Periodontal Maintenance Therapy Evaluation and Care.

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


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


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


Specific components:– Dental history

Sensitivity Compliance New concerns

– Intraoral & extraoral exam New medications xerostomia


Specific components:– Periodontal exam

Gingival tissues Probing depths, recession Attachment loss Bleeding on probing Furcation involvement, mobility Suppuration Deposit accumulation


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


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


3 month interval:– Adult ortho clients– Women with pregnancy associated ging.– Smokers– Diabetic clients where control is marginal– Elderly clients with active perio


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

Periodontal Maintenance Therapy Evaluation and Care.

Documents

Transcript of Periodontal Maintenance Therapy Evaluation and Care.