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Decision Making Related to Nonsurgical Periodontal Therapy

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Diana Macri

on 27 March 2017

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Transcript of Decision Making Related to Nonsurgical Periodontal Therapy

plaque removal
plaque control
supragingival scaling
subgingival scaling
root planing
use of chemical adjuncts
Decision Making Related to Nonsurgical Periodontal Therapy
More terms:

Disease severity
is the measure of the destruction that occurred before the assessment
Disease activity
refers to inflammation, connective tissue degeneration, and bone or attachment loss that is ongoing at the time of the examination
refers to periodontal disease states that continue to progress despite client adherence with recommended oral self-care and professional care that yields successful clinical outcomes for most clients.
Phases of
Phase I
Phase II
Phase III
Phase IV
Therapeutic procedures:
Self-care education
Manual and mechanized instrumentation: scaling and root planing, periodontal debridement
Chemotherapeutic interventions
Pain-control strategies
Stain removal, as needed

Expected Outcomes
Change in the type of microbial colonization

2 weeks after perio debridement; the time required for initial reduction in clinical signs of inflammation
4-6 week- comprehensive evaluation: did you miss anything? how did the patient respond? anything else you have to do? Specifically.....
to preserve, maintain and improve the natural dentition, implants and peridontium
to achieve function, health, comfort, aesthetics
removal and control of oral biofilm through self-care and professional periodontal debridement, supplemented by adjunctive therapy with chemotherapeutics or host modulation agents as needed, for the treatment of periodontal disease involving natural teeth and implant replacements
**the absence of inflammation characterizes health!!**
Variables in care planning approaches:
Classification and diagnosis of periodontitis
Severity of periodontitis
Systemic health or disease of client
Client’s human needs and informed consent
Practitioner’s philosophy of care
Subgingival therapy does not significantly affect other areas (e.g., tongue, tonsillar area) that might be a source for reemerging periodontal bacteria
Minimal or no bone repair occurs after scaling and root planing

species seen in aggressive perio are not eradicated
Perio Maintenance Therapy
PM continues for the life of the dentition or its implant replacements
Clients with gingivitis and periodontitis have a chronic disease entity that must be controlled by frequent periodontal care and daily self-care

Table 30-3 p. 543, Suggested PM Intervals

What is NSPT?
Important Concepts:
NSPT has been shown to arrest periodontitis
The main focus of NSPT is oral self-care education (client's responsibility) and the mechanical removal of biofilm and biofilm retentive factors (clinician's responsibility)
The hyperinflammatory response of the host is responsible for the destruction of collagen and bone (i.e. periodontitis)
The goal of periodontal surgery is to enhance access so that clinician and client can keep areas clean
Quadrant periodontal debridement, full-mouth debridement and full-mouth disinfection (FMD) are all viable approaches
"Treatment plans are developed according to professional standards and client needs, not according to the provisions of the client's insurance policy" (Darby, p.544)
Procedure Codes for NSPT (created by the ADA)

274 Bitewings – four (4) radiographic images
277 Vertical bitewings – seven (7) to eight (8) radiographic images
210 Intraoral complete series of radiographic images
Learning objectives:

1. Discuss aspects of nonsurgical periodontal therapy including disease activity, disease severity,
2. Define and differentiate: scaling, oral prophylaxis, root planing, periodontal debridement, periodontal maintenance, chemotherapy for periodontal disease, full mouth disinfection, clinical endpoint, therapeutic endpoint,
4. Describe implementation of nonsurgical periodontal therapy including evaluation of outcomes, treatment modalities and treatment intervals.

Scaling- instrumentation of the crown and root
to remove oral biofilm, calculus, stain
Oral prophylaxis- supra and subgingival scale with stain and biofilm removal
Root planing- definitive procedure to remove cementum or surface dentin that is rough, impregnated with calculus or contaminated with toxins/microorganism
Periodontal debridement-removal of all subgingival plaque (oral biofilm) its by-products, clinically detectable biofilm retentive factors and detectable calculus-embedded cementum
Full-mouth disinfection [FMD] involves the scaling and root planing of all pockets within a 24-hour time period.
Clinical endpoint
measures the tooth surface’s preparation for the healing of adjacent tissues

Therapeutic endpoint
of therapy determined at the evaluation visit includes the measurement of critical criteria such as probing depth, clinical attachment level, and gingival inflammation accompanied by bleeding

Factors to consider for reevaluation:
gingival inflammation
pocket depths
CAL, furcations, mobility
patient response
other needs- overhangs? occlusion?
pt. managment of risk factors
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