Periodontal Maintenance Therapy

1
Periodontal Maintenance Therapy

• Evaluation and Care

2
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 clients 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

3
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 clients involvement

4
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

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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

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Objectives of PMT

• Secondary objectives
• Early recognition treatment of conditions
  affecting oral cavity
• Reinforce oral self-care techniques
• Reinforce value of continuous oral care

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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

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Need for Continuous Periodontal Care

• Rationale
• Reduce stress on immune system
• Improve clients plaque control

9
Client Compliance

• Compliance 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.
• Compliance can by assessed in 2 ways
• Evaluating clients compliance with home care
• Clients compliance with a continuous care regimen

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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

11
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

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Initial Therapy Evaluation

• Evaluation of initial therapy necessary to
  determine
• Length of interval
• Necessity of surgery
• Evaluation 4-6 weeks following active treatment

13
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

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Periodontal Maintenance Therapy

• Recommended average interval for periodontal
  clients is 3 months
• Lengthened or shortened as necessary

15
PMT Intervals

• Factors 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

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PMT intervals

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

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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

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PMT Procedures

• Specific components
• Dental history
• Sensitivity
• Compliance
• New concerns
• Intraoral extraoral exam
• New medications ? xerostomia

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PMT Procedures

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

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PMT Procedures

• Specific components
• Radiographic assessment
• Diagnosis
• Sites that responded to therapy vs. those that
  didnt
• Type of disease present (refractory)
• Type of therapy required
• Surgery
• Debridement
• Antimicrobials/antibiotics

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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

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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

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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

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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

25
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

26
Success!

• Upper right lingual 6 months after surgery

• Client 2 years after periodontal therapy