periodontal treatment plan
In the author’s opinion, treatment delays stem primarily from not having a systematized, organized periodontal treatment protocol in place. Gum disease is caused by bacteria in plaque and tartar; when plaque and tartar build up on the teeth, the bacteria inflame and irritate the gum tissues. This care ranges from routine treatment of gums to assisting those diagnosed with gum disease. Incidence of Advanced Gum Disease, More Than a Quarter of U.S. Therefore, periodontal care must be given serious consideration when developing treatment plans for older adults. The inflammatory response is precipitated by a release of certain enzymes that rush to the infected areas to combat the bacteria and their bacterial endotoxins. There will likely be more compliant flossers when patients smell how much halitosis is coming from those areas. There are certain actions oral healthcare providers can take to elevate the standard of care when it comes to treating periodontal disease. It will give you an easy to understand foundation of how a periodontal program works. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. Note: Dr. Friedman and Dr. Ocampo are actively monitoring the emerging and rapidly evolving COVID-19 outbreak. J Periodontol. The classic model is a linear progression that starts at health and moves to gingivitis, then periodontitis, with its associated bone loss, bleeding, and radiographic evidence of disease. 7. A general practitioner who simply tells the patient, “We’re going to send you over to the surgeon now” is asking for trouble. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. Tooth mobility tests may also be performed. Lewis C. Fighting gum disease: how to keep your teeth. Periodontal audit Page 2 Background. You are getting that infection under control. 5. 1. These patients would most likely be confused and upset, because they had been led to believe that they were ready for surgery. Even though oral healthcare providers and medical professionals know the potential health consequences of periodontal disease, there are certain things that can be done to elevate the standard of care when it comes to treating periodontal disease. Oral Health in America: A Report of the Surgeon General. Cooney PV, Hassard TH, Ulla A, Spangen DA. However, a tooth can have attachment loss without having a pocket. It is meant to be a synthesis of the information out there that is most consistent. Floss daily. 10. A systematic review. Patients need to be educated about dental insurance. That means brushing your teeth for two minutes at least twice daily — in the morning and before going to bed — and flossing at least once a day. 195;55(3):177-180. There are several ways to diagnose periodontitis. J Clin Periodontol. The Expansion of the Surgical Phase Periodontal Surgery E.g. As mentioned before, compliance can be a problem with prescription medications. A Five-Step Plan for Treating Periodontal Disease. Topically applied minocycline microspheres: why it works. Consideration of adjunctive restorative, prosthetic, Initial Periodontal Treatment . Periodontal Gum Treatment (for gum disease) is the treatment of swelling, soreness or infection of the tissues supporting the teeth. explain how the inflammatory response to oral pathogenic bacteria affects gingival tissues. The results of these studies, where tray drug delivery systems were used as adjunct to non-surgical periodontal therapy, provide no strong evidence that show adjunctive use of tray delivery systems is more effective than traditional non-surgical periodontal therapy alone. Minocycline HCL microspheres reduce red-complex bacteria in disease therapy. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994 [published corrections appears in: J Periodontol. Radiographs can be used, but they have limitations in initial diagnosis because bone loss is typically associated with severe and chronic periodontal disease; therefore, radiographs are better used to confirm diagnosis. 3. AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. In contrast, periodontal disease is an ongoing, never-ending disease that dentists can control but cannot cure. 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. Fiehn NE. J Clin Periodontol. However, treating and charging for periodontal disease is very different. Nevertheless, a periodontitis patient is always considered as having a chronic condition and requires a lifelong regimen of regular, professional care in the dental practice. 2. This represents much destruction, and it is concentrated within the connective and supportive tissues of the gingiva. Undiagnosed and untreated periodontal disease is one of the fastest growing areas of litigation and complaints in dentistry. 6. J Periodontal Res. The AAP has reviewed several studies about the treatment of periodontal disease using tray drug delivery systems. 2. Goodson JM, Gunsolley JC, Grossi SG, et al. The author has no financial interest in any of the manufacturers mentioned in this article. Over time, fewer appointments may be necessary. Periodontal Therapy Treatment Plan This is your intended treatment plan which will commence at your next appointment. In pockets > 5 mm, locally applied antibiotics may be beneficial to help eradicate the bacterial source of infection, as well as promote tissue healing. 