Try these measures to reduce or prevent periodontitis: 1. 1. Gingival recession can indicate attachment loss, which can vary from tooth to tooth. Doing so is a good way of educating physicians about the systemic links and other emerging research in the dental field. Topically applied minocycline microspheres: why it works. This may include additional nonsurgical therapy sessions, supportive periodontal care and maintenance, or surgical treatment. Subsequent treatment can proceed in several ways, depending on the initial response. 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. The author’s recommended response would be: “That would be a very good historical record for us to have in your files, so we can see the progression that has occurred over time, because everyone’s progression is different. 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. The author has no financial interest in any of the manufacturers mentioned in this article. 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. Periodontal Therapy Treatment Plan This is your intended treatment plan which will commence at your next appointment. Several frameworks are available to aid in the care of this patient population. The cost of periodontal surgery varies greatly depending on the type of procedure and the severity of your disease. Periodontitis, or gum disease, is a common infection that damages the soft tissue and bone supporting the tooth. 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. Not seeking care is likely a result of a number of factors. Flossing before you brush allows you to clean away the loosened food particles and bacteria. 8. 1. 18 The Journal of Dental Hygiene Special supplement itive diagnosis and a diagnosis-driven treatment plan. The fee for periodontal treatment can vary considerably depending on the type of problems, the complexity, and length of treatment. Failure to control active periodontitis can result in acute exacerbations and bone loss during tooth movement. You are getting that infection under control. 3. Hanes PJ, Purvis JP. Tooth mobility tests may also be performed. 2000;131:483-491. Many practices are realizing there’s more to the treatment of periodontal disease than just cleaning and polishing. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. 2003;18(3):209-218. 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. Forgot your password? It is meant to be a synthesis of the information out there that is most consistent. 1. Gluck G, Aroskar M, Arthur N. Cost containment in dentistry and its impact on the distribution of services. discuss methods of encouraging patient at-home compliance. Scaling and Root Planing. Because compliance is clearly a major issue, how do oral healthcare providers encourage it? Regular dental visits. 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. 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. 14. But the end result is that, over time, the disease continues to get worse.”. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. However, today’s emerging research indicates that periodontal disease really occurs in spurts, or bursts of activity, that can wax and wane. 2. 2007;78(8):1568-1579. It has a unique position in the periodontal treatment plan, as it should be undertaken only after active periodontal disease has been controlled . 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. 1999;70(1):13-29. In this case, the periodontist could explain: “Dr. When indicated, the plan should include: 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. Treatment options for periodontal disease The exact treatments that your dentist or surgeon will choose depends on the severity of the periodontal disease. Your response to therapy will be assessed at a follow up appointment. J Periodontal Res. Oral Health in America: A Report of the Surgeon General. However, a tooth can have attachment loss without having a pocket. This process will help to ensure better patient outcomes. 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. 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. This study was conducted by purposive sampling and a quasi-experimental design. Queries for the author may be directed to jromano@aegiscomm.com. Periodontitis progresses in stages, and its clinical manifestations include varying degrees of receding gums, gingival attachment loss, measurable pocket formation, and infection. When patients start to hear about the oral/systemic connection not only from their dentist, but their doctor, too, it adds emphasis and another dimension of credibility: “My dentist always told me I needed to take better care of my teeth and gums, and now my doctor is telling me the same thing—I better start taking this more seriously.”. 16. There are two main types of gum disease: ‘gingivitis’ and ‘periodontitis’. Consider using an electric toothbrush, which may be more effective at removing plaque and tartar. 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. One effective way to charge patients to do their part is to scrape the dorsum of their tongue with a plastic spoon, or even a mirror, and allow them smell it. The Cost of Periodontal Disease Treatments: This post will help clarify and define the costs involved in available periodontal treatment options, including Regenerative Periodontal Endoscopy (RPE), Perioscopy, Osseous Periodontal Surgery, Extractions, Implants, traditional laser periodontal therapy, LANAP, and root planing combined with Arestin (antibiotics). Development of a logical and properly sequenced treatment plan is a derivative of the periodontal assessment and diagnosis. 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. Cooney PV, Hassard TH, Ulla A, Spangen DA. American Academy of Periodontology. Goodson JM, Gunsolley JC, Grossi SG, et al. 2000;15:57-60. J Periodontol. 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? For example, some insurance companies, particularly Aetna Dental and CIGNA, are now paying for additional and adjunct periodontal maintenance therapies because it may reduce the cost of more significant treatments for heart disease, pre-term birth, and other systemically linked illnesses. REFERENCES The profession needs to change the way this is discussed, and validate the fee in treatment planning. 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. Predetermination as a Cost-containment Mechanism in a Social Allowances Dental Program in Manitoba. 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. Non-surgical periodontal treatment does have its limitations. 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.The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy. 2. Consequently, the overall potential periodontal risk is … Once patients realize that they have active infection in their mouths, it is usually a wake-up call they can understand. Remember that the most important member of the treatment team is you. Reducing stress directly enforces the body’s ability to fight disease and this is crucial to the successful management of periodontal disease. Clinical findings, including probing depths, from the patient’s initial examination are compared to the reevaluation findings. 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. 7. It must also be communicated that this is a sign of infection in their gums and that it should be treated immediately (Figure 1). 195;55(3):177-180. When locally administered antibiotics such as minocycline hydrochloride are used, there are no compliance concerns. 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. Did Dr. Jones do all of the same assessments that we did here today, with measurements, and bleeding points, and pocket depths?” Inevitably, the patient responds “no,” but in the unlikely event they do say “yes,” that is fine, too. Your interest, participation and commitment are essential to make your treatment a success. In addition to a prescribed home care regimen, antibiotics may be prescribed. Therefore, periodontal care must be given serious consideration when developing treatment plans for older adults. Undiagnosed and untreated periodontal disease is one of the fastest growing areas of litigation and complaints in dentistry. Treatment protocols must be easily implemented and easy to put into practice. Again, the treatment plan will vary and should be based on ongoing clinical assessment and individual patient response to treatment. 6. Sample scripting that gives examples on how to talk with patients each step of the way can be helpful, as are listings of the proper insurance codes to maximize patient benefits for each phase of treatment. All rights reserved. Periodontal audit Page 2 Background. The fact is, the less a patient is asked to do, the greater the compliance. 2. Encouraging patients to comply with a home-care regimen is delving into behavior modification territory. 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