Periodontal Maintenance Therapy

1. Periodontal Maintenance Therapy Evaluation and Care

2. Learning Outcomes • Determine appropriate intervals for supportive periodontal care for clients presenting with gingival and/or periodontal conditions • Outline a periodontal maintenance therapy program based on a client’s compliance with home care and risk of disease recurrence • Determine reasonable outcomes reflective of the periodontal maintenance plan that will promote client compliance • 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 anextension of the initial periodontal therapy • For those at risk: • Stable dental condition, reduce active episodes • Re-educate, support client’s 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

5. 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

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

7. 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

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

9. Client Compliance • Compliance: “the consistency & accuracy with which a client follows the regimen prescribed by a health professional”(1997) Stedman’s ConciseMedical Dictionary for the Health Professions (3rd 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

10. 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”

12. 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

14. 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: • 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

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

17. 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

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

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

20. 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

21. 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

22. 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

23. 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

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