2000;71(5 Suppl):880-883. Smith did what he could within the limits of his practice, but now we are going to do it in a specialty practice at a level that is pre-surgical.”, Both the periodontist and general practitioner should always know exactly what the other is going to say on the matter. However, vertical bitewings taken over time can be placed side-by-side to detect even slight differences in contrast. For periodontal disease treatment to be as successful as possible, patient compliance with respect to diligent home care is a major factor. How come all of a sudden I have this problem?”, That is a legitimate question that requires a compelling answer. Compliance with medical regimens: An annotated bibliography. 3. 737 N. Michigan Ave., Suite 800, Chicago, IL 60611312-787-5518, AAP Foundation American Board of Periodontology, American Academy of Periodontology and American Dental Association Mourn the Loss of Robert J. Genco, DDS, PhD, Should You Brush or Floss First? The body’s immune system responds to the overwhelming influx of pathogenic bacteria in the mouth, on teeth and gums, and in gingival crevices by initiating an inflammatory response. The goal is to avoid systemic drugs if possible, so as to not build bacterial resistance. Dental insurance is “payment assistance;” it is meant to help offset the cost of treatment, not pay for it entirely. Adults are Dishonest with Dentists about How Often They Floss Their Teeth, Oral Hygiene Habits and Hypertension Risk, Periodontal Disease More Prevalent among Ethnic Minorities, Proceedings from the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions, Insurance Reimbursement and Third Party Issues, Periodontal Literature Review: The Next Generation. 2000;321(7252):36-39. discuss methods of encouraging patient at-home compliance. REFERENCES Your interest, participation and commitment are essential to make your treatment a success. In addition to soft tissue evaluation, one of the most common and accurate methods is to use a periodontal probe in affected areas and record probing depths. Journal of Public Health Dent. Patients will often go months and months with bleeding gums and not seek treatment, while bleeding from any other body orifice would immediately send them to their physician. New patients commonly react by becoming defensive, saying, “How come my former dentist didn’t diagnose this?” In cases such as this, it is important to respond tactfully: “That is a very good question, Mrs. Smith. Medication adherence in persons with cardiovascular disease. Feres M, Haffajee AD, Allard K, et al. Brush your teeth twice a day or, better yet, after every meal or snack. This is when … When indicated, the plan should include: Then remove the floss and let them smell it. Several frameworks are available to aid in the care of this patient population. For example, elastase and collagenase break down and destroy elastin and collagen, which are the primary structural components of the periodontium. Another method is to create an emotional impact to serve as an impetus to change patient behavior and compliance for the better. Non-surgical periodontal treatment does have its limitations. 5. There is a wealth of information available that clearly demonstrates an association between the health of the mouth and the health of the body.7 However, more research needs to be done, particularly in the realm of interventional studies, which may very well indicate some causal link between periodontal disease and systemic diseases and conditions. 18 The Journal of Dental Hygiene Special supplement itive diagnosis and a diagnosis-driven treatment plan. 9. Theoretical Medicine and Bioethics 1983;4(2). Gluck G, Aroskar M, Arthur N. Cost containment in dentistry and its impact on the distribution of services. Again, the treatment plan will vary and should be based on ongoing clinical assessment and individual patient response to treatment. Communication is essential so that everyone is always on the same page. Nonsurgical treatments However, the majority of patients will require ongoing maintenance therapy to sustain health. Doing so is a good way of educating physicians about the systemic links and other emerging research in the dental field. Advancing your knowledge of perio-dontal disease treatment is good … The author advises against prescribing too many systemic antibiotics when there are other infection treatment modalities, including locally administered antibiotics such as minocycline hydrochloride 1 mg which is proven safe and effective, without building up antibiotic resistance.5,13 Other site-specific antibiotics for the treatment of periodontal disease include doxycycline hyclate, 10 mg, and chlorhexidine gluconate, 2.5 mg. Once the proper diagnosis has been established, the next step is treatment planning. Periodontal disease is known as a “silent” disease because patients do not know they have it (or simply ignore the symptoms) until it has reached an advanced state. 18. The profession needs to change the way this is discussed, and validate the fee in treatment planning. FDA Consum. 2003;8(1):79-98. So the question remains: why are oral healthcare providers not treating everyone for periodontal disease or providing preventive care in the early, non-surgical treatment stages? 2003;24(4):247-257. 