G ood by e R ou tin e R ecal l Hel lo Health y Cl ien t an d Pr actice

A System of Successful Treatment of Soft Tissues Beth Ryerse, RDH

Oral Disease and Oral Care Solutions

Three major diseases we are concerned with as RDHs

Periodontal Disease Oral Cancer Caries

Oral Dis-ease ManagementEase being very comfortable and able to live as you want, without any worries or problems.

Dis-ease being uncomfortable and not able to live as you want, with worries or problems.

Oral Health context ability to chew, talk, smile, kiss and be comfortable with your presenting self.

Oral Dis-ease a state where those simple tasks are troublesome, humiliating and possibly, painful.

P.I. Eke, B.A. Dye, L. Wei, G.O. Thornton-Evans, and R.J. Genco. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. J DENT RES 0022034512457373, first published on August 30, 2012 as doi:10.1177/0022034512457373

September 4, 2012One out of every two American adults aged 30 and over has periodontal disease, according to recent findings from the Centers for Disease Control and Prevention (CDC). A study titled Prevalence of Periodontitis in Adults in the United States: 2009 and 2010 estimates that 47.2 percent, or 64.7 million American adults, have mild, moderate or severe periodontitis, the more advanced form of periodontal disease.

http://jdr.sagepub.com/content/early/2012/08/29/0022034512457373.abstract

Periodontal Disease is a Bacterial Infectionand the bodys reaction to that infection

Other factors that may increase risk:

Family history

Medications

Age

Gender

Family transmission

Smoking

Prior gum disease

Clenching/grinding

Stress

Osteoporosis

Diabetes

Hormones

Periodontal Disease may increase your risk for a variety of health concerns including:

Diabetes Cardiovascular disease Stroke Lung Infections Preterm, low birth-weight

infants Respiratory diseases

Examination & Charting

History Oral Exam Data Gathering Co-Discovery Co-Diagnosis Case Presentation Fees and Insurance

Perio Exam

Call the numbers out loud once client understands the significance of them

Give the client a hand mirror hold in right hand see what I am seeing

Ask client to raise left hand if any areas are tender

Client is now very involved in the exam

and learning!

Case Type I Gingivitis

Case Type II Chronic Periodontitis

Generalized, Slight

Case Type III Chronic Periodontitis

Generalized, Moderate

Root Caries and Overall Health

root caries was an independent predictor of incident myocardial infarction.may be a marker for an overall decline in health.

Mauriello SM et al. 2006. Root caries prevalence and incident myocardial infarction. Abstract 1471, v. 85,

Special Issue A, AADR Annual Meeting, Orlando, FL

Oral CancerTwo etiological factors:1. Alcohol and tobacco

2. Human Papilloma virus

Approximately 75% of Canadians will have a HPV infection in their lifetime.

A 225% increase in HPV-positive oropharyngeal cancers is reported by major cancer registries.

If this trend continues, this type of cancer will surpass cervical by year 2020.

- JADA 142(8):2011;915-924

Case Presentation

Pain / Time / $

Elements of a Complete Case Presentation

Information data collected and assessment findings are shared

Education explanation of the significance of assessment short and long range possibilities and consequences - ASK ?s to determine level of understanding and client priorities and interest in pursuing care

Options alternative methods of care - benefits, time involved, treatment risks, risks of non-treatment and cost for each option

Choice informed decision based on understanding of info, priorities, desire for treatment and perceived needs

Agreement client and professional concur on a course to follow dental hygienist as advocate, supports the informed decision made by the client

Scaling

Instrumentation of the crown and root surfaces of the teeth to remove bacterial plaque biofilm, calculus, and extrinsic stains from surfaces without the intentional removal of tooth surface.

D & W 2003

Root PlaningDefinitive treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms; no longer recommended as a routine procedure for all root surfaces of periodontally involved teeth

Dr. Irene Woodall

Ultrasonic instrumentation is now the first choice over hand instrumentation for most patients. This constitutes a major shift in dental hygiene approach to treatment This text has placed hand instrumentation secondary to ultrasonic instrumentation

(Woodall I., et al Comprehensive Dental Hygiene Care, 4th ed.)

Disease ManagementHow Important is Homecare?

What role does disease management at home play in a successful therapy program?

What are the tools our patients need to be successful?

What role do we play in the success of a patient's disease management at home?

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A Novel Strategy to Reduce Biofilm

The ADA Risk Management Series states:

In viewing periodontal treatment, the role of the patient should not be overlooked. The patient must be an active participant in the treatment through compliancein fact, the role of the patient is paramount to the success of therapy.

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Multi-Modal Options

MechanicalProfessional -- Scaling / Root Planing

Patient -- Brushing & interproximal cleaning

ChemicalProfessional -- Antimicrobial (local &

systemic)

Patient -- Dentifrice, Rinses

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Qualities of an Ideal Chemotherapeutic Agent

Effective against specific microbes Inhibit the overgrowth of other organisms

Not cause bacterial resistance

Nontoxic to oral tissues Acceptable to the patient (taste, ease of

use, cost)

Bioactive (available and active in the oral cavity) long after the application has ceased.

Behavior Modification

An approach to correction of undesirable conduct that focuses on changing observable actions; modification of behaviour is accomplished through systematic manipulation of the environmental and behavioral variables related to the specific behaviour to be changed.

Dispensing Easy way to help clients get the self-care

products that can provide them with the greatest benefit

Part of an all encompassing treatment plan and ensures measurable clinical results

To recommend is human; to dispense is divine

Julie Csoki RDH, BS & Liz Lundry RDH

RDH Feb 2009

Supportive Periodontal Therapy

Long-term, frequent maintenance therapy (scaling and antimicrobial therapy) used after active therapy has been successful in eliminating periodontitis

- continues for the life of the dentition or its implant replacements

- Clients must understand that they have a chronic disease that cannot be cured , only controlled by frequent periodontal care and daily self-care.

Keys To Your Success?

Better client communication. Increased client compliance. Making a more powerful contribution to the practice.

HealthyPracticeNow.ca

Online continuing education:

dentalcare.ca