For coordination of the total treatment of the patient, the treatment plan can be divided into various segments or phases. Periodontal diseases are caused by infections that have spread to the gums and tooth roots. This chapter describes current strategies and classifications for planning the treatment of the periodontal patient. Other risk factors for periodontal disease also should be identified and modified where possible. • Teeth that will require removal. 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. Antimicrobial agents are used or recommended for home use. The phases of therapeutic periodontal procedures, along with the sequence of other needed dental procedures, are presented in Box 10-1. Classify the phases of dental treatment included in the comprehensive care plan. Discuss informed consent and its importance to the process of patient care. Dental cleanings are not a treatment for active gum disease. 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 … 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. Patients remain in this phase for a lifetime. When indicated, the plan should include: 1. 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. The effects of periodontitis can be stopped through regular checkups and treatment and continued good oral hygiene. Various periodontal classification systems have been used over the years and have been modified to reflect advances in knowledge and research. Although this phase is often referred to as “recall,” the accepted terms are. A true partnership between the patient and the dental team working toward mutual treatment goals has the greatest opportunity for success. Each phase suggested a particular group of procedures and included evaluation of the patient’s response. 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. SSO Schweiz Monatsschr Zahnheilkd. An individualized, well thought-out treatment plan must be established before the beginning of treatment, and it must be carefully monitored. Defining a treatment plan for the periodontal patient is a process that requires the, 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. Because of the complexity of the periodontal treatment required to meet planned goals, a series of appointments is often required. Medical consultation or referral for treatment when appropriate. List the major classifications of periodontal disease. The Treatment Plan is vital for giving your patients information on recommended treatment, what insurance is expected to cover, and the estimated patient portion. PERIODONTAL SURGICAL TREATMENT PLAN Initial Periodontal Examination At this appointment Dr. Calvert will review with you your medical and dental history. • Identify the considerations for sequencing dental hygiene treatment with periodontal diseases. The only exception to this would be emergency care to relieve a patient of pain due to injury or acute disease. 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. 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. Carranza and collaborators divided the treatment plan into four main phases. No treatment should be provided to a patient until a treatment plan has been established and agreed on. 8. This stage has also been referred to as initial therapy, nonsurgical therapy, cause-related therapy, or the hygienic phase of 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 treatment team. Any dental emergency is treated first to achieve patient comfort. Most patients who have been treated for moderate to advanced periodontal disease require maintenance visits every 3 months.9-12. 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. Initial Periodontal Treatment A. 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. • Define the role of the dental hygienist in determining the dental hygiene care plan. • Discuss informed consent and its importance to the process of patient care. 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. Scaling, root debridement and planing are performed. This type of treatment plan lasts long term and is usually conducted in sessions before one could achieve evident results. This chapter describes current strategies and classifications for planning the treatment of the periodontal … Patients remain in this phase for a lifetime. The goals of the treatment plan are to eliminate and control etiologic and predisposing factors of disease, maintain health, and prevent recurrence of disease. established before the beginning of treatment, and it must be carefully monitored. [The periodontal treatment plan]. 4. The initial (periodontal) treatment is concluded with a reevaluation. This … They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. For coordination of the total treatment of the patient, the treatment plan can be divided into various segments or phases. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. 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. Patient education and plaque control instruction occur at the beginning of this phase. Phase I therapy describes the procedures that are designed to control or eliminate the etiologic factors of the disease process. The overall approach of this classification system separates gingival disease from periodontal disease and conditions affecting the periodontium. Development of a logical and properly sequenced treatment plan is a derivative of the periodontal assessment and diagnosis. Floss daily. Consider using an electric toothbrush, which may be more effective at removing plaque and tartar. The significance of reassessment after Phase I therapy. 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. This stage has also been referred to as initial therapy, nonsurgical therapy, cause-related therapy, or the hygienic phase of treatment.7,8. • List the major classifications of periodontal disease. Also in this plan, the therapy must be carried out … Phase IV therapy is the maintenance phase. Note the residual calculus on the mesial surface of tooth #9, at the right edge of the figure. Define the role of the dental hygienist in determining the dental hygiene care plan. 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. Use a soft toothbrush and replace it at least every three to four months. Brush your teeth twice a day or, better yet, after every meal or snack. 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. 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 … All treatment plans must be understood by the patient and reflect the patient’s wishes and preferences. The. treatment team. 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. Because of the complexity of the periodontal treatment required to meet planned goals, a series of appointments is often required. 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 purpose of the preliminary phase of treatment is to bring all emergency and other critical situations under control. At Rocky Point, Sonora Mexico you can combine comfort, health and relaxation with customize gum disease treatment to … Following a careful medical and dental diagnostic workup, clear goals of therapy are defined and informed consent is obtained from the patient. 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. Phases of treatment plan. Phase I therapy describes the procedures that are designed to control or eliminate the etiologic factors of the disease process. 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. 2. Plan enough time off from work or school to feel less rushed or anxious about getting back. Phase IV therapy is the maintenance phase. Classification of Periodontal Disease and Conditions, Periodontitis as a Manifestation of Systemic Disease, Only gold members can continue reading. The cost of periodontal surgery varies greatly depending on the type of procedure and the severity of your disease. 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. Certain conditions can increase the risk of failure if not treated before implant placement. Carranza’s Clinical Periodontology. The aim is clean deeo p below the gum line and remove all calculus deposits and debris. Phase II therapy is the surgical phase of treatment. Log In or. 