Good oral hygiene and a healthy lifestyle to reduce inflammation is the foundation for an optimal response to treatment and long-term control of the disease. This step also includes professional removal of supragingival bacteria (plaque and tartar).
Full Answer
What is supportive periodontal therapy for periodontitis?
The third challenge in the treatment of chronic periodontitis involves the long-term maintenance of the periodontium. This phase of therapy is known as supportive periodontal therapy, or periodontal maintenance.
Are You a candidate for non-surgical periodontal treatment?
Depending on your unique case, you may be a candidate for non-surgical periodontal treatment. However, these procedures do have limitations. When non-surgical treatment does not achieve optimal periodontal health, your periodontist may recommend gum surgery.
What is the standard of care for periodontal disease?
The standard of care for patients who have received definitive treatment for chronic or aggressive periodontitis is a 3-month maintenance interval; however, stable patients can be appointed for longer intervals.
Should patients who smoke be offered nonsurgical periodontal therapy?
Prior to initiating nonsurgical periodontal therapy, patients who smoke should be educated about the effects of smoking and encouraged to quit. Studies have reported that smokers exhibit less reduction in subgingival microbial loads and probing depths during NSPT than nonsmoking patients. 5,6 FIGURE 1.
What would be the most effective treatment for severe periodontitis?
Antibiotics. Topical or oral antibiotics can help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning.
What do you do when a patient refuses periodontal treatment?
The ADA states, “If the patient refuses the proposed treatment, the dentist must inform the patient about the consequences of not accepting the treatment and get a signed informed refusal. However, obtaining an informed refusal does not release the dentist from the responsibility of providing a standard of care.
How do you treat patients with aggressive periodontitis?
For patients experiencing aggressive periodontitis, the most efficient method of therapy seems to be mechanical removal of bacteria and calculus through scaling and root planing with ultrasonic debridement or hand instruments coupled by immediate prescription of systemic antibiotics, although there seems to be no ...
What interventions are indicated in patients with periodontal disease?
Prevention and treatment Such treatment might include deep cleaning of the tooth root surfaces below the gums, medications prescribed to take by mouth or placed directly under the gums, and sometimes corrective surgery.
When is SRP recommended?
If your dentist recommends SRP, it means you have symptoms of gum disease or periodontal disease. Dental deep cleaning is necessary to stop the damaging effects of this disease.
When is SRP indicated?
It is indicated for patients who have swollen, inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing. It should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures.”
What is the most effective antimicrobial therapy available to reduce plaque and gingivitis?
Of all the products included here, chlorhexidine appears to be the most effective agent for reduction of both plaque and gingivitis, with short-term reductions averaging 60% (29).
What is the prognosis for aggressive periodontitis?
Generalized aggressive periodontitis results in rapid destruction of the periodontium and can lead to early tooth loss in the affected individuals if not diagnosed early and treated appropriately.
What antibiotic is used for aggressive periodontitis?
Amoxicillin and metronidazole are the ideal antibiotic combination to use in addition to scaling and root planing for the treatment of aggressive periodontitis, according to international expert doctors Magda Feres, Panos Papapanou and Joerg Meyle, who were present at the scientific sessions in the last Meeting of the ...
Which instructions would the patient receive following periodontal surgery?
After Periodontal Surgery: Post op instructionsDo NOT rinse, Do NOT drink through a straw, Do NOT spit.Only drink liquids or eat foods at room temperature or cooler- NOTHING hot.NO physical activity for minimum of 24-48 hours- ie: exercise.More items...
What is done in a periodontal maintenance procedure?
It involves both scaling and root planing, meaning tartar must be removed from deep between the teeth and gums. During a periodontal maintenance appointment, the hygienist will remove tartar build up from in between your teeth and gums down the entire length of each tooth, stopping where the gum, root and bone meet.
How do you regrow bone loss from periodontal disease naturally?
Proper periodontal therapy in combination with good home oral hygiene (proper tooth brushing, flossing and interdental cleaning) can eradicate the disease and even regrow some of the bone loss.
What are the factors that affect periodontal health?
Pregnancy, genetic predisposition, oral hygiene habits, smoking or drug use, stress, and eating habits should also be considered. Look for other medical conditions such as HIV or blood disorders. All of these impact periodontal health. Make sure to complete a full periodontal charting on each visit.
Can a dental hygienist be confused?
A recent hot topic in the Facebook forum Dental Hygienists Talk, which has more than 10,000 dental hygiene members, revealed that some new hygienists are feeling confused, insecure, or lost when it comes to implementing a periodontal program in their office. It’s no fault of their own. But getting a quick, yet comprehensive answer to how to implement a periodontal program seems to be quite a challenge.
Is gingivitis a CDT?
There is a lot of confusion about the diagnosis and treatment of gingivitis. There is no ADA CDT code specifically for its treatment. Gingivitis is typically diagnosed when there is bleeding upon probing but there is no attachment loss, no bone loss, and pockets measure 3 mm or less.
They have a written periodontal protocol
Hygienist and doctor need to sit down as a team and talk about diagnosis. What are your standards? Reach a consensus regarding the type of periodontal probe that’s preferred and provides the most accurate readings. Also be on the same page regarding the proper location and angle of the probe, and amount of pressure on the probe.
X-rays are a large part of the diagnostic process
If a patient dictates on the phone that he wants a cleaning, does not want x-rays and has no current x-rays, he’s waving a huge red flag. In many states, it is malpractice to attempt to diagnose oral conditions without x-rays. Even if you have the patient sign a consent/release form refusing x-rays, you can still be liable.
