2017 Oregon Dental Conference Course Handout

Transcription

1 2017 Oregon Dental Conference Course Handout Kimberly Miller, RDH Course 8123: Principle Based Periodontal Therapy and Treatment Planning! Thursday, April 6 9 am - 4:30 pm

2 Principle Based Periodontal Therapy and Treatment Planning Oregon Dental Conference - April, 2017 Kim Miller, RDH, BSDH kim@inspiredhygiene.com Principles Of Care #1 : (partial list) Risk Factors: Diabetes Tobacco use Immunodeficiency Family History of PD Ethnicity & Age Other health factors Medications Visit: Occlusal trauma Restorative considerations Aesthetic considerations Behavior considerations Plaque / Calculus Professional dental care Personal history of PD Genetics #2 : Having a standard diagnostic procedure and treatment recommendations are critical steps toward improving a patient's overall oral and systemic health. Despite the prevalence of periodontal disease among adults, it is still under diagnosed and under treated, putting patients at risk for systemic disease American Dental Association "Boneloss is evident by the increase in pocket depth and/or clinical attachment loss but may not be visible radiographically, since, according to the AAP 30-50% of the bone mineral must be resorbed before changes appear radiographically." Ref: AAP Position Paper, Diagnosis of Periodontal Diseases, J Periodontol 2003;74: #3 : Complete debridement site by site followed by disease remission is the therapeutic goal of nonsurgical therapy. According to the 2000 AAP Parameters of Care, in patients where the periodontal condition does not resolve, additional therapy may be required. Not all patients or sites will respond equally or acceptably, and additional therapy may be warranted on a site specific basis. #4 : o Patient Compliance o Patient home care o Mechanical debridement o Chemical debridement o Site specific antibiotics o Systemic antibiotics 1

3 Principle Based Periodontal Therapy and Treatment Planning Oregon Dental Conference - April, 2017 Kim Miller, RDH, BSDH kim@inspiredhygiene.com #5 : A recall appointment should include complete periodontal exam, response diagnosis, professional supra and sub gingival tooth cleaning and recommendations for any additional treatment. From a legal standpoint both the patient and the practitioner have acquired new duties. The professional is obligated to inform the patient that professional plaque control is necessary on a two to three months basis (60-90 days) and to provide professional tooth cleaning, examination and diagnosis. Providing periodontal treatment without accompanying SPT (PM) should be considered negligent care by the practitioner. The patient retains the previous duty to perform adequate personal plaque control and acquires the duty of complying with the prescribed interval for professional plaque control. Failure of the patient to comply with these duties will result in disease progression which the professional will be powerless to prevent. JADA Vol. 11, Nov 1993 The Four-Pronged Approach to Treatment Planing Treating disease from the outside in includes the use of: Treating disease from the inside out includes the use of: Treating disease from the top down includes what the patient does at home: o Type and frequency of tooth brushing o Interproximal cleaning o Professionally recommended topical applications Treating disease from the bottom up includes: 2

4 Principle Based Periodontal Therapy and Treatment Planning: CDHA ~ October 17, 2015 Kim Miller, RDH, BSDH kim@inspiredhgyiene.com Primary Risk Factors (High) Tobacco use Diabetes/CVD Immunodeficiency Personal History of PD Pregnancy Moderate Risk Factors Other health factors Medications Occlusal trauma Restorative considerations Aesthetic considerations Behavioral considerations Increased Risk w/ Modifying Factors Family History of PD Ethnicity Age Plaque: L M - H Calculus: L M - H Frequency of dental care Risk Level: High - one of primary + inflammation Moderate - no primary + others Low - no primary, no other Inflammatory / Medical Systemic Factors Cardio Vascular Disease Heart Disease High Blood Pressure Migraines Erectile Dysfunction Polycystic Ovaries Psoriasis / Gout Rheumatoid Arthritis Abdominal Obesity Auto Immune Disease Other inflammatory conditions Sleep problems ADA Case Type: Chronic / Acute Case Type I: Gingivitis: C / A Case Type II: Early: C / A Case Type II: Moderate: C / A Case Type II: Advanced: C / A Clinical Data Recession - loc / gen Bone loss loc / gen Pocket Depth Range Bleeding L / M / H Bleeding loc / gen AAP Classifications I. Gingival Disease II. Chronic perio III. Aggressive perio IV. Manifest from Systemic Disease V. Necrotizing Perio Diseasesine VI. Abscess of the Periodontium VII. Perio assoc with Endo Lesion VIII. Developmental / Acquired Deformities and Conditions Other Compliance P / F / G / E Root Debrid. UR LR UL LL Prognosis - P / F / G / E HC: PTB, F, SF, WP, PA, PB, SP Adjunctive Procedures Clinical Lab testing: Bacteria / Celsus One / HPV LAA est. # Antimicrobial rinse Laser Therapy Other Treatment Plan: PT visits + Perio Maint D4910 in weeks Restorative Priorities: 3

5 Treatment Planning Worksheet: Getting great results one patient at a time! kim@inspiredhygiene.com 4