第11章 prognostic judgment treatment planning 牙周病的预后和计划
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QUESTION ？QUESTION ？Is my disease fatal?Will I lose my teeth?Will your treatment help me?What can you do to help me?
Is my disease fatal?Will I lose my teeth?Will your treatment help me?What can you do to help me?
第 11 章 PROGNOSTIC JUDGMENT
TREATMENT PLANNING
第 11 章 PROGNOSTIC JUDGMENT
TREATMENT PLANNING
牙周病的预后和计划牙周病的预后和计划
PROGNOSISPROGNOSISPrognosisForecast
预后预测PrognosisForecast
预后预测
预 后 类 型预 后 类 型骨吸收 病 因 依从性 全身病变
极佳 无可消除 良好 无
良好 轻较差 中
难消除 差 明显 /未控制极差 重
整体预后依据
整体预后依据
病史、年龄病史、年龄
疾病类型 发展速度疾病类型 发展速度
全身因素 环境因素全身因素 环境因素
患者意愿、依从性患者意愿、依从性
菌斑 牙石量 解剖菌斑 牙石量 解剖牙周破坏程度牙周破坏程度
有全身因素的牙龈炎全身因素控制后可以痊愈有全身因素的牙龈炎
全身因素控制后可以痊愈
龈炎的预后单纯性龈炎：良好龈炎的预后单纯性龈炎：良好
牙周炎的预后牙周炎的预后总预后个别牙预后总预后个别牙预后
牙周炎总预后对整个牙列预后的评估，内容包括牙周炎总预后
对整个牙列预后的评估，内容包括
1. 牙周炎的类型单因素轻中度 CP ，疗效易巩固有全身因素的牙周炎，变化多样
1. 牙周炎的类型单因素轻中度 CP ，疗效易巩固有全身因素的牙周炎，变化多样
2.骨破坏的速度、程度、类型 2.骨破坏的速度、程度、类型 3.局部因素消除情况 : 菌斑、根分叉问题、咬
合3.牙松动4.余留牙的数目、分布；5.患者依从性6.环境与行为因素7.全身、遗传、年龄因素
3.局部因素消除情况 : 菌斑、根分叉问题、咬
合3.牙松动4.余留牙的数目、分布；5.患者依从性6.环境与行为因素7.全身、遗传、年龄因素
牙周炎个别牙预后牙周炎个别牙预后1.探诊深度、附着水平：
部位？程度？袋深浅不是决定的因素。
2.牙槽骨：破坏部位、程度、根分叉病变；
3.牙松动度：自限性？进行性牙松动？
4.牙解剖：
1.探诊深度、附着水平：部位？程度？袋深浅不是决定的因素。
2.牙槽骨：破坏部位、程度、根分叉病变；
3.牙松动度：自限性？进行性牙松动？
4.牙解剖：
牙周病治疗计划牙周病治疗计划
总体目标总体目标1.控制菌斑、炎症2.合理的牙周组织形态
纠正：牙周袋 龈退缩骨缺损 牙松动牙齿及邻接关系
1.控制菌斑、炎症2.合理的牙周组织形态
纠正：牙周袋 龈退缩骨缺损 牙松动牙齿及邻接关系
3.恢复牙周组织功能合理的咬合关系修复失牙戒除不良习惯
3.恢复牙周组织功能合理的咬合关系修复失牙戒除不良习惯
4.维持长期疗效防复发口腔卫生指导与菌斑控制定期检查
4.维持长期疗效防复发口腔卫生指导与菌斑控制定期检查
治疗程序治疗程序主要分为四个阶段主要分为四个阶段
第一阶段病因治疗
第一阶段病因治疗
基础治疗INITIAL THERAPY
消除、控制：致病因素临床炎症
基础治疗INITIAL THERAPY
消除、控制：致病因素临床炎症
包括下列方法：包括下列方法：1.自我控制菌斑的方法：
