Chapter 21 — Clinical Decision Making for Periodontal Care

What is the first step of treatment planning?

Assigning a correct diagnosis

Signs of disease are …

Directly observable or measurable features of a disease

Symptoms of disease are …

Features of disease that are noticeable only to the patient

Examples of visible signs

• Changes in color of gingiva

• Contour changes of gingiva

• Changes in consistency of gingiva

Examples of hidden signs

• Bone loss

• Purulence (exudate)

• BOP

What is known as a silent disease?

Periodontitis

Symptoms of stage 4 perio

• Loose teeth

• Difficulty chewing

• Profuse gingival bleeding

• Bad taste in mouth

Can perio go unnoticed by patients?

Yes

If assessment reveals absence of overt or hidden signs of inflammation what is the diagnosis?

Periodontal health

If assessment reveals presence of overt or hidden signs of inflammation in periodontium what is the diagnosis?

Inflammatory disease

If assessment reveals no AL in presence of inflammation what is the diagnosis?

Gingivitis

If assessment reveals AL in presence of inflammation the diagnosis is

Periodontitis

CAL should be apparent and detectable by clinician before radiographic evidence T/F

True

Documentation of periodontal/implant diagnosis should include

• Diagnostic term

• Disease stage

• Disease grade

• Disease extent

Stage 1 perio

Initial perio

Stage 2 perio

Moderate perio

Stage 3 perio

Severe perio with potential for tooth loss

Stage 4 perio

Advanced perio with extensive tooth loss and potential for loss of dentition

Perio grade A

Slow rate of progression

Perio grade B

Moderate rate of progression

Perio grade C

Rapid rate of progression

Disease extent

• Localized

• Generalized

• Molar/incisor

Localized

30% or less of teeth in the mouth are involved

Generalized

More than 30% of the teeth in the mouth are involved

Molar/incisor pattern

Only molars and incisors exhibit periodontal breakdown

ADA case type: 1

Patients with gingivitis only

ADA case type: 2

Patients with slight (mild) perio

ADA case type: 3

Patients with moderate periodontitis

ADA case type: 4

Patients with severe periodontitis

Case type system should only be used as a supplemental description T/F

True

• Fails to specify disease extent, no staging or grading info

Phases of treatment plan

• Assessment and preliminary therapy

• Nonsurgical periodontal therapy

• Surgical therapy

• Restorative therapy

• Periodontal maintenance

Assessment & preliminary therapy phase includes

• Collection of data

• Urgent care for any acute conditions (emergency therapy)

• OE

• Radiographs

• Diagnosis

• Planning

• Extraction

Nonsurgical periodontal therapy includes

• Self-care ed

• Periodontal instrumentation

• Correction of local risk factors

• Caries control and temporary restorations

• Occlusal therapy

• Reevaluation of phase 1 therapy

Other names for Nonsurgical periodontal therapy

• Initial periodontal therapy

• Phase 1 therapy

• Bacterial control

• Anti-infective therapy

What’s another name for surgical therapy phase?

Phase 2 therapy

What is included in surgical phase therapy?

• Periodontal surgery to control or eliminate periodontal disease

• Placement of implants

What’s another name for the restorative therapy phase?

Phase 3 therapy

What’s included in restorative therapy phase?

• Dental restorations

• Replacement of missing teeth

  • Fixed or removable prostheses

What’s another name for periodontal maintenance therapy?

Phase 4 therapy

What’s included in periodontal maintenance therapy?

All measures used by dental team and patient to keep perio from recurring once inflammatory disease is under control

The diagnosis and plan of therapy does not need modifications at a later date T/F

False

• Potentially will need to make modifications

Phase 1 therapy

Nonsurgical periodontal therapy

Phase 2 therapy

Surgical therapy

Phase 3 therapy

Restorative therapy

Phase 4 therapy

Periodontal maintenance