17. Scaling and Root Planning . Up until recently, we thought that periodontal disease was a gradual disease. Patients in the Type II through V range will initially require scaling and root planing, in addition to oral hygiene instructions and patient education. The aim of this study was to determine whether the care plan could improve the oral health-related quality of life of patients with PD.. The prevalence of periodontal disease is quite significant. Preshaw PM, Hefti AF, Jepsen S, et al. This chapter highlights the principles and phases of periodontal treatment that should be provided for young patients with periodontal diseases. Personal reasons, including fear and embarrassment, may also come into play. Treatment protocols vary and should be assessed on a case-by-case basis. Doxycycline-resistant bacteria in periodontally diseased individuals after systemci doxycycline therapy and in healthy individuals. When gingivitis is included, close to 100% of the population is affected. 8. Periodontal disease is the most common disease of companion animals—more common than kidney disease, diabetes and lymphoma. Study: Dental Practices Effective in Preventing Spread of COVID-19, American Academy of Periodontology Stresses the Importance of Periodontal Health during COVID-19, American Academy of Periodontology, SUNSTAR Announce 2019 Innovation Grant Recipients, ©2020 American Academy of Periodontology. Periodontal procedures to be performed. Encouraging patients to comply with a home-care regimen is delving into behavior modification territory. 2. Oral Microbol and Immunol. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. Gingivitis usually precedes periodontitis, but not all gingivitis progresses to periodontal disease. This process will help to ensure better patient outcomes. Antibiotic resistance of subgingival species during and after antibiotic therapy. This may include additional nonsurgical therapy sessions, supportive periodontal care and maintenance, or surgical treatment. Therefore, there are periods of healing, followed by periods where the disease wins out over the body’s own defense mechanisms. Here is one approach: “That is a very good question, Mrs. Smith, and I understand your surprise and concern. Gum disease treatments may cost between $500 and $10,000 . “How much is my insurance going to pay for?” This is the question dental professionals hear most often from patients, and the author thinks that is the foundation of the widespread fear of charging for periodontal treatment. It is also important to explain to patients that the health of their gums is assessed every time they come in; but at this point in time, there are some areas of bleeding on probing, with pockets of disease around their teeth greater than 3 mm deep. Registration on CDEWorld is free. Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis. That is why it may be best to ask them to do the two most basic and important things—brush and floss—and show them how to do it well enough to make a positive difference in their oral health. 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. J Periodontol. A review. The fee for periodontal treatment can vary considerably depending on the type of problems, the complexity, and length of treatment. Dean JW, Branch-Mays GL, Hart TC, et al. Use a soft toothbrush and replace it at least every three to four months. Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist. After reading this article, the reader should be able to: The author reports no conflicts of interest associated with this work. Periodontal Treatments and Procedures Periodontists are dentistry's e xperts in treating periodontal disease. When indicated, the plan should include: 1. Periodontal disease, which is also known as gum disease, is a condition that affects the gum tissues and can cause serious problems for your entire smile. With the advent of PPO and DMO plans, the fees paid for dental services to participating dentists are effectively reduced by contract as a cost containment measure.17 Today, insurance companies continue to try to reduce their own costs by attempting to alter treatment plans and thus limit treatment by raising the patients’ financial contribution.18 However, there has been some progress made with insurance companies, as reported by The New York Times in November 2006. With periodontal disease, the imperative need for treatment is not as obvious. Smith, this is a primary bacterial population that is growing on your tongue, and it is the same bacteria that is growing in your gums.”. New Study Suggests the Ideal Sequence for Removing Plaque, American Academy of Periodontology 2017 World Workshop Proceedings, American Academy of Periodontology Publishes Proceedings from Best Evidence Consensus Meeting on Lasers, American Academy of Periodontology, SUNSTAR Announce 2018 Innovation Grant Recipients, World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, Best Evidence Consensus Meeting on Cone-Beam Computed Tomography (CBCT), American Academy of Periodontology Installs New President, Officers in Boston, American Academy of Periodontology Announces 2017 Award Winners, American Academy of Periodontology Announces First Recipient of SUNSTAR Innovation Grant, American Academy of Periodontology Names New Executive Director, Marijuana Use Linked to Increased Gum Disease Risk, Gum Disease Experts: Floss or Risk Losing Your Teeth, Statement from the AAP on Flossing Efficacy, Study: Gum Disease May Increase Lung Cancer Risk, CDC Estimate: New Mexico, Hawaii Have Highest U.S. There are basically two models of periodontal disease. Slots J. 2. Predetermination as a Cost-containment Mechanism in a Social Allowances Dental Program in Manitoba. Keeping your teeth and gums healthy after treatment Periodic periodontal cleanings help you stay on top of your gum disease. While this might seem like a less important section of the treatment plan, it is, in fact, one of the key solutions. 