Post on 31-May-2015
Periodontal Maintenance Periodontal Maintenance TherapyTherapy
Evaluation and Care
Learning OutcomesLearning Outcomes
1. Determine appropriate intervals for supportive periodontal care for clients presenting with gingival and/or periodontal conditions
2. Outline a periodontal maintenance therapy program based on a client’s compliance with home care and risk of disease recurrence
3. Determine reasonable outcomes reflective of the periodontal maintenance plan that will promote client compliance
4. Accurately document new clinical findings and revise the care plan as required
IntroductionIntroduction
Clients with persistent or chronic periodontal problems are in need of professional care at regular intervals
Serves as an extension of the initial periodontal therapy
For those at risk:– Stable dental condition, reduce active episodes– Re-educate, support client’s involvement
Risk AssessmentRisk Assessment
Clients who have experienced gingival and/or periodontal disease are at risk for future disease
Clients with increased risk:– Attachment loss of 2 mm or more– Clients over 70 years of age– Clients who use tobacco– Pathologically mobile teeth– Poor oral care, systemic involvement
Objectives of PMTObjectives of PMT
Primary objective – prevent recurrence or development of disease affecting dentition & soft tissues
This is accomplished by:– Maintaining attachment levels & alveolar
bone height– Controlling inflammation– Maintenance of oral health– Reducing incidence of tooth loss
Objectives of PMTObjectives of PMT
Secondary objectives:– Early recognition & treatment of conditions
affecting oral cavity– Reinforce oral self-care techniques– Reinforce value of continuous oral care
Need for Continuous Need for Continuous Periodontal CarePeriodontal Care
Rationale:– Client susceptible to periodontal breakdown– Client not a candidate for periodontal surgery
Health reasons Financial reasons Client refuses
– Improves prognosis for periodontally involved teeth
Need for Continuous Need for Continuous Periodontal CarePeriodontal Care
Rationale:– Reduce stress on immune system– Improve client’s plaque control
Client ComplianceClient Compliance
Compliance: “the consistency & accuracy with which a client follows the regimen prescribed by a health professional” (1997) Stedman’s
Concise Medical Dictionary for the Health Professions (3rd ed.) ,Edited by John Dirckx Baltimore: Williams & Wilkins.
Compliance can by assessed in 2 ways:– Evaluating client’s compliance with home care– Client’s compliance with a continuous care
regimen
Client ComplianceClient Compliance
Factors that interfere with compliance:– Education, economic problems– Values, culture– Fear, self-destructive behaviour– Perceived indifference on part of clinician– Lack of understanding of disease process– Oral care too demanding, inconvenient– Client unconvinced of necessity
Client ComplianceClient Compliance
Strategies to improve compliance:– Positive reinforcement– Promote oral health as part of an overall
healthy lifestyle– Simplify information– Easy verbal & written instructions– Involve client when setting goals– “Reminders”
Initial Therapy EvaluationInitial Therapy Evaluation
Evaluation of initial therapy necessary to determine:– Length of interval– Necessity of surgery
Evaluation – 4-6 weeks following active treatment
Initial Therapy EvaluationInitial Therapy Evaluation
Response of tissues to initial therapy dictates options available:– Further treatment– 3 month PMT interval– Use of antimicrobials/antibiotics
Surgery not indicated for at least 3 months following initial therapy
Periodontal Maintenance Periodontal Maintenance TherapyTherapy
Recommended average interval for periodontal clients is 3 months
Lengthened or shortened as necessary
PMT IntervalsPMT Intervals
Factors to consider when selecting an interval:– Client’s risk for soft & hard tissue disease– Client’s risk for oral cancers– Factors that predispose client to disease– Client compliance– Intraoral factors, rate of deposit formation– History of soft tissue disease
PMT intervalsPMT intervals
Clients who may have special requirements:– Diabetic client– Extensive prosthetic/restorative dentistry – Rampant decay– Orthodontic clients– Disability – Health concerns
PMT ProceduresPMT Procedures
Client involvement a must! Recognize outcomes – modification
required?Specific components:
– Review of health history Smoking status, stress levels Systemic concerns New medications and/or conditions
PMT ProceduresPMT Procedures
Specific components:– Dental history
Sensitivity Compliance New concerns
– Intraoral & extraoral exam New medications xerostomia
PMT ProceduresPMT Procedures
Specific components:– Periodontal exam
Gingival tissues Probing depths, recession Attachment loss Bleeding on probing Furcation involvement, mobility Suppuration Deposit accumulation
PMT ProceduresPMT Procedures
Specific components:– Radiographic assessment– Diagnosis
Sites that responded to therapy vs. those that didn’t Type of disease present (refractory) Type of therapy required
– Surgery
– Debridement
– Antimicrobials/antibiotics
PMT ProceduresPMT Procedures
Therapy:– Review of home care– Debridement as required– Deplaquing, polishing– Desensitization
Appointment scheduling:– 1 hour minimum– Assessment & therapy may take 1-2
appointments
Guidelines for PMT IntervalsGuidelines for PMT Intervals
Shortened intervals may be required:– PSR score of 3+ & poor OH– Mod-severe perio & poor OH– 2 month interval
3 month interval:– Moderate perio involvement– Early-mod perio & fair OH– Early perio & stress
Guidelines for PMT IntervalsGuidelines for PMT Intervals
3 month interval:– Adult ortho clients– Women with pregnancy associated ging.– Smokers– Diabetic clients where control is marginal– Elderly clients with active perio
Guidelines for PMT IntervalsGuidelines for PMT Intervals
4 month interval:– Early disease & fair OH– Mod perio involvement, PSR (3), excellent OH
6 month interval:– Healthy clients – probing depths 1-4 mm– Pedodontic clients– Motivated client with early gingivitis &
improving OH
Recurrence of PDRecurrence of PD
Lack of continued care & OH recurrence of PD possible
Factors that contribute to recurrence:– Ineffective plaque control– Failure to show for continued care– Client smokes– Health problems, genetic risk factors– Incomplete periodontal debridement
Success!Success!
Upper right lingual 6 months after surgery
Client 2 years after periodontal therapy