Periodontics: Chapter 10- Clinical Decision Making for Periodontal Care

define clinical decision-making

process by which all members of the dental team use the info gathered during the comprehensive periodontal assessment to arrive at an appropriate diagnosis and identify treatment strategies that meet the individual needs of the patient

whats are 3 examples of a fundamental diagnostic question?

1. does this clinical assessment indicate periodontal health or inflammatory disease in the periodontium?

2. is the disease gingivitis or periodontitis?

3. if the patient has gingivitis, what type of gingivitis?

if the patient is in health in the oral cavity, what is the protocol?

no need for further diagnostic decisions

if the patient is in disease in the oral cavity, what is the protocol?

further diagnostic decisions will need to be made

decision if the mouth is in a health or disease state should be based on what?

based on signs of INFLAMMATION

signs of disease can be observed and measured by the _______________

signs of disease can be observed and measured by the CLINICIAN

symptoms of disease are noted by the ___________

symptoms of disease are noted by the PATIENT

what are some viable signs of disease?

-color changes in the gingiva

-contour changes in the gingiva

-changes in consistency in the gingiva

what are some hidden signs of disease?

-bone loss

-exudate

-bleeding on probing

is there attachment loss in gingivitis?

no

what is seen with periodontitis?

-attachment loss

-bone loss seen on radiographs

describe what "flexability" means in terms of assigning a periodontal condition to a patient

means that a patient could have more than one periodontal condition going on in their mouth

describe what our documentation of periodontal disease should be like?

-adhere to the standard format for documentation

-use correct diagnostic terms

-include descriptive modifiers to describe severity of disease

we should be using the multidimensional staging system when diagnosing periodontal disease (true or false)

true

what 3 things does staging identify?

1. severity

2. complexity of management

3. extent of distribution of disease

what are the 4 stages of periodontitis?

stage I: initial periodontitis

stage 2: moderate periodontitis

stage 3: severe periodontitis with potential of tooth loss

stage 4: advanced periodontitis with extensive tooth loss and potential for loss of dentition

what is grading of a disease used for?

used as an indicator of anticipated rate of progression of periodontal disease

what are the 3 grades used in periodontal disease?

grade A: slow rate of progression

grade B: moderate rate of progression

grade C: rapid rate of progression

what 2 words do we use describe the disease extent?

1. localized (less that 30%)

2. generalized (more than 30%)

what are the 4 insurance case types?

case type I: gingivitis only

case type II: mild periodontitis

case type III: moderate periodontitis

case type IV: severe periodontitis

describe the case type system for periodontal patients

-limited in value

-has been standard practice in US

-used in reports to insurance companies

-case type alone does not specify precise periodontal disease classification

define master treatment plan

a sequential outline of measures to be carried out by the dentist, dental hygienist and patient to: eliminate disease and restore a healthy periodontal environment

what else does the master treatment plan include?

-coordinates and sequences al treatment and education

-estimates length of time required for comprehensive treatment

what are the 4 phases of the periodontal treatment plan?

phase I: nonsurgical perio therapy

phase II: surgical therapy

phase III: restorative therapy

phase IV: periodontal maintenance

describe the assessment and preliminary therapy phase

-assessment data collection

-care for immediate treatment needs

-comprehensive clinical periodontal assessment

also called the emergency therapy stage

describe phase I: nonsurgical periodontal therapy

-all nonsurgical measures used to help control gingivitis and periodontitis (periodontal instrumentation)

-dental hygiene care and educational measures

also called bacterial control and anti-infective therapy

describe phase II: surgical therapy

-periodontal surgery

-placement of implants

-root canal therapy

describe phase III: restorative therapy

-splinting of teeth

-restorations

-replacement of missing teeth by fixed or removable prosthesis

-reevaluation of overall response to treatment

describe phase IV: periodontal maintenance

-on going care at specified intervals

-all measures used to keep periodontitis under control

-this phase used to maintain teeth functioning throughout life

-goal is to prevent recurrence of disease

a periodontal diagnosis and plan for therapy at one point in time may require modification at a later date (true or false)

true, maybe due to personal situations

it is important to communicate the possibility of change in plan to the patient (true or false)

true

periodontal care requires adjustment over time, why?

because the periodontium.....

-is dynamic and continuously changes over time

-subject to physiologic tissue remodelling

-subject to periodontal destruction throughout lifetime of the tooth

clinical decision making and treatment planning is ongoing and continues to evolve over time (true or false)

true