Ch. 21: Clinical Decision Making for Perio Care

Question 1

Clinical Decision Making

Answer 1

process where dental team uses information from comprehensive periodontal assessment to arrive at appropriate diagnosis and identify treatment strategies

Question 2

First step to treatment planning

Answer 2

assigning correct diagnosis

Question 3

Signs

Answer 3

observable or measurable
Erythema, edema, BOP, loss of attachment, tooth mobility, loss of alveolar bone

Question 4

Symptoms

Answer 4

noticeable only to patient
Loose teeth, difficult chewing, profuse gingival bleeding, bad taste in mouth

Question 5

Periodontitis

Answer 5

often called silent disease; early symptoms often so subtle they go unnoticed

Question 6

Gingivitis

Answer 6

NO attachment loss in presence of inflammation

Question 7

Periodontitis (CAL)

Answer 7

attachment loss in presence of inflammation
important to use dental radiographs and clinical findings during assessment; CAL should be apparent and detected before radiographic evidence

Question 8

Peri-mucositis

Answer 8

damage to soft tissue only

Question 9

Peri-implantitis

Answer 9

damage to soft tissue and surrounding bone

Question 10

Flexibility

Answer 10

refers to retaliation that important fundamental decision as to presence of gingivitis or periodontitis may not describe overall condition; must document other periodontal conditions as well
Ex/ recession of gingival margin, occlusal trauma, aberrant frenum position

Question 11

Primary criteria (grading)

Answer 11

direct or indirect evidence of progression

Question 12

Does staging/grading apply to other diseases or conditions?

Answer 12

No, only periodontitis

Question 13

Disease extent

Answer 13

localized pattern (<30%), generalized pattern (>30%), molar/incisor pattern (pedo)

Question 14

Case Type I

Answer 14

patients w/ gingivitis only

Question 15

Case Type II

Answer 15

patients w/ slight/mild periodontitis

Question 16

Case Type III

Answer 16

patients w/ moderate periodontitis

Question 17

Case Type IV

Answer 17

patients w/ severe periodontitis

Question 18

Assessment and Preliminary Therapy Phase

Answer 18

assessment of collected data, urgent care for any acute conditions
Sometimes called emergency therapy
Oral examination, assessment data collection, radiographs, diagnosis, planning of nonsurgical therapy, extraction of hopeless teeth

Question 19

Nonsurgical Periodontal Therapy Phase

Answer 19

all non surgical measures to control gingivitis/periodontitis
Includes periodontal instrumentation and comprehensive patient education
Can include steps to minimize impact of local contributing factors
Aka: initial perio therapy, Phase I therapy, bacterial control, anti-infective therapy

Question 20

Surgical Therapy Phase

Answer 20

any necessary periodontal surgery to control or eliminate periodontal disease that cannot be managed by nonsurgical therapy alone
Includes placement of dental implants
Also called Phase II therapy
Not indicated for patients if perio health can be re established solely by nonsurgical therapy

Question 21

Restorative Therapy Phase

Answer 21

may include placement of dental restoration and replacement of missing teeth by fixed or removable prosthesis
Aka Phase III therapy

Question 22

Periodontal Maintenance Phase

Answer 22

includes all measured by dental team and patient to keep periodontitis from recurring once inflammatory disease brought under control
Objective: to maintain teeth function throughout life of patient
Aka Phase IV therapy