The dental hygienist must also use the visual and verbal feedback from the patient to judge the patient’s level of understanding. Using a system that is understood and used by a large number of dental professionals greatly facilitates communication regarding cases. Several frameworks are available to aid in the care of this patient population. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 10: Treatment Planning for the Periodontal Patient. Although this phase is often referred to as “recall,” the accepted terms are periodontal maintenance or periodontal recall because the patient’s periodontal health must be continuously monitored from this point. In 1999, an international group of periodontal experts approved the classification system currently in use. The dental hygiene treatment plan consists of services that are performed by the dental hygienist within the total treatment plan.2 Treatment planning occurs after the assessment of all clinical data and reflects the diagnosis and prognosis of the patient. In their classic studies, Ramfjord and Ash demonstrated that 3-month maintenance intervals were responsible for the long-term success of periodontal treatment.7, The interval between periodontal maintenance appointments is determined by the periodontal condition and the plaque control that the patient is able to attain and maintain. Phase IV therapy is the maintenance phase. The effects of periodontitis can be stopped through regular checkups and treatment and continued good oral hygiene. This system is based on the clinical manifestations of disease and conditions. • Discuss informed consent and its importance to the process of patient care. Scaling and root planing is sometimes followed by adjunctive therapy such as local delivery antimicrobials, systemic antibiotics, and host modulation, as needed on a case-by-case basis. Note the residual calculus on the mesial surface of tooth #9, at the right edge of the figure. Dental and periodontal abscesses should be treated. Classify the phases of dental treatment included in the comprehensive care plan. Now customize the name of a clipboard to store your clips. That specialist, such as an oral surgeon or periodontist, would become involved in helping to create the final treatment plan and in rendering treatment, if needed. A good plan includes visiting the dentist or hygienist every three months, brushing and flossing without fail, and using an antimicrobial mouth rinse. Disease classifications are useful for diagnosis, prognosis, and treatment planning because they help define the extent of disease and facilitate communication among members of the. The dental hygienist noted the redness and swelling that remained in the tissue and reinstrumented the area. Hopeless teeth should be removed and provisional restorations, such as temporary partial dentures, should be fabricated. Consider using an electric toothbrush, which may be more effective at removing plaque and tartar. The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy.1 This plan includes all procedures performed to attain and maintain the long-term oral health of the patient and should involve all members of the health care team and the patient. Phase II therapy is the surgical phase of treatment. OF PERIODONTICS, List the major classifications of periodontal disease. 5. Periodontal therapy is often referred to by patients as a dental deep cleaning. The dental hygienist is often responsible for treatment of the periodontal patient in the nonsurgical, or Phase I, and maintenance, or Phase IV, stages of periodontal treatment. 1 This plan includes all procedures performed to attain and maintain the long-term oral health of the patient and should involve all members of the health care team and the patient. After any initial treatment, plaque levels must be kept low to avoid a resurgence of the disease. No treatment should be provided to a patient until a treatment plan has been established and agreed on. The sequence of treatment depends on a number of factors, including the periodontal diagnosis and prognosis, the patient’s systemic and periodontal condition, and the patient’s preferences. Patients of Ravenel Periodontics have confidence that their treatment plan is unique to their specific needs. Gum disease can erode bone in the jaw and damage the tissues that surround and support your teeth; left untreated, it may eventually lead to tooth loss. The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy. Identify the considerations for sequencing dental hygiene treatment with periodontal diseases. GURU NANAK INSTITUTE OF DENTAL SCIENCES & RESEARCH. During this phase, procedures are undertaken to reduce the effects of disease. Once the diagnosis is determined, various treatment options can be formulated. For coordination of the total treatment of the patient, the treatment plan can be divided into various segments or phases. Phase IV therapy is the maintenance phase. Scaling, root debridement and planing are performed. At San Francisco and Marin Reconstructive Periodontics, we believe an investment in your smile is an investment in your future. With periodontitis, the gum tissue pulls away from the teeth, creating pockets where additional bacteria can build up and cause an infection. The prevalence of periodontal disease is quite significant. Treatment Planning Development of a logical and prop- erly sequenced treatment plan is a deriv- ative of the periodontal assessment and diagnosis. Some periodontists are inclined to suggest surgical intervention to immediately address and correct the issue, whereas others focus on non-surgical approaches and making lifestyle changes to slowly