The doctor conducts a thorough examination
The doctor’s examination is typically 10-15 minutes during a new-patient appointment. She ideally first sees a new patient in her chair. After connecting with the patient, she does a complete exam, looking at every tooth, as well as soft tissues and bone. Then she conducts an oral cancer screening.
The doctor makes the periodontal diagnosis
At the new-patient exam, the doctor should at minimum conduct a spot probe of the tissues and have a sense of the periodontal status of the patient. I prefer the full probing be completed by the health care provider that’s going to provide the hygiene services.
The seven stages of treatment planning are routinely followed
You know the 7 stages of treatment planning; unfortunately, I often see doctors and team members jump from step 1 to step 5 without considering the ramifications:
Tanya Pierce
Thanks to Paul J.Pavlik for the above information! This is also excellent information I have learned in my past management consultations in different offices! These ideas can make an office work better together! ;)
Tanya Pierce
Thank you Karoline Blame! This is an excellent short article on a team approach that is extremely necessary for success! Often at times the offices don't have a plan in order to work together! The problems I have seen over 26 years in the dental field is that we all try to separate our success in the office when in actual reality we work best and achieve the most results together! Plus as a team you can celebrate success going to lunch or by buying new equipment for different advancement approaches!.
Dr. Paul J. Pavlik
Hi Karoline. Thanks for posting the "7 Steps ... Periodontal Protocol." That was a very interesting and important article. In Step 2, monitoring progress is mentioned.
What stage of periodontitis should antibiotics be used in?
Systemic antibiotics may benefit specific patient groups or defined conditions (eg, Stage III or Stage IV) If used as part of a treatment protocol for periodontitis, systemic antibiotics should be used in conjunction with scaling and root planing.
What are the risk factors for periodontal disease?
Several risk factors have well established associations with both periodontal and systemic diseases, such as diabetes, smoking, stress, immunodeficiency, medications, obesity, hormones, and nutrition. For optimal treatment results, systemic risk factors must be modified or eliminated.
What is periodontitis characterized by?
Periodontitis is characterized by gingival inflammation and loss of alveolar bone. In moderate to severe stages, gingival recession, loss of interproximal papilla, tooth mobility, and furcation involvement may also be clinical features.
Does obesity affect periodontal disease?
Obesity and BMI are positively correlated to an increased incidence of periodontitis. Further, it appears that obesity can adversely impact periodontal treatment outcomes. 11 Gorman et al 12 reported that as BMI increases by one unit, the rate of alveolar bone loss increases by 5%.
Is scaling and root planing a statistical difference?
Antimicrobials. The adjunctive use of systemic antibiotics with scaling and root planing is known to yield a statistical difference, but arguably not a clinically significant difference. In a consensus report, Sanz and Teughels 30 suggested the following guidelines regarding the use of systemic antibiotics:
Do systemic risk factors need to be eliminated?
For optimal treatment results, systemic risk factors must be modified or eliminated. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. Other more subtle systemic and environmental issues may also need to be addressed to achieve optimal results.
Does eating whole grains cause periodontitis?
Merchant et al 17 noted that higher intake of whole grains is associated with a 23% decreased risk for developing periodontitis. Whole grains have a high fiber content that, in turn, may help decrease inflammation and improve host insulin sensitivity.
Scaling and Root Planing
In scaling and root planing, your periodontist will perform a deep cleaning of your tooth root surfaces. First, your periodontist will scale beneath the gumline to remove plaque and other bacterial toxins from periodontal pockets. Root planing allows your periodontist to smooth the tooth root to prevent future plaque or toxins from adhering.
Laser Treatment
Lasers can be used to treat periodontal disease. Current controlled studies have shown that similar results have been found with laser treatment compared to specific other non-surgical treatment options, including scaling and root planing alone.
Tray Delivery Systems
A tray delivery system consists of a custom-fit tray made from impressions of the patient’s mouth. Patients use the tray at home to deliver medications that have been prescribed by their dental professional.
What is the best treatment for periodontal abscess?
Periodontal abscess: Antibiotic therapy is indicated for periodontal abscesses with systemic manifestations (fever, malaise, lymphadenopathy). Antibiotics for the treatment of abscesses should be prescribed in conjunction with surgical incision and drainage.[3]
Which is more effective, amoxicillin or minocycline?
Minocycline appears to be the most effective antibiotic, which achieves levels that should be completely inhibitory (antibiotic activity = 600%) to most of the periodontal pathogens but may inhibit the growth of beneficial species as well.[10] . Amoxicillin appears almost as effective as minocycline.
How long does metronidazole last?
The most commonly prescribed regimen is 250 mg tid for 7 days.
Is augmentin good for periodontitis?
Augmentin may be useful in the management of patients with refractory or localized aggressive periodontitis patients. In guided tissue regeneration, systemic amoxicillin-clavulanic acid therapy has been used to suppress periodontal pathogens and increase the gain of clinical attachment.[3] Cephalosporins. Pharmacology.
Can antibiotics improve periodontal health?
It has been established that systemic antibiotics can significantly enhance the effects of mechanical periodontal therapy in conjunction with measures that improve the oral hygiene.
Do antibiotics help with periodontitis?
Antibiotics have also been shown to have value in reducing the need for periodontal surgery in patients with chronic periodontitis. Systemic antibiotic therapy should be an adjunct to a comprehensive periodontal treatment plan.
Is ciprofloxacin used for periodontal disease?
At present, ciprofloxacin is the only antibiotic in periodontal therapy to which all strains of A. actinomycetemcomitansare susceptible.