_maintenance therapy牙周炎维护治疗课件

Periodontal Maintenance Therapy Evaluation and Care Learning Outcomes lDetermine appropriate intervals for supportive periodontal care for clients presenting with gingival and/or periodontal conditions lOutline a periodontal maintenance therapy program based on a clients compliance with home care and risk of disease recurrence lDetermine reasonable outcomes reflective of the periodontal maintenance plan that will promote client compliance lAccurately document new clinical findings and revise the care plan as required Introduction lClients with persistent or chronic periodontal problems are in need of professional care at regular intervals lServes as an extension of the initial periodontal therapy lFor those at risk: Stable dental condition, reduce active episodes Re-educate, support clients involvement Risk Assessment lClients who have experienced gingival and/or periodontal disease are at risk for future disease lClients 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 lPrimary objective prevent recurrence or development of disease affecting dentition & soft tissues lThis is accomplished by: Maintaining attachment levels & alveolar bone height Controlling inflammation Maintenance of oral health Reducing incidence of tooth loss Objectives of PMT lSecondary 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 lRationale: Client susceptible to periodontal breakdown Client not a candidate for periodontal surgery lHealth reasons lFinancial reasons lClient refuses Improves prognosis for periodontally involved teeth Need for Continuous Periodontal Care lRationale: Reduce stress on immune system Improve clients plaque control Client Compliance lCompliance: “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 Baltimore: Williams & Wilkins. lCompliance can by assessed in 2 ways: Evaluating clients compliance with home care Clients compliance with a continuous care regimen Client Compliance lFactors 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 lStrategies 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 lEvaluation of initial therapy necessary to determine: Length of interval Necessity of surgery lEvaluation 4-6 weeks following active treatment Initial Therapy Evaluation lResponse of tissues to initial therapy dictates options available: Further treatment 3 month PMT interval Use of antimicrobials/antibiotics lSurgery not indicated for at least 3 months following initial therapy Periodontal Maintenance Therapy lRecommended average interval for periodontal clients is 3 months lLengthened or shortened as necessary PMT Intervals lFactors to consider when selecting an interval: Clients risk for soft & hard tissue disease Clients 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 lClients who may have special requirements: Diabetic client Extensive prosthetic/restorative dentistry Rampant decay Orthodontic clients Disability Health concerns PMT Procedures lClient involvement a must! lRecognize outcomes modification required? lSpecific components: Review of health history lSmoking status, stress levels lSystemic concerns lNew medications and/or conditions PMT Procedures lSpecific components: Dental history lSensitivity lCompliance lNew concerns Intraoral & extraoral exam lNew medications xerostomia PMT Procedures lSpecific components: Periodontal exam lGingival tissues lProbing depths, recession lAttachment loss lBleeding on probing lFurcation involvement, mobility lSuppuration lDeposit accumulation PMT Procedures lSpecific components: Radiographic assessment Diagnosis lSites that responded to therapy vs. those that didnt lType of disease present (refractory) lType of therapy required Surgery Debridement Antimicrobials/antibiotics PMT Procedures lTherapy: Review of home care Debridement as required Deplaquing, polishing Desensitization lAppointment scheduling: 1 hour minimum Assessment & therapy may take 1-2 appointments Guidelines for PMT Intervals lShortened intervals may be required: PSR score of 3+ & poor OH Mod-severe perio & poor OH 2 month interval l3 month interval: Moderate perio involvement Early-mod perio & fair OH Early perio & stress Guidelines for PMT Intervals l3 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 l4 month interval: Early disease & fair OH Mod perio involvement, PSR (3), excellent OH l6 month interval: Healthy clients probing depths 1-4 mm Pedodontic clients Motivated client with early gingivitis & improving OH Recurrence of PD lLack of continued care & OH recurrence of PD