALSE! NO fixed schedule because the frequency depends on the needs of each pt
for maintenance, appts may vary from ____ to ____ months
2-6
what are some predisposing diseases, conditions, and behaviors for periodontal disease?
diabetes
HIV/AIDS
host genetic factors
smoking
stress
what are local factors of maintenance? (1)
rate of calc formation
what are restorative complications of maintenance? (2)
implants, prosthetic replacements
what are three "risks" for contributing factors of maintenance frequency?
perio disease activity
dental carious lesions
oral cancer: tobacco and alcohol users
which 6 categories of pt's may need intervals of 2-3 months for special appointment requirements?
mentally or physically disabled
diabetes
cardiovascular disease
pt undergoing extensive dental care
rampant dental caries
ortho therapy
why might someone with diabetes need to be on a 2-3 mo recall??
it can predispose pt's to lowered resistance to infection; tissues MUST not be allowed to develop advanced disease
why might short appts be necessary for someone with cardiovascular disease?
brushing is a difficult procedure to carry out
fort appts can be tolerated because of the fatigue factor
when a pt is undergoing ___________ ________ _________, the gingival or perio tx may be completed by the time appts for restorative phases of tx are underway. the first maintenance needs to be dated from the _______of the initial gingival and perio tx.
when extensive restorative prosthetic, or tx is in progress, the frequent tissue maint. during long term therapy is essential
extensive dental care
completion
why would someone with rampant dental caries need to have 2-3 mo interval appts?
topical fl2 application
dietary supervision
personal factors for biofilm control
what is PMT?
perio maint. therapy
what are the four PMT's?
preventive
trial
compromise
posttreatment
ALL P to the M to the T
to prevent the initiation of disease in individuals without perio = (what PMT?)
preventive PMT
to proved an interm study period for borderline pts with conditions that ust be observed and further evaluated before a decision can be made for correctvie surgery or whether maint is possible wi/out further advanced disease therapy = (what PMT?)
trial PMT
to slow the progress of disease in pts for whom corrective surgery and advanced tx are indicated but cannot be implemented for reasons of health, economics or other personal factors= (what pmt?)
Compromise PMT
to prevent the recurrence of disease and maintain the state of perio health attained during perio therapy. It may be surgical or nonsurgical = (what PMT?)
Posttreatment PMT
t/f at maintenance appt assessment preparations are the same plan as for a new pt?
true!
what needs to be completed at EVERY maintenance appt whether it is 3, 6, whatever month intervals for a pt of any age?(3)
reassessment, progress diagnosis, and maint. care plan
t/f radiographs are taken routinely
FALSE! it is based on the dentist's determination of an individuals needs
what should be examined of the teeth during maint. appts?
integrity of restorations and sealants
dental caries: demineralization, early dental caries, and cavitated lesions
sensitivity
during a perio exam with complete probing of maint appt, what three things are taken into consideration?
BOP
attachment levels
compare with previous probings to check for changes
after applying a disclosing agent relating biofilm to teeth can help see areas of _______ ______, ________ and other signs of inflammation
gingival redness
enlargement
areas of special problems include __________ treated teeth, __________ areas, implants, _____ factors, and prosthetic appliances
endodontically
postsurgical
occlusal factors
during continuing care, the pt is considered a _________
cotherapist
a perio pocket exam with bop indicates need for deep ______ and ______ _______
scaling and root planing
what type of anesthetic might be needed for perio scaling and debridement?
local anesthesia or subgingival gel
local delivery of antimicrobials when doing perio scaling and debrid should be administered for isolated ______ _____ _____
persistant deep pockets
should you plan on a number of appts for scaling and debrid?
yep, unless you are houdini and make the calc disappear (hey! maybe i should practice being a magician!)
what are the three points during pt care when the hygienist may confer with the dentist to determine the need for referral to a periodontist?
initially
later during reevaluation
during maintenance
if a new pt comes in and has severe advanced perio or has uncommon perio disease (juvenile perio), NUG or NUP, or a drug-induced gingival enlargement (phenytoin for seizures), when would this be noticed during which of the three point referral stage?
initial
after perio quad scaling for nonresponsive or refractory type of mod or advanced perio condition, when would this be noticed?
later during the reevaluation for poss referral
pocket depth that prohibits access to complete debrid, furcation involvements that cannot be accessed without surgical methods, mucogingival problems (lack of attached gingiva near healthy receded gingival margin, and perio disease that is refractory (not responsive) should: be ________ _______ _______
referred during maint
recurrence signs and symptoms of perio infection indicates what?
recolonization of perio pathogens
recolonization of a pocket can occur within HOW MANY DAYS?
42 days!
without dail personal dental biofilm control and regular professional supervision and maint. procedures, _______ can recur
infection
t/f it depends on the pt how soon after completion of tx recurrence of perio happens.
true!
what are 6 CONTRIBUTING factors for recurrence of perio disease?