5: Calculus and Other Disease-Associated Factors, 9: Systemic Factors Influencing Periodontal Diseases, 12: Plaque Biofilm and Disease Control for the Periodontal Patient, 11: Occlusion and Temporomandibular Disorders, 18: Prognosis and Results After Periodontal Therapy, Periodontology for the Dental Hygienist 4e. Principally, the comprehensive periodontal therapy can be divided into four main phases followed by any dental emergency 7. Other situations are evaluated on a case-by-case basis. Because of the complexity of the periodontal treatment required to meet planned goals, a series of appointments is often required. • Classify the phases of dental treatment included in the comprehensive care plan. This system was adopted by the American Academy of Periodontology (AAP) and is widely accepted by the dental community as the preferred classification system. 2. 6. • Teeth that will require removal. 5. This 41-year-old male patient had completed Phase I therapy consisting of quadrant scaling and root planing and oral hygiene instructions. This system was adopted by the American Academy of Periodontology (AAP) and is widely accepted by the dental community as the preferred classification system.13 The classifications are outlined in Box 10-2. Some serious general healthconditions absolutely preclude placing implants. Phase II therapy or Surgical Phase. Define the role of the dental hygienist in determining the dental hygiene care plan. Such teeth often serve as abutments for fixed and removable partial dentures, and their position in an arch may add stability to a dental prosthesis. The sequence of treatment depends on a number of factors, including the periodontal diagnosis and prognosis, the patient’s systemic and periodontal condition, and the patient’s preferences. Scaling and Root Planning In the first phase of your treatment, special instruments will be used to carefully and thoroughly clean (debride) and polish each tooth and its root surfaces. The treatment sequence begins with a preliminary phase (incorporating immediate treatment needs), followed by Phase I (etiologic treatment), Phase II (surgical treatment), Phase III (restorative treatment), and Phase IV (maintenance treatment). A holistic approach to treating gum disease completes this by introducing certain measures meant to help patients improve the health of their bodies because this will actually have a significant effect on the gum issues as well. Creating Your Plan After considering all of the information the dental team has gathered, the team can begin to create an individualized dental treatment plan for each patient. The, Extraction of hopeless teeth and provisional replacement if needed (may be postponed to a more convenient time), Diet control (for patients at high caries risk), Scaling and root planing to remove bacterial plaque biofilm and calculus, Correction of contributing restorative and prosthetic factors, Removal of caries and restoration of teeth (temporary or final, depending on whether a definitive prognosis for the tooth has been arrived at and on the location of the caries), Antimicrobial therapy (local or systemic), Evaluation of response to Phase I (occurs 1 month or longer after completion), Reassess gingival condition and pocket depth, Rechecking for plaque, calculus, and caries, Periodontal surgery, including placement of implants, Evaluation of response to restorative phase, Periodontal condition (pockets, inflammation). The. Procedures in this phase included restorative dentistry, extensive orthodontics, and any needed occlusal therapy. Plan enough time off from work or school to feel less rushed or anxious about getting back. During this phase, procedures are undertaken to reduce the effects of disease. The role of the dental hygienist may vary depending on the type of case, experience of the hygienist, requirements of the state dental practice act, practice setting, and philosophy of the periodontist or general dentist. In 1999, an international group of periodontal experts approved the classification system currently in use. Patient education and plaque control instruction occur at the beginning of this phase. Other risk factors for periodontal disease also should be identified and modified where possible. With this information the periodontist and the patient can determine which treatment plan to follow. When indicated, the plan should include: 1. Brush your teeth twice a day or, better yet, after every meal or snack. Defining a treatment plan for the periodontal patient is a process that requires the assessment, preventive, therapeutic, and evaluative skills of the dental hygienist and the dentist. Substantial amounts of calculus remained on the tooth. This stage has also been referred to as initial therapy, nonsurgical therapy, cause-related therapy, or the hygienic phase of treatment.7,8. Endodontic therapy can be performed to relieve pain, even if its completion carries over to other phases of treatment, and oral lesions of any type should be evaluated and treated or referred. The maxillary right area did not respond well around tooth #7. The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy.1 This plan includes all procedures performed to attain and maintain the long-term oral health of the patient and should involve all members of the health care team and the patient. Floss daily. After this second treatment, the pocket depth resolved to 2 to 3 mm, and tissue color and texture then appeared similar to the other areas of the mouth—pink and firm. The treatment plan should be used to establish the methods and sequence of delivering appropriate periodontal treatment. Hopeless teeth should be removed and provisional restorations, such as temporary partial dentures, should be fabricated. • Discuss informed consent and its importance to the process of patient care. At Rocky Point, Sonora Mexico you can combine comfort, health and relaxation with customize gum disease treatment to … Describe the goals and rationale for periodontal treatment planning. The interval between periodontal maintenance appointments is determined by the periodontal condition and the plaque control that the patient is able to attain and maintain. 