Periodontal Maintenance


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Periodontal Maintenance

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