Periodontal Maintenance Therapy Evaluation and Care

Learning Outcomes 1. Determine appropriate intervals for supportive periodontal care for clients presenting with gingival and/or periodontal conditions 2. Outline a periodontal maintenance therapy program based on a client’s compliance with home care and risk of disease recurrence 3. Determine reasonable outcomes reflective of the periodontal maintenance plan that will promote client compliance 4. Accurately document new clinical findings and revise the care plan as required

Introduction Clients with persistent or chronic periodontal problems are in need of professional care at regular intervals Serves as an extension of the initial periodontal therapy For those at risk: – Stable dental condition, reduce active episodes – Re-educate, support client’s involvement

Risk Assessment Clients who have experienced gingival and/or periodontal disease are at risk for future disease Clients with increased risk: – Attachment loss of 2 mm or more – Clients over 70 years of age – Clients who use tobacco – Pathologically mobile teeth – Poor oral care, systemic involvement

Objectives of PMT Primary objective – prevent recurrence or development of disease affecting dentition & soft tissues This is accomplished by: – Maintaining attachment levels & alveolar bone height – Controlling inflammation – Maintenance of oral health – Reducing incidence of tooth loss

Objectives of PMT Secondary objectives: – Early recognition & treatment of conditions affecting oral cavity – Reinforce oral self-care techniques – Reinforce value of continuous oral care

Need for Continuous Periodontal Care Rationale: – Client susceptible to periodontal breakdown – Client not a candidate for periodontal surgery Health reasons Financial reasons Client refuses – Improves prognosis for periodontally involved teeth

Need for Continuous Periodontal Care Rationale: – Reduce stress on immune system – Improve client’s plaque control

Client Compliance Compliance: “the consistency & accuracy with which a client follows the regimen prescribed by a health professional” (1997 ) Stedman’s Concise Medical Dictionary for the Health Professions (3 rd ed.),Edited by John Dirckx Baltimore: Williams & Wilkins. Compliance can by assessed in 2 ways: – Evaluating client’s compliance with home care – Client’s compliance with a continuous care regimen

Client Compliance Factors that interfere with compliance: – Education, economic problems – Values, culture – Fear, self-destructive behaviour – Perceived indifference on part of clinician – Lack of understanding of disease process – Oral care too demanding, inconvenient – Client unconvinced of necessity

Client Compliance Strategies to improve compliance: – Positive reinforcement – Promote oral health as part of an overall healthy lifestyle – Simplify information – Easy verbal & written instructions – Involve client when setting goals – “Reminders”

Initial Therapy Evaluation Evaluation of initial therapy necessary to determine: – Length of interval – Necessity of surgery Evaluation – 4-6 weeks following active treatment

Initial Therapy Evaluation Response of tissues to initial therapy dictates options available: – Further treatment – 3 month PMT interval – Use of antimicrobials/antibiotics Surgery not indicated for at least 3 months following initial therapy

Periodontal Maintenance Therapy Recommended average interval for periodontal clients is 3 months Lengthened or shortened as necessary

PMT Intervals Factors to consider when selecting an interval: – Client’s risk for soft & hard tissue disease – Client’s risk for oral cancers – Factors that predispose client to disease – Client compliance – Intraoral factors, rate of deposit formation – History of soft tissue disease

PMT intervals Clients who may have special requirements: – Diabetic client – Extensive prosthetic/restorative dentistry – Rampant decay – Orthodontic clients – Disability – Health concerns

PMT Procedures Client involvement a must! Recognize outcomes – modification required? Specific components: – Review of health history Smoking status, stress levels Systemic concerns New medications and/or conditions

PMT Procedures Specific components: – Dental history Sensitivity Compliance New concerns – Intraoral & extraoral exam New medications  xerostomia

PMT Procedures Specific components: – Periodontal exam Gingival tissues Probing depths, recession Attachment loss Bleeding on probing Furcation involvement, mobility Suppuration Deposit accumulation

PMT Procedures Specific components: – Radiographic assessment – Diagnosis Sites that responded to therapy vs. those that didn’t Type of disease present (refractory) Type of therapy required –Surgery –Debridement –Antimicrobials/antibiotics

PMT Procedures Therapy : – Review of home care – Debridement as required – Deplaquing, polishing – Desensitization Appointment scheduling : – 1 hour minimum – Assessment & therapy may take 1-2 appointments

Guidelines for PMT Intervals Shortened intervals may be required: – PSR score of 3+ & poor OH – Mod-severe perio & poor OH – 2 month interval 3 month interval: – Moderate perio involvement – Early-mod perio & fair OH – Early perio & stress

Guidelines for PMT Intervals 3 month interval: – Adult ortho clients – Women with pregnancy associated ging. – Smokers – Diabetic clients where control is marginal – Elderly clients with active perio

Guidelines for PMT Intervals 4 month interval: – Early disease & fair OH – Mod perio involvement, PSR (3), excellent OH 6 month interval: – Healthy clients – probing depths 1-4 mm – Pedodontic clients – Motivated client with early gingivitis & improving OH

Recurrence of PD Lack of continued care & OH  recurrence of PD possible Factors that contribute to recurrence: – Ineffective plaque control – Failure to show for continued care – Client smokes – Health problems, genetic risk factors – Incomplete periodontal debridement

Success! Upper right lingual 6 months after surgery Client 2 years after periodontal therapy