MaintenanceTherapy牙周炎维护治疗课件

1、Periodontal Maintenance TherapyEvaluation and CareLearning OutcomesDetermine appropriate intervals for supportive periodontal care for clients presenting with gingival and/or periodontal conditionsOutline a periodontal maintenance therapy program based on a clients compliance with home care and risk

2、 of disease recurrenceDetermine reasonable outcomes reflective of the periodontal maintenance plan that will promote client complianceAccurately document new clinical findings and revise the care plan as requiredIntroductionClients with persistent or chronic periodontal problems are in need of profe

3、ssional care at regular intervalsServes as an extension of the initial periodontal therapyFor those at risk:Stable dental condition, reduce active episodesRe-educate, support clients involvementRisk AssessmentClients who have experienced gingival and/or periodontal disease are at risk for future dis

4、easeClients with increased risk:Attachment loss of 2 mm or moreClients over 70 years of ageClients who use tobaccoPathologically mobile teethPoor oral care, systemic involvementObjectives of PMTPrimary objective prevent recurrence or development of disease affecting dentition & soft tissues This is

5、accomplished by:Maintaining attachment levels & alveolar bone heightControlling inflammationMaintenance of oral healthReducing incidence of tooth lossObjectives of PMTSecondary objectives:Early recognition & treatment of conditions affecting oral cavityReinforce oral self-care techniquesReinforce va

6、lue of continuous oral careNeed for Continuous Periodontal CareRationale:Client susceptible to periodontal breakdownClient not a candidate for periodontal surgeryHealth reasonsFinancial reasonsClient refusesImproves prognosis for periodontally involved teethNeed for Continuous Periodontal CareRation

7、ale:Reduce stress on immune systemImprove clients plaque controlClient ComplianceCompliance: “the consistency & accuracy with which a client follows the regimen prescribed by a health professional” (1997) Stedmans Concise Medical Dictionary for the Health Professions (3rd ed.) ,Edited by John Dirckx

8、 Baltimore: Williams & Wilkins.Compliance can by assessed in 2 ways:Evaluating clients compliance with home careClients compliance with a continuous care regimenClient ComplianceFactors that interfere with compliance:Education, economic problemsValues, cultureFear, self-destructive behaviourPerceive

9、d indifference on part of clinicianLack of understanding of disease processOral care too demanding, inconvenientClient unconvinced of necessityClient ComplianceStrategies to improve compliance:Positive reinforcementPromote oral health as part of an overall healthy lifestyleSimplify informationEasy v

10、erbal & written instructionsInvolve client when setting goals“Reminders”Initial Therapy EvaluationEvaluation of initial therapy necessary to determine:Length of intervalNecessity of surgeryEvaluation 4-6 weeks following active treatmentInitial Therapy EvaluationResponse of tissues to initial therapy

11、 dictates options available:Further treatment3 month PMT intervalUse of antimicrobials/antibioticsSurgery not indicated for at least 3 months following initial therapyPeriodontal Maintenance TherapyRecommended average interval for periodontal clients is 3 monthsLengthened or shortened as necessaryPM

12、T IntervalsFactors to consider when selecting an interval:Clients risk for soft & hard tissue diseaseClients risk for oral cancersFactors that predispose client to diseaseClient complianceIntraoral factors, rate of deposit formationHistory of soft tissue diseasePMT intervalsClients who may have spec

13、ial requirements:Diabetic clientExtensive prosthetic/restorative dentistry Rampant decayOrthodontic clientsDisability Health concernsPMT ProceduresClient involvement a must! Recognize outcomes modification required?Specific components:Review of health historySmoking status, stress levelsSystemic con

14、cernsNew medications and/or conditionsPMT ProceduresSpecific components:Dental historySensitivityComplianceNew concernsIntraoral & extraoral examNew medications xerostomiaPMT ProceduresSpecific components:Periodontal examGingival tissuesProbing depths, recessionAttachment lossBleeding on probingFurc

15、ation involvement, mobilitySuppurationDeposit accumulationPMT ProceduresSpecific components:Radiographic assessmentDiagnosisSites that responded to therapy vs. those that didntType of disease present (refractory)Type of therapy requiredSurgeryDebridementAntimicrobials/antibioticsPMT ProceduresTherap

16、y:Review of home careDebridement as requiredDeplaquing, polishingDesensitizationAppointment scheduling:1 hour minimumAssessment & therapy may take 1-2 appointmentsGuidelines for PMT IntervalsShortened intervals may be required:PSR score of 3+ & poor OHMod-severe perio & poor OH2 month interval3 mont

17、h interval:Moderate perio involvementEarly-mod perio & fair OHEarly perio & stressGuidelines for PMT Intervals3 month interval:Adult ortho clientsWomen with pregnancy associated ging.SmokersDiabetic clients where control is marginalElderly clients with active perioGuidelines for PMT Intervals4 month interval:Early disease & fair OHMod perio involvement, PSR (3), excellent OH6 month interval:Healthy clients probing depths 1-4 mmPedodontic clientsMotivated client with early gingivitis & improving OHRecurrence of PDLack of continued care & OH recurrence of P