correct the issue. Treatment philosophy: Every periodontist will have a slightly different philosophy when it comes to treatment. Treatment planning provides an opportunity to explain problems and treatment goals to the patient in understandable terms.4–6 Listening to the patient’s concerns is a crucial element in the treatment planning process so that the plan can address the patient’s perceived needs along with the disease identified by the clinician. Therefore, periodontal care must be given serious consideration when developing treatment plans for older adults. The maxillary right area did not respond well around tooth #7. The goals of the treatment plan are to eliminate and control etiologic and predisposing factors of disease, maintain health, and prevent recurrence of disease.1,4 These goals are the same, regardless of the sequence of treatment or the individual who is delivering the dental care. Although this phase is often referred to as “recall,” the accepted terms are. The interval between periodontal maintenance appointments is determined by the periodontal condition and the plaque control that the patient is able to attain and maintain. This “pocket reduction” surgery is an effective treatment which, in many cases, stops the progression of periodontal disease. The rest of the team must understand that not all patients fit perfect guidelines, and custom treatment plans are essential to effective disease control. Floss daily. The role of the dental hygienist may vary depending on the type of case, experience of the hygienist, requirements of the state dental practice act, practice setting, and philosophy of the periodontist or general dentist. October 20, 2016 @ 5:00 pm – 8:00 pm Periodontists are dentistry's experts in treating periodontal disease. The. Different aspects of implant therapy have been discussed in “Dental implant therapy” section. Providing the patient a quick overview helps them more readily accept treatment plans and commit to good oral health habits in between visits. Carranza’s Clinical Periodontology. Principles of scaling & root planing dr alaa attia, General principles of Periodontal surgery, General principles of periodontal surgery, No public clipboards found for this slide, https://www.facebook.com/saidbenrida & https://www.pinterest.com/saidbenrida/. If you are new to managing a periodontal program this one page guide gives you a great foundation to build on. MASTER PLAN FOR TOTAL TREATMENT The aim of the treatment plan is total treatment, that is, the coordination of all the short- and long-term goals for the purpose of creating a well- functioning dentition in a healthy periodontal environment. • Describe the goals and rationale for periodontal treatment planning. An optimistic but realistic periodontal treatment plan geared toward … Treatment plan is guiding map for perio treatment – no treatment should be initiated without forming a solid TP & Although Its clinician’s responsibility to make individual patient realize the value of Treatment – motivated patient is a prerequisite for optimum outcome of perio therapy 69 When gingivitis is … Classification of Periodontal Disease and Conditions, Periodontitis as a Manifestation of Systemic Disease, Only gold members can continue reading. Dr. Ravenel will educate you on the issues affecting your dental health, share the options available to you, and work with you to create a treatment plan. STUDENT, DEPT. The overall approach of this classification system separates gingival disease from periodontal disease and conditions affecting the periodontium. 5: Calculus and Other Disease-Associated Factors, 9: Systemic Factors Influencing Periodontal Diseases, 12: Plaque Biofilm and Disease Control for the Periodontal Patient, 11: Occlusion and Temporomandibular Disorders, 18: Prognosis and Results After Periodontal Therapy, Periodontology for the Dental Hygienist 4e. The Cost of Periodontal Disease Treatments: This post will help clarify and define the costs involved in available periodontal treatment options, including Regenerative Periodontal Endoscopy (RPE), Perioscopy, Osseous Periodontal Surgery, Extractions, Implants, traditional laser periodontal therapy, LANAP, and root planing combined with Arestin (antibiotics). See our User Agreement and Privacy Policy. Phase I therapy describes the procedures that are designed to control or eliminate the etiologic factors of the disease process. Because of the complexity of the periodontal treatment required to meet planned goals, a series of appointments is often required. Disease classifications are useful for diagnosis, prognosis, and treatment planning because they help define the extent of disease and facilitate communication among members of the treatment team. Define the role of the dental hygienist in determining the dental hygiene care plan. The treatment plan designed & restore dentition to maximal function with esthetically pleasing result, is what care plan? Periodontal disease is known to be the leading cause of adult tooth loss. Phase III therapy usually involves restorations and replacement of missing teeth. This chapter describes current strategies and classifications for planning the treatment of the periodontal patient. This stage has also been referred to as initial therapy, nonsurgical therapy, cause-related therapy, or the hygienic phase of treatment. Because of the complexity of the periodontal treatment required to meet planned goals, a series of appointments is often required. The only exception to this would be emergency care to relieve a patient of pain due to injury or acute disease. See our Privacy Policy and User Agreement for details. You can change your ad preferences anytime. DR AMIT DE Periodontal Treatment Periodontal disease is a serious, chronic bacterial infection that, if left untreated, gradually destroys the gums and bone supporting your teeth. Patient education and plaque control instruction occur at the beginning of this phase. 