2002;36(3):16-22. Or they simply just do not realize the scope of the disease or its potential impact on whole-body health. A better way to communicate is: “You deserve some further attention and I work with a specialist, so let’s get his/her input before we go any further.”. One reason for this is that, once periodontal disease is diagnosed, the patient may ask, “I come in every 6 months. This level of orderliness is also the key to maximizing profitability. In advanced (severe) periodontal diasease, furcation probing is important and a reliable diagnostic technique. Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. According to the US Surgeon General’s report on Oral Health published in 2000, the mouth—including the teeth, gums, and supporting bone structures—is a “mirror for general health and well-being.” In the report, periodontal disease is also described as the second most prevalent disease in the United States (the first being heart disease), and the leading cause of adult tooth loss.1, In addition, a 2002 poll of 1,000 people over the age of 35 conducted by Harris Interactive Inc (Rochester, NY) found that 60% of adults surveyed knew little, if anything, about gum disease, the symptoms, available treatments, and—most importantly—the consequences. Another reason oral healthcare professionals avoid or delay treating periodontal disease is the fact that the success of the treatment depends so much on the success of patients’ compliance with bacterial control at home: plaque control, brushing, flossing, etc. Gingivitis means inflammation of the gums. 1990;5(4):219-222. 2002;37(5):389-398. It has a unique position in the periodontal treatment plan, as it should be undertaken only after active periodontal disease has been controlled . The patient is treated chairside, and the antibiotic is syringed into each pocket, where it stays and continues to provide antibiotic action for up to 30 days.14 Figure 2 depicts the administration of a locally applied antibiotic. Lastly, consider opening up lines of communication with physicians, especially if a patient’s overall systemic health may be in some way impacted by oral health status, such as patients with diabetes, heart disease, or other prevailing systemic conditions. 12. The fact is, the less a patient is asked to do, the greater the compliance. The patients’ oral hygiene and self-awareness are experienced as crucial parts while the mechanical infection control is perceived as successful but … Gelatinase destroys the gelatinous matrix that surrounds the biofilm, and proteases destroy proteins. Ann R Australa Coll Dent Surg. What is the treatment for periodontal … This can also be applied to the amount of oral home care prescribed. Washington, DC: May 2000. Regular dental visits. After reading this chapter the practitioner should be aware of how to plan periodontal … 1. Development of a logical and properly sequenced treatment plan is a derivative of the periodontal assessment and diagnosis. Consider using an electric toothbrush, which may be more effective at removing plaque and tartar. Bleeding on probing is another indication of unhealthy periondontal tissues. 1999;70(3): 351]. Periodontal therapy is often referred to by patients as a dental deep cleaning. Key finding: The periodontal treatment is perceived more as a standardised workflow than as an individually tailored treatment. 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. Clinical findings, including probing depths, from the patient’s initial examination are compared to the reevaluation findings. Hanes PJ, Purvis JP. Of course, not all cases of gingivitis will progress to periodontal disease, but there is a definite imbalance between the small amount of periodontal therapy that is being provided with regard to the great amount of periodontal disease that exists in the population. There are five periodontal disease classifications: Type 1, Gingivitis; Type II, Mild Periodontitis; Type III, Moderate Periodontitis; Type IV, Advanced Periodontitis; and Type 5, Refractory Periodontitis. Periodontitis, or gum disease, is a common infection that damages the soft tissue and bone supporting the tooth. Periodontitis progresses in stages, and its clinical manifestations include varying degrees of receding gums, gingival attachment loss, measurable pocket formation, and infection. Not seeking care is likely a result of a number of factors. Gingivitis is initially caused by plaque build-up, the clinical manifestation of which is inflamed gingiva that bleeds easily during flossing and sometimes during brushing. Compend Contin Educ Dent. J Periodontol. 2. Good for you.” This is behavior modification in action. Non-surgical periodontal treatment does have its limitations. Volumes have been written about compliance and behavior modification in the medical industry, with notable research into compliance in regard to taking prescribed medication.8 Research has shown that compliance increases as the number of pills required per day decreases. 14. 13. 16. Queries for the author may be directed to [email protected] Subsequent treatment can proceed in several ways, depending on the initial response. A comprehensive plan for periodontal disease (PD) care in Taiwan provides non-surgical and supportive periodontal treatment. 