Ch 19 Flashcards
(34 cards)
1
Q
what is the evidence based approach
A
- improve treatment results by using information from the research literature
- periodontal literature better determines and evaluates the pros and cons of various treatments in the context of individual patients
- GOAL: control inflammation
2
Q
what is problem based learning
A
- develops an individualized treatment plan for each patient
- identifies problems from the patient’s history/assessment
- interpretation and/or dental hygiene diagnosis will be made from each problem
- determine prognosis: diagnosis of periodontitis, nonsurgical tx of ging and perio, surgical perio therapy
3
Q
what are the goals of periodontal therapy
A
- ideal goal is to restore the periodontium to a functional state of health
4
Q
what is arrestive therapy
A
- periodontal therapy that aims to prevent the:
- initiation
- progression
- or recurrence of periodontal disease
5
Q
what is regenerative therapy
A
- reformation of periodontal tissue lost due to disease
- requires arrestive therapy first
6
Q
how is periodontal therapy considered ongoing care
A
- different therapies for every patient
- continued reassessments
- continued periodontal maintenance care: ethical and legal responsibilities; referrals when out of scope of abilities! send early rather than late
7
Q
what is a problem list
A
- take into consideration the patient’s chief complaint or concern, signs, and symptoms
- identify the patient’s problem
- a solution must be given for each problem
- expected outcomes (result of taking care of the problem)
- prognosis (predication of recovery)
8
Q
why is a risk assessment for periodontal disease important
A
- essential for treatment planning
- identification of risk factors and risk indicators or predictors (crystal ball)
- some risk factors cannot be modified ie socioeconomic status and genetics
- some risk factors can be modifiable ie. smoking, biofilm control
9
Q
guidelines for referral to periodontist
A
- rapid progressing periodontitis
- periodontitis with systemic factors
- refractory (nonresponsive) cases
- moderate to severe periodontitis (moderate if you feel out of scope)
10
Q
what is a level 3 patient
A
- patient who should be treated by periodontitis
11
Q
what do level 3 patients present with
A
- severe periodontitis
- furcation involvement
- vertical/angular bony defects
- a periodontal abscess and other acute periodontal conditions
- significant root surface exposure and/or progressive gingival recession
- peri implant disease
- any patient with periodontal disease, regardless of severity, whom the referring dentist prefers not to treat
- rapidly progressing periodontitis
12
Q
what is a level 2 patient
A
- patients who would likely benefit from co-management by the referring dentist and the periodontitis
13
Q
what does a level 2 patient present with
A
any patient with periodontitis who demonstrates at reevaluation, or any dental examination, one or more of the following risk factors/indicators known to contribute to the progression of perio:
- early onset of perio (prior to 35)
- unresolved inflammation at any site (eg. bleeding upon probing, pus, and/or redness)
- pocket depths of 5 mm or greater
- vertical bone defects
- radiographic evidence of progressive bone loss
- progressive tooth mobility
- progressive attachment loss
- anatomic gingival deformities
- exposed root surfaces
- a deteriorating risk profile
- smoking/tobacco use
- diabetes
- osteoporosis/osteopenia (low bone density)
- drug-induced gingival conditions (eg. phenytoins, calcium channel blockers, immunosuppressants and long term systemic steroids)
- compromised immune system, either acquired or drug induced
- a deteriorating risk profile
14
Q
what is a level 1 patient
A
- patients who may benefit from comanagement by the referring dentist and the periodontist
15
Q
what do level 1 patients present with
A
any patient with periodontal inflammation/infection and the following systemic conditions: - diabetes - pregnancy - CV disease - chronic respiratory disease any patient who is a candidate for the following therapies who might be exposed to risk from periodontal infection, including but not limited to the following treatments: - cancer therapy - CV surgery - joint-replacement surgery - organ transplantation
16
Q
what are the phases of treatment
A
order of how we are to do things
- phase I: nonsurgical/initial preparation
- phase II: periodontal surgery
- phase III: restorative care
- phase IV: maintenance care
17
Q
what is phase I of treatment
A
- nonsurgical/initial preparation
- emergencies taken care of first (pain, abscess, NUG, injury)