11th ed. • Define the role of the dental hygienist in determining the dental hygiene care plan. This 41-year-old male patient had completed Phase I therapy consisting of quadrant scaling and root planing and oral hygiene instructions. 3rd YEAR M.D.S. Procedures in this phase included restorative dentistry, extensive orthodontics, and any needed occlusal therapy. Endodontic therapy can be performed to relieve pain, even if its completion carries over to other phases of treatment, and oral lesions of any type should be evaluated and treated or referred. All treatment plans must be understood by the patient and reflect the patient’s wishes and preferences. St. Louis, MO: Elsevier Saunders; 2012.). Patients remain in this phase for a lifetime. What is Periodontitis? Nonsurgical treatments Your dentist will first start with nonsurgical treatments. Phase I therapy describes the procedures that are designed to control or eliminate the etiologic factors of the disease process. Try these measures to reduce or prevent periodontitis: 1. • List the major classifications of periodontal disease. This is also a part of treatment once an infection occurs. 59. established before the beginning of treatment, and it must be carefully monitored. Calculus at this location adheres to the root surface right at the cementoenamel junction and is very difficult to remove. During the comprehensive treatment plan, the implant placement can be scheduled along with other surgical procedures to reduce the number of surgical appointments. • Identify the patient factors to be considered when establishing the treatment plan sequence. • Need for emergency treatment (pain, acute infections). Each phase suggested a particular group of procedures and included evaluation of the patient’s response. Defining a treatment plan for the periodontal patient is a process that requires the assessment, preventive, therapeutic, and evaluative skills of the dental hygienist and the dentist. Periodontists are also experts in … The overall approach of this classification system separates gingival disease from periodontal disease and conditions affecting the periodontium. The treatment plan defines the methods and sequence of delivering appropriate treatment.1,3,4. Source: Dental Health for … Selective extraction of teeth, roots, or implants when indicated, in order to facilitate periodontal therapy, implant therapy, implant site development, or im- plant, restorative and/or prosthetic treatment plans. Use a soft toothbrush and replace it at least every three to four months. An individualized, well thought-out treatment plan must be established before the beginning of treatment, and it must be carefully monitored. Your dentist might use a laser, rather than chemicals, to lighten gingival hyperpigmentation caused by abnormally high amounts of melanin. The sequence of treatment depends on a number of factors, including the periodontal diagnosis and prognosis, the patient’s systemic and periodontal condition, and the patient’s preferences. Periodontal insurance refers to dental plans that include benefits for periodontal care. The, Extraction of hopeless teeth and provisional replacement if needed (may be postponed to a more convenient time), Diet control (for patients at high caries risk), Scaling and root planing to remove bacterial plaque biofilm and calculus, Correction of contributing restorative and prosthetic factors, Removal of caries and restoration of teeth (temporary or final, depending on whether a definitive prognosis for the tooth has been arrived at and on the location of the caries), Antimicrobial therapy (local or systemic), Evaluation of response to Phase I (occurs 1 month or longer after completion), Reassess gingival condition and pocket depth, Rechecking for plaque, calculus, and caries, Periodontal surgery, including placement of implants, Evaluation of response to restorative phase, Periodontal condition (pockets, inflammation). With this information the periodontist and the patient can determine which treatment plan to follow. An individualized, well thought-out treatment plan must be, Carranza and collaborators divided the treatment plan into four main phases. The Periodontal Exam, Diagnosis, and Treatment Plan. Treatment of this disease will depend on the severity. Creating Your Plan After considering all of the information the dental team has gathered, the team can begin to create an individualized dental treatment plan for each patient. Brush your teeth twice a day or, better yet, after every meal or snack. 3. optimum. 8. This stage has also been referred to as initial therapy, nonsurgical therapy, cause-related therapy, or the hygienic phase of treatment.7,8. 9. Clinical examination and full mouth series radiographs are the two other important factors required for an accurate general picture of the case, in order to draft the temporary treatment plan. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. Most patients who have been treated for moderate to advanced periodontal disease require maintenance visits every 3 months. Patients remain in this phase for a lifetime. A true partnership between the patient and the dental team working toward mutual treatment goals has the greatest opportunity for success. Once your gum disease is under control, it is very important for you to get dental care on a consistent basis. Patients with extensive surgical and restorative needs often have treatment extend over many months, even years. If you continue browsing the site, you agree to the use of cookies on this website. The significance of reassessment after Phase I therapy. Keeping your teeth and gums healthy after treatment Periodic periodontal cleanings help you stay on top of your gum disease. ... A periodontal pocket is recorded on exam form when depth of measurement on the periodontal probe is greater than__mm? Various periodontal classification systems have been used over the years and have been modified to reflect advances in knowledge and research. Identify the patient factors to be considered when establishing the treatment plan sequence. Various periodontal classification systems have been used over the years and have been modified to reflect advances in knowledge and research.1 A classification system is simply a method for comparing treatment approaches and likely results. Patient education and plaque control instruction occur at the beginning of this phase. This care ranges from routine treatment of gums to assisting those diagnosed with gum disease. Treatment of periodontal disease helps maintain your teeth in a healthy state, but it is also beneficial to your entire body. Use it as a study guide. Antimicrobial agents are used or recommended for home use. The purpose of the preliminary phase of treatment is to bring all emergency and other critical situations under control. Gum depigmentation, also referred to as bleaching, is a cosmetic periodontal treatment (similar to tooth whitening) that removes dark spots and patches to restore natural pink color to your smile. Substantial amounts of calculus remained on the tooth. The total treatment plan is the sequential outline of the essential services and procedures to be provided to eliminate disease and restore the oral cavity to health and function. Discuss informed consent and its importance to the process of patient care. 2. The phases of therapeutic periodontal procedures, along with the sequence of other needed dental procedures, are presented in Box 10-1. A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal, or disease, and in the placement of dental implants. 4. Different from a regular cleaning, this treatment involves scaling and root planning which is important for re-gaining loss of attachment, treating gum recession, and preventing tooth loss resulting from periodontitis or … Regenerative techniques are performed to help restore periodontal tissues that have been lost due to disease. There are a variety of treatments for gum disease depending on the stage of disease, how you may have responded to earlier treatments, and your overall health. Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist. Periodontics is the dental specialty focusing exclusively in the inflammatory disease that destroys the gums and other supporting structures around the teeth. This system is based on the clinical manifestations of disease and conditions. These phases are structured to ensure that periodontal therapy is conducted in a logical sequence, consequently improving the prognosis of the patient, in comparison to indecisive treatment plan without a clear goal. treatment team. For coordination of the total treatment of the patient, the treatment plan can be divided into various segments or phases. Customized Treatment Options. The role of the dental hygienist may vary depending on the type of case, experience of the hygienist, requirements of the state dental practice act, practice setting, and philosophy of the periodontist or general dentist. The dental hygienist is often responsible for treatment of the periodontal patient in the nonsurgical, or Phase I, and maintenance, or Phase IV, stages of periodontal treatment. • Extraction of hopeless teeth and provisional replacement if needed (may be postponed to a more convenient time), • Diet control (for patients at high caries risk), • Scaling and root planing to remove bacterial plaque biofilm and calculus, • Correction of contributing restorative and prosthetic factors, • Removal of caries and restoration of teeth (temporary or final, depending on whether a definitive prognosis for the tooth has been arrived at and on the location of the caries), • Antimicrobial therapy (local or systemic), • Evaluation of response to Phase I (occurs 1 month or longer after completion), • Reassess gingival condition and pocket depth, • Rechecking for plaque, calculus, and caries, • Periodontal surgery, including placement of implants, • Evaluation of response to restorative phase, • Periodontal condition (pockets, inflammation), (Reprinted and adapted by permission from Newman MG, Takei HH, Klokkevold PR, et al, eds. The cost for treating periodontal disease is expensive and can cost thousands of dollars in severe cases. The treatment sequence begins with a preliminary phase (incorporating immediate treatment needs), followed by Phase I (etiologic treatment), Phase II (surgical treatment), Phase III (restorative treatment), and Phase IV (maintenance treatment). • Classify the phases of dental treatment included in the comprehensive care plan. Replacement of teeth by dental implants. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. In this video, we talk about the five phases of periodontal treatment, so stay tuned for lots of important information covered on the board exam. Most patients who have been treated for moderate to advanced periodontal disease require maintenance visits every 3 months.9-12. 3. Describe the goals and rationale for periodontal treatment planning. 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