2. 1 This plan includes all procedures performed to attain and maintain the long-term oral health of the patient and should involve all members of the health care team and the patient. Consider using an electric toothbrush, which may be more effective at removing plaque and tartar. For coordination of the total treatment of the patient, the treatment plan can be divided into various segments or phases. Gum disease treatments may cost between $500 and $10,000 . The dental hygiene treatment plan consists of services that are performed by the dental hygienist within the total treatment plan.2 Treatment planning occurs after the assessment of all clinical data and reflects the diagnosis and prognosis of the patient. PERIODONTAL SURGICAL TREATMENT PLAN Initial Periodontal Examination At this appointment Dr. Calvert will review with you your medical and dental history. Many of her teeth were beyond help and, due to the severe nature of the bone loss, providing her with a lasting aesthetic solution that … Phases of treatment plan. Development of a logical and properly sequenced treatment plan is a derivative of the periodontal assessment and diagnosis. Once the diagnosis is determined, various treatment options can be formulated. [Article in French] Matter J. PMID: 1059252 [PubMed - indexed for MEDLINE] The goals of the treatment plan are to eliminate and control etiologic and predisposing factors of disease, maintain health, and prevent recurrence of disease. The phases of therapeutic periodontal procedures, along with the sequence of other needed dental procedures, are presented in Box 10-1. Many restorative dental treatments in particular require the establishment of healthy periodontal tissues for their clinical success. 11th ed. Dental Treatment Plan – A type of treatment plan that is centered on dental care and would usually depend on the patient’s overall dental condition. Prevention and Treatment of Periodontal Diseases in Primary Care. When you make your appointment, ask how long a cleaning and … Each phase suggested a particular group of procedures and included evaluation of the patient’s response. The overall approach of this classification system separates gingival disease from periodontal disease and conditions affecting the periodontium. Carranza’s Clinical Periodontology. All treatment plans must be understood by the patient and reflect the patient’s wishes and preferences. v ... • Record the diagnosis, suggested treatment plan and details of costs. timely treatment of existing periodonti-tis.3,4 Although the evidence is limited, there is a strong suggestion that use of a periodontal probe for diagnosis and recording of periodontal status in treat-ment records in general dental practices has yet to achieve the level of … Dental Treatment Plan – A type of treatment plan that is centered on dental care and would usually depend on the patient’s overall dental condition. The dental hygienist is often responsible for treatment of the periodontal patient in the nonsurgical, or Phase I, and maintenance, or Phase IV, stages of periodontal treatment. Disease classifications are useful for diagnosis, prognosis, and treatment planning because they help define the extent of disease and facilitate communication among members of the. In 1999, an international group of periodontal experts approved the classification system currently in use. Various periodontal classification systems have been used over the years and have been modified to reflect advances in knowledge and research.1 A classification system is simply a method for comparing treatment approaches and likely results. So, the phases of treatment plan are, Emergency phase. Identify the considerations for sequencing dental hygiene treatment with periodontal diseases. The Treatment Plan is vital for giving your patients information on recommended treatment, what insurance is expected to cover, and the estimated patient portion. The purpose of the preliminary phase of treatment is to bring all emergency and other critical situations under control. Periodontal diseases are caused by infections that have spread to the gums and tooth roots. SSO Schweiz Monatsschr Zahnheilkd. No treatment should be provided to a patient until a treatment plan has been established and agreed on. Periodontists are also experts in … Note the residual calculus on the mesial surface of tooth #9, at the right edge of the figure. 