1. 2000;131:483-491. In addition to a prescribed home care regimen, antibiotics may be prescribed. Reducing stress directly enforces the body’s ability to fight disease and this is crucial to the successful management of periodontal disease. BMJ. In the author’s opinion, in the early 1980s, the profession became accustomed to using a great “closer” to get patients to accept dental treatment: “Don’t worry, your insurance will pay for that.” That statement worked back then because, for the most part, insurance coverage was closest to actual fees for service. The holistic dentist can help patients find the best ways possible to relieve stress. Dentists can bill the non-surgical medical treatment, “curettage of periodontal abscesses,” to medical insurance (Taxin 2016). Albandar JM, Brunelle JA, Kingman A. US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research. 2004;31(9):697-707. Anyone who has had treatment for advanced periodontal disease knows that meticulous homecare is the key to keeping periodontal disease from rearing its ugly head – again. Systemic antibiotics have been used for decades and they do work, but usually they are prescribed in short-term “blasts.” Combinations of drugs, such as a 2-week course of doxycyline (100 mg, once a day) along with surgical or non-surgical debridement can lead to stabilization of the disease process. When determining the best course of treatment for your specific case, be sure to discuss the pros and cons of all available treatment options with your dental professional. As oral healthcare providers, it may be easier to elevate a personal standard of care by adopting a simple five-step plan that includes diagnosis, treatment, appropriate fees, and referrals. Parameter on systemic conditions affected by periodontal diseases. Flossing before you brush allows you to clean away the loosened food particles and bacteria. Periodontal therapy is diagnosis-driven and, to the extent possible, should address all modifying factors and risk factors that impact development and progression of plaque-induced periodontal disease. An approximate fee can usually be determined during the initial visit; but on occasion, some initial treatment or further diagnostics must be completed before the final periodontal treatment plan can be established. If the patient had a nose bleed every day, he or she would surely seek medical attention. When locally administered antibiotics such as minocycline hydrochloride are used, there are no compliance concerns. Periodontal disease is the second most prevalent disease in the United States, and healthcare providers are aware of its potential health consequences. Sign up today! Failure to control active periodontitis can result in acute exacerbations and bone loss during tooth movement. There are many specific things performed during a patient’s hygiene experience, and it should never be downplayed as simply “a cleaning.” Dental professionals do not “clean” teeth; they perform preventive prophylaxis or therapeutic treatments. Without treatment, the alveolar bone … A. These enzymes include collagenase, elastase, gelatinase, and proteases, which are destructive to the connective tissues of the gingiva. This is often accomplished through non-surgical periodontal treatment. Next, take a thick piece of floss and take several passes in between the first and second upper molars. Once patients realize that they have active infection in their mouths, it is usually a wake-up call they can understand. For example, in a study of people taking medication for cardiovascular conditions, the average adherence was 95% for once-per-day dosing, 84% for two- and three-times per day dosing, and 78% for those taking four pills per day.9 Subjects who were on a once-a-day regimen had an average compliance rate of 83% compared to 53% for those on a twice-daily regimen and 27% for those on a four-times-per-day regimen.9. In addition, a periodontal, or gum, abscess can stem from periodontitis disease, a deep periodontal pocket, or a weak immune system “unable to fight off infections” (Higuera 2018). Ideally, the protocol should be one that can be choreographed in an appointment-by-appointment fashion, organized by disease state and/or pocket depth. J Cardiovasc Nurs. Because patients do not or will not take notice on their own accord, it is up to dental professionals to become the front line of awareness for their patients. Now is the time to take a closer look at the specific “fears” surrounding the failure to diagnose, treat, charge, and refer patients with periodontal disease; recognize the areas in need of improvement; and focus on implementing this five-step plan for elevating and committing to your personal standard of care. Ideally, a structured treatment plan should be implemented to achieve an optimum periodontal state. One way to speak to a patient about this subject can begin like this: “Mrs. Are destructive to the connective tissues of the gingiva containment in dentistry and its impact on the of... Not all gingivitis progresses to periodontal disease actively monitoring the emerging and rapidly evolving COVID-19 outbreak sessions! Usually precedes periodontitis, or surgical treatment that ’ s dentition is a good... Electric toothbrush, which are destructive to the connective tissues of the gingiva passes... 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