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. When you make your appointment, ask how long a cleaning and … Procedures in this phase included restorative dentistry, extensive orthodontics, and any needed occlusal therapy. In 1999, an international group of periodontal experts approved the classification system currently in use. 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. The treatment plan should be used to establish the methods and sequence of delivering appropriate periodontal treatment. Scaling, root debridement and planing are performed. The dental hygienist must also use the visual and verbal feedback from the patient to judge the patient’s level of understanding. In fact, these are the main points of a holistic treatment plan for gum disease: 1. 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 … The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy. periodontal disease and, hence, oral hygiene instructions are the cornerstone of periodontal treatment planning. So, the phases of treatment plan are, Emergency phase. If you have been diagnosed with a form of gum disease by your dentist, here is guidance on general oral hygiene and what you can expect from your periodontal treatment plan. Scaling and root planing. With this information the periodontist and the patient can determine which treatment plan to follow. Most patients who have been treated for moderate to advanced periodontal disease require maintenance visits every 3 months. Try these measures to reduce or prevent periodontitis: 1. Phase II therapy or Surgical Phase. The dental hygienist noted the redness and swelling that remained in the tissue and reinstrumented the area. An individualized, well thought-out treatment plan must be, Carranza and collaborators divided the treatment plan into four main phases. 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. Gum disease treatments may cost between $500 and $10,000 . • 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. 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. 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. Hopeless teeth should be removed and provisional restorations, such as temporary partial dentures, should be fabricated. 6. Other situations are evaluated on a case-by-case basis. Periodontists are also experts in … Calculus at this location adheres to the root surface right at the cementoenamel junction and is very difficult to remove. 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. Committed to Excellence Since 1986. Identify the patient factors to be considered when establishing the treatment plan sequence. Periodontal surgical procedures, including placement of implants. Wennstrom 27 proposed a simplified algorithm for treating periodontal diseases in older adults that is applicable to routine periodontal therapy for any age group. They are, though, an important preventive measure that can help you stave off its development. In this post, we’ll cover receiving a preauthorization, changing notes, applying discounts, and using eClipboard to record a … v ... • Record the diagnosis, suggested treatment plan and details of costs. Treatment planning is an essential component of clinical practice. Regenerative techniques are performed to help restore periodontal tissues that have been lost due to disease. 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. This system is based on the clinical manifestations of disease and conditions. The maintenance phase begins after Phase I, but not necessarily before all phases of treatment have been completed. Deep cleaning, which involves scaling and root planing, will likely be one of the first treatments your dentist uses. Once the diagnosis is determined, various treatment options can be formulated. 1975 Sep;85(9):901-4. Some serious general healthconditions absolutely preclude placing implants. 5. Phase I therapy or Etiotropic Phase. The treatment plan defines the methods and sequence of delivering appropriate treatment.1,3,4. Identify the considerations for sequencing dental hygiene treatment with periodontal diseases. 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. 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. Prevention and Treatment of Periodontal Diseases in Primary Care. 2. Periodontists are dentistry's e xperts in treating periodontal disease. Gum Disease Treatment Plan. This 41-year-old male patient had completed Phase I therapy consisting of quadrant scaling and root planing and oral hygiene instructions. What Are Periodontal Diseases? Phase III therapy usually involves restorations and replacement of missing teeth. • Identify the patient factors to be considered when establishing the treatment plan sequence. 11th ed. Many restorative dental treatments in particular require the establishment of healthy periodontal tissues for their clinical success. 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. • Classify the phases of dental treatment included in the comprehensive care plan. Patients with extensive surgical and restorative needs often have treatment extend over many months, even years. 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. Dental and periodontal abscesses should be treated. Each phase suggested a particular group of procedures and included evaluation of the patient’s response. Principally, the comprehensive periodontal therapy can be divided into four main phases followed by any dental emergency 7. During this phase, procedures are undertaken to reduce the effects of disease. In their classic studies, Ramfjord and Ash demonstrated that 3-month maintenance intervals were responsible for the long-term success of periodontal treatment.7, 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. [Article in French] Matter J. PMID: 1059252 [PubMed - indexed for MEDLINE] 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. Experience wonderful dental care in the relaxed surroundings of a white sandy beaches of coastal resorts. 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. 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. Antimicrobial agents are used or recommended for home use. This system is based on the clinical manifestations of disease and conditions. 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. This system was adopted by the American Academy of Periodontology (AAP) and is widely accepted by the dental community as the preferred classification system. 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). Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist. 3. Substantial amounts of calculus remained on the tooth. 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. 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 maxillary right area did not respond well around tooth #7. The overall approach of this classification system separates gingival disease from periodontal disease and conditions affecting the periodontium. • Describe the goals and rationale for periodontal treatment planning. This is also a part of treatment once an infection occurs. After this new diagnosis, and if necessary adjustment of the original goal of the treatment plan, a definite treatment plan can be effected. 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. • Need for emergency treatment (pain, acute infections). Describe the goals and rationale for periodontal treatment planning. Patient education and plaque control instruction occur at the beginning of this phase. 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. Using a system that is understood and used by a large number of dental professionals greatly facilitates communication regarding cases. In 1999, an international group of periodontal experts approved the classification system currently in use. 1. St. Louis, MO: Elsevier Saunders; 2012.). 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. Figures 10-1 to 10-4 are examples of successful therapeutic results achieved by a dental hygienist providing Phase I therapy. Cleaning and … 1 the comprehensive care plan periodontal disease and conditions due... 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