3. Dental cleanings are not a treatment for active gum disease. Various periodontal classification systems have been used over the years and have been modified to reflect advances in knowledge and research. The goals of the treatment plan are to eliminate and control etiologic and predisposing factors of disease, maintain health, and prevent recurrence of disease.1,4 These goals are the same, regardless of the sequence of treatment or the individual who is delivering the dental care. Phase IV therapy is the maintenance phase. Initial Periodontal Treatment A. MASTER PLAN FOR TOTAL TREATMENT The aim of the treatment plan is total treatment, that is, the coordination of all the short- and long-term goals for the purpose of creating a well- functioning dentition in a healthy periodontal environment. In fact, these are the main points of a holistic treatment plan for gum disease: 1. Scaling, root debridement and planing are performed. The cost of periodontal surgery varies greatly depending on the type of procedure and the severity of your disease. • Identify the patient factors to be considered when establishing the treatment plan sequence. The sequence of treatment depends on a number of factors, including the periodontal diagnosis and prognosis, the patient’s systemic and periodontal condition, and the patient’s preferences. This is also a part of treatment once an infection occurs. 1975 Sep;85(9):901-4. Use a soft toothbrush and replace it at least every three to four months. This system is based on the clinical manifestations of disease and conditions. That specialist, such as an oral surgeon or periodontist, would become involved in helping to create the final treatment plan and in rendering treatment, if needed. Although this phase is often referred to as “recall,” the accepted terms are periodontal maintenance or periodontal recall because the patient’s periodontal health must be continuously monitored from this point. Classify the phases of dental treatment included in the comprehensive care plan. The total treatment plan is the sequential outline of the essential services and procedures to be provided to eliminate disease and restore the oral cavity to health and function. Treatment planning provides an opportunity to explain problems and treatment goals to the patient in understandable terms.4–6 Listening to the patient’s concerns is a crucial element in the treatment planning process so that the plan can address the patient’s perceived needs along with the disease identified by the clinician. Scaling and root planing. The dental hygienist must also use the visual and verbal feedback from the patient to judge the patient’s level of understanding. 4. This type of treatment plan lasts long term and is usually conducted in sessions before one could achieve evident results. Medical consultation or referral for treatment when appropriate. • List the major classifications of periodontal disease. This chapter describes current strategies and classifications for planning the treatment of the periodontal … St. Louis, MO: Elsevier Saunders; 2012.). The treatment plan defines the methods and sequence of delivering appropriate treatment.1,3,4. Try these measures to reduce or prevent periodontitis: 1. The only exception to this would be emergency care to relieve a patient of pain due to injury or acute disease. The overall approach of this classification system separates gingival disease from periodontal disease and conditions affecting the periodontium. Because of the complexity of the periodontal treatment required to meet planned goals, a series of appointments is often required. The role of the dental hygienist may vary depending on the type of case, experience of the hygienist, requirements of the state dental practice act, practice setting, and philosophy of the periodontist or general dentist. Using a system that is understood and used by a large number of dental professionals greatly facilitates communication regarding cases. Periodontal surgical procedures, including placement of implants. This system is based on the clinical manifestations of disease and conditions. • Extraction of hopeless teeth and provisional replacement if needed (may be postponed to a more convenient time), • Diet control (for patients at high caries risk), • Scaling and root planing to remove bacterial plaque biofilm and calculus, • Correction of contributing restorative and prosthetic factors, • Removal of caries and restoration of teeth (temporary or final, depending on whether a definitive prognosis for the tooth has been arrived at and on the location of the caries), • Antimicrobial therapy (local or systemic), • Evaluation of response to Phase I (occurs 1 month or longer after completion), • Reassess gingival condition and pocket depth, • Rechecking for plaque, calculus, and caries, • Periodontal surgery, including placement of implants, • Evaluation of response to restorative phase, • Periodontal condition (pockets, inflammation), (Reprinted and adapted by permission from Newman MG, Takei HH, Klokkevold PR, et al, eds. Certain conditions can increase the risk of failure if not treated before implant placement. Disease classifications are useful for diagnosis, prognosis, and treatment planning because they help define the extent of disease and facilitate communication among members of the treatment team. After this new diagnosis, and if necessary adjustment of the original goal of the treatment plan, a definite treatment plan can be effected. Regenerative techniques are performed to help restore periodontal tissues that have been lost due to disease. [The periodontal treatment plan]. Phase II therapy is the surgical phase of treatment. Antimicrobial agents are used or recommended for home use. The significance of reassessment after Phase I therapy. Patient education and plaque control instruction occur at the beginning of this phase. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. 8. Log In or. Identify the patient factors to be considered when establishing the treatment plan sequence. Periodontal maintenance occurs while the other phases of treatment are ongoing because the completion of the entire treatment plan can take months or years, and decline in the status of periodontal patients has been observed much earlier, after as little as 90 days. Dental and periodontal abscesses should be treated. This … This chapter describes current strategies and classifications for planning the treatment of the periodontal patient. treatment team. Although this phase is often referred to as “recall,” the accepted terms are. periodontal disease and, hence, oral hygiene instructions are the cornerstone of periodontal treatment planning. Antimicrobial agents are used or recommended for home use. Treatment plan is guiding map for perio treatment – no treatment should be initiated without forming a solid TP & Although Its clinician’s responsibility to make individual patient realize the value of Treatment – motivated patient is a prerequisite for optimum outcome of perio therapy 69 60. Any dental emergency is treated first to achieve patient comfort. The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy. When developing a treatment plan for the patient with a variety of tooth-related problems, such as periodontal disease, caries, and failing large restorations, a first step may be to identify the important or key teeth that can be salvaged. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. Patients remain in this phase for a lifetime. Most patients who have been treated for moderate to advanced periodontal disease require maintenance visits every 3 months. Phase I therapy or Etiotropic Phase. List the major classifications of periodontal disease. established before the beginning of treatment, and it must be carefully monitored. Patients with extensive surgical and restorative needs often have treatment extend over many months, even years. Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist. The effects of periodontitis can be stopped through regular checkups and treatment and continued good oral hygiene. Carranza and collaborators divided the treatment plan into four main phases. Deep cleaning, which involves scaling and root planing, will likely be one of the first treatments your dentist uses. A true partnership between the patient and the dental team working toward mutual treatment goals has the greatest opportunity for success. Also in this plan, the therapy must be carried out … Treatment planning is an essential component of clinical practice. The experimental group received comprehensive non-surgical periodontal treatment which included 3 steps: Step 1—dental examination and oral hygiene education including a brochure describing the plan for comprehensive PD; Step 2—periodontal treatments, including subgingival curettage and root planing (supportive therapy); Step 3—evaluation of the effectiveness of the comprehensive periodontal … Experience wonderful dental care in the relaxed surroundings of a white sandy beaches of coastal resorts. • Define the role of the dental hygienist in determining the dental hygiene care plan. Figures 10-1 to 10-4 are examples of successful therapeutic results achieved by a dental hygienist providing Phase I therapy. Gum Disease Treatment Plan. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 10: Treatment Planning for the Periodontal Patient. An individualized, well thought-out treatment plan must be established before the beginning of treatment, and it must be carefully monitored. A dentist or dental hygienist provides this treatment by scraping and removing the plaque and tartar off of your teeth and root surfaces by scaling, and then smoothing away any roughness on the roots to prevent bacteria from gathering again. • Need for emergency treatment (pain, acute infections). Scaling and root planing is sometimes followed by adjunctive therapy such as local delivery antimicrobials, systemic antibiotics, and host modulation, as needed on a case-by-case basis. The Challenge: Advanced periodontal disease and severe bone loss The solution: Periodontal disease treatment, full mouth rehabilitation and dental implants Our 38-year old patient was devastated by the thought of losing her teeth and ha ving dentures. Wennstrom 27 proposed a simplified algorithm for treating periodontal diseases in older adults that is applicable to routine periodontal therapy for any age group. This stage has also been referred to as initial therapy, nonsurgical therapy, cause-related therapy, or the hygienic phase of treatment. What Are Periodontal Diseases? The initial (periodontal) treatment is concluded with a reevaluation. For coordination of the total treatment of the patient, the treatment plan can be divided into various segments or phases. Tooth # 9, at the beginning of treatment is to bring all emergency and other situations. Treatment is concluded with a reevaluation carranza and collaborators divided the treatment sequence! 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