2.3 Prevention and Maintenance in Periodontology

• Phase I: etiologic tx

• Phase II: surgical tx

• Phase III: restorative tx

• Phase IV: maintenance phase

What are the four main phases of treatment?

Preliminary phase

This phase treats urgent conditions such as abscesses, extraction of hopeless teeth, and referral or suspicious lesions

• Nonsurgical phase

• Etiologic phase

• Initial therapy

• Cause-related therapy

• Hygienic phase of tx

What are other names for phase 1 therapy?

1. Control the disease process

2. Eliminate the etiologic factors of disease process

What are the 2 goals of phase 1?

• OHI

• SRP/debridement

• Antimicrobial therapy

• Occlusal therapy

• Correction of plaque retentive factors

• Nutritional and smoking cessation counseling

• Minor ortho

• Fluoride therapy

• Re-evaluation

What are the treatments that are included in phase 1?

RDH

Who completes phase 1?

DDS or periodontist

Who completes phase II?

1. Reduce the effects of periodontal disease

2. Regenerate healthy periodontal tissue

What are the 2 goals of phase II?

True

T/F: Implant placement and endodontic therapy is included in phase II of tx

DDS

Who completes phase III tx?

1. Restore function

2. Replace missing teeth

What are the goals of phase III tx?

• Restorations

• Orthodontics

• Splinting

• Occlusal therapy

• Implant restorations

What are examples of procedures in phase III therapy?

RDH

Who completes phase IV tx?

Maintain oral health for a lifetime

What is the goal of phase IV tx?

True

T/F: More involved periodontal areas begin to deteriorate after 90 days which is the rationale for the 3-month recall of a PM patient.

• Periodontal diagnosis and prognosis

• Patient’s systemic and periodontal conditions

• Patient’s preferences

What are the influencing factors for the sequence of periodontal therapy?

True

T/F: Patient education and plaque control instruction are critical aspects of treatment?

1. Patient gains ownership for positive changes

2. Healthier gingival tissues are able to withstand SRP better than inflamed

What are the two reasons for initiating OHI before SRP?

False

T/F: It is okay for an RDH to promise a particular result of treatment if the clinician is certain that the results will be favorable

Prognosis

The prediction of forecast of the extent and duration of disease and its response to treatment

• Age of patient

• Systemic health

• Type of perio disease

• Oral conditions

• Attitudes and perceptions of the pt

• Smoking/tobacco use

What are overall prognosis factors?

• Pocket depth and inflammation

• Mobility

• Number and location of furcations

• Location of mucogingival tissue

• Tooth morphology

• Bone levels

• Ability to modify etiologic factors

What are individual tooth prognosis factors?

Excellent

This prognosis suggests that a tooth or dentition will remain healthy and in function for an indefinite period of time.

• No bone loss

• Excellent gingival condition

• No systemic considerations

• Good pt cooperation

Good

This prognosis suggests a tooth or dentition will remain healthy for an indefinite period of time

• Adequate remaining support

• Easy to maintain for hygienist and patient

• Adequate pt cooperation

Fair

This prognosis suggests that conditions may worsen at some time in the future

• Attachment loss/class I furcations

• Systemic factors controlled

• Pt cooperation likely

Poor/guarded

Prognosis that indicates that efforts to save the tooth or teeth may not be successful

• Class II or III furcas, mobility

• Systemic factors present

• Difficult to maintain

Questionable

This prognosis suggests that the condition may not be treatable and the tooth or teeth may be lost even with treatment

• Poor crown/root ratio, poor root form, root proximity

• Class II, III furcas and mobility

• Systemic factors present

Hopeless

This prognosis suggests that the tooth is expected to be lost and needs to be extracted

• Advanced bone and attachment loss

• Uncontrolled systemic factors

• Refractory aggressive perio

Actinomyces viscosus

What is the predominant organism in biofilm covering root surfaces?

Cold, sweets, acid, drying, scraping with metal

Which stimuli can cause a rapid and immediate flow of tubule contents in an outward direction?

Hot

Which stimuli cause rapid inflow of fluid into the pulp chamber, stimulating the nerves?

True

T/F: The smear layer is removed during a dental cleaning

Smear layer

The amorphous or crystalline layer present on the dentinal surface that cannot be rinsed off or readily washed away; thicker layer means less sensitivity

• Potassium nitrate containing products

• Strontium chloride

• MI paste

• Fluoride products: prevident, crest pro-health

What are different at-home products that can be used to decrease sensitivity?