Management of periodontitis in the maintenance phase Flashcards
What should the initial tx management be based on?
Emergency tx XLA of irrational teeth Pt info Plaque control - correction of plaque retentive factors RSD Initial occlusal adjustment Reassessment and monitoring
What is the aim of perio tx?
Shallow pockets with no BOP
Maintain infec control
What to do in a review?
Check all necessary tx has been completed Check OH 6 point charting Evaluation - is tx aim reached? Plan follow up
What does future tx planning consist of?
Initial phase is complete and tx aims are achieved:
- Follow up: individulaised recall programme
Initial phase complete and aims are partially achieved: - Follow up: perio surgery
Initial phase incomplete:
- Follow up, review diagnosis and tx plan –> reassessment
What does the review and treatment evaluation consist of?
Recall
Good initial therapy but poor result = refractory periodontitis, need further investigations - med or genetic
Initial therapy incomplete: tx carried out well, pt compliance, OHI, smoking
Surgical therapy?
How to maintain a pt?
Re-motivation
Pts cannot clean subgingivally
Re-infection issues
Episodic nature of disease
Clinical criteria for diagnosis and prognosis?
BOP Amount and position of plaque - plaque score Pocket depth Furcation - analysis Occlusion and articulation, mobility Evaluate restorations/prosthese Examination for caries
Radiological criteria for diagnosis and prognosis?
Bone levels in relation to CEJ Type of bone defect Furcation-analysis Bredth of periodontal space Impacted teeth Evaluate restorations/prosthese Examine for caries
Influences on risk level of periodontitis?
High plaque score Bacterial flora - p.gingivalis Compliance Number and depth of pockets Furcation involvement Restorative retention factors
BOP >25% >RISK
Low resistance:
- Systemic factors
- Genetic factors
- Age
Lifestyle = smoking, stress, alcohol
List the systemic factors that influence periodontitis
Diabetes Medication Pregnancy Crohn's disease Sjogren's syndrome Radiotherapy Menopause
Genetic factors
Age
Factors of low risk pts?
BOP 10% PD <4 Bone levels <0.5 Non-smoker Med NAD No perio pathogens present No active lesions (root caries) in last 3 yrs
Factors of medium risk pts?
BOP 10-25% PD 5-8mm Bone level 0.5-1 Smoking 10-19/day MH - well controlled conditions 1-2 active root lesions in last 3 yrs
Factors of high risk pts?
BOP >25% PD 9+mm Bone levels >1 Smokes 20+/day MH - unstable conditions Perio pathogens present >2 active lesions in previous 3 yrs
How to work out the pts risk analysis?
Bone level/age
e.g. 55 yr old pt, 20% bone loss
= 20/55 = 0.36
When to recall a low risk pt (1 item from medium)?
6 monthly