- nonrestorable teeth are identified and extracted
- oral hygiene instruction
- periodontal debridement/oral
prophylaxis (multiple appointments) - tissue response: re-evaluation
- overall goal: reduce all etiological and risk factors to the maximum extent possible. patient become a cotheraptist (actively involved, take accountability)
18
Q
what is phase II of treatment
A
- periodontal surgery
- reduction/elimination of inflammation surgical phase
- access to deep periodontal pockets
- various surgeries:
- arrestive or regenerative surgery
- periodontal plastic surgery (gingival recession)
- ridge augmentation
- crown lengthening
19
Q
what is phase III of treatment
A
- restorative care
- final restorations completed: aesthetic, comfort, functional needs
- all dental clinicians involved: dental hygienist, general dentist, periodontist, prosthodontist
20
Q
what is phase IV of treament
A
- maintenance care
- periodontal maintenance
- to prevent continued and recurrent periodontal destruction
- frequency of visits:
- individualized, self care motivation, self-care effectiveness, periodontal status, medical conditions
21
Q
what is periodontal health
A
- minimal calculus
- no bleeding on probing
- minimal plaque removal sub g
- 6-12 month maintenance (12 month more rare)
- generally dental aware and keen
22
Q
what is gingival disease/gingivitis
A
- plaque induced
- establish gingival health
- eliminate etiological factors
- establish OHI and debridement key factors
- relate bleeding to flossing/brushing
- plaque staining and relationship of biofilm to patient presentation
23
Q
how do we treat gingival enlargement
A
- orthodontic
- meticulous oral hygiene
- frequent maintenance visits
- recurrence if surgical removal of enlarged gingiva
24
Q
how do we treat hormone associated gingivitis
A
- stress meticulous homecare
- frequent maintenance visits
medication induced/non plaque induced:
- stress meticulous homecare
- may be able to have medication changed if severe
- may need surgical correction ie gingivectomy
25
what do the 4 appointments of a perio patient consist of
1. oral hygiene instruction
2. periodontal debridement
3. reevaluation of tissue response
4. refer for surgery or maintain without surgery
- establish periodontal maintenance program
26
what is refractory periodontitis
- patients that do not respond to treatment
| - gingivitis or periodontitis
27
how do we treat gingival recession
- determine etiology
- if it is an esthetic problem, refer for gingival grafting to cover exposed roots
- refer to problem list
- refer to periodontist
28
how do we treat aggressive/fast onset periodontitis
- similar treatment as in old chronic grade B periodontitis
- additionally, usually required systemic antibiotics because bacteria invade connective tissue
- referral to periodontist immediately if rapidly progressing do not do initial therapy unless can't get into periodontist for a bit!!!
29
how do we treat necrotizing ulcerative gingivitis
- patient in extreme pain
- analgesics and antibiotics initially
- periodontal debridement
- maintenance
30
how do we treat necrotizing ulcerative periodontitis
- tissue and bone necrosis
- systemic involvement (immunosuppressed patients)
- referral to periodontist
31
how do we treat peri-implantitis
- mechanical debridement
- oral hygiene instruction
- mouth rinses
- referral to periodontist
32
what is the classification of prognosis for periodontal disease
- good: not much periodontal destruction including probing depths so sites easily maintained by patients
- fair: class I furcation defects about 75% of bone remains around tooth
- poor: approx. 50% bone remains, class II furcation defects
- questionable: less than 50% of bone remains. class III furcation involvement cannot be maintained without possible extraction
- hopeless: no bony support remains and tooth must be extracted
33
what are adjunctive treatments
- therapy used in conjunction with mechanical debridement and oral hygiene instruction
- not intended to be a substitute
- periodontal debridement is the foundation for all treatment
- antimicrobial mouth rinses for gingival inflammation
- controlled-release devices: for localized chronic periodontitis sites >5mm and BOP after scaling/root planing. atridox, arestin
- systemic antibiotics: use in aggressive and refractory cases. not used in chronic periodontitis
34
what are some periodontal considerations for geriatric patients
- plaque control: limited
- xerostomia: due to drugs, decreased salivary gland function. saliva substitutes
- treatment considerations: mouth rinses, automated oral hygiene devices (power brushes and water pics etc). frequent visits