① 刷牙方法和习惯；② 牙线和牙签；③ 菌斑显示剂检查④ 漱口剂
1.自我控制菌斑的方法：① 刷牙方法和习惯；② 牙线和牙签；③ 菌斑显示剂检查④ 漱口剂
2.拔除病牙2.拔除病牙3.洁治、刮治、根面平
整术4.药物控制感染5.咬合调整
3.洁治、刮治、根面平整术
4.药物控制感染5.咬合调整
6.治疗龋齿，矫正不良修复体和食物嵌塞
6.治疗龋齿，矫正不良修复体和食物嵌塞
7.处理牙周 - 牙髓病变7.处理牙周 - 牙髓病变1st阶段结束后 4~6 周再评估，确认疗效、依从性、治疗方案1st阶段结束后 4~6 周再评估，确认疗效、依从性、治疗方案
第二个阶段第二个阶段牙周手术治疗
并非每个患者都要进行牙周手术治疗
并非每个患者都要进行
牙周手术目的牙周手术目的清除袋内感染物
根面平整治疗牙槽骨缺损
纠正龈及膜龈畸形基础治疗后 1~3 月全面评估
清除袋内感染物根面平整
治疗牙槽骨缺损纠正龈及膜龈畸形
基础治疗后 1~3 月全面评估
手术的种类手术的种类1.牙龈切除术
切除肥大增生的牙龈病理性牙周袋
1.牙龈切除术切除肥大增生的牙龈病理性牙周袋
2.翻瓣术2.翻瓣术3.牙周骨手术
骨修整术、植骨4. GTR5.膜龈手术6.牙种植术
3.牙周骨手术骨修整术、植骨
4. GTR5.膜龈手术6.牙种植术
第三阶段修复治疗阶段
并非每个患者都要进行
第三阶段修复治疗阶段
并非每个患者都要进行
2st阶段后 2~3 月进行松牙固定
义齿修复、正畸
2st阶段后 2~3 月进行松牙固定
义齿修复、正畸
第四阶段疗效维护期
第四阶段疗效维护期
1st阶段后无论是否需要进行2 、 3 阶段治疗即应当开始，内容包括：
1st阶段后无论是否需要进行2 、 3 阶段治疗即应当开始，内容包括：
1.定期复查1.定期复查1. 时间：一般 3~6 个月 1次。2. 内容：
PLI 、 CI 、 DI 、 GI 、 BOP 、 PD 、附着水平、牙松动度、咬合情况、骨高度、密度、危险因素：吸烟、全身疾病
1. 时间：一般 3~6 个月 1次。2. 内容：
PLI 、 CI 、 DI 、 GI 、 BOP 、 PD 、附着水平、牙松动度、咬合情况、骨高度、密度、危险因素：吸烟、全身疾病
2.复治2.复治根据发 现的问题进行新一轮的治疗与疗效维护根据发 现的问题进行新一轮的治疗与疗效维护
牙周治疗与院内感染牙周治疗与院内感染
P163-164自学P163-164自学
OVERTHANKS
OVERTHANKS
牙周治疗与院内感染交叉感染 是医院内感染 (NOSOCOMIAL INF
ECTION) 中的重要内容之一。
牙周治疗与院内感染交叉感染 是医院内感染 (NOSOCOMIAL INF
ECTION) 中的重要内容之一。
医院感染的传播途径有：医院感染的传播途径有：直接接触病损、血液、体液、龈沟液、菌斑等；
吸人含致病菌的气雾或飞溅物 (如血液、唾液等 ) ；
间接接触 (污染器械、手、治疗台等传染媒体 ) ；
手机供水管道中的存水返流人口中。
直接接触病损、血液、体液、龈沟液、菌斑等；
吸人含致病菌的气雾或飞溅物 (如血液、唾液等 ) ；
间接接触 (污染器械、手、治疗台等传染媒体 ) ；
手机供水管道中的存水返流人口中。
我国人群中 HBV携带者约占 10% ，
艾滋病、梅毒等也有增多的趋势。
我国人群中 HBV携带者约占 10% ，
艾滋病、梅毒等也有增多的趋势。
牙周诊室控制感染特点及原则
牙周诊室控制感染特点及原则
病史采集及必要的检查重视询问全身疾病、传染性疾病。
“一致对待”原则universal precaution
即假定每位患者均有血源性传播的感染性疾病，诊治中一律严格防交叉感染，必要时作有关的
化验检查。
病史采集及必要的检查重视询问全身疾病、传染性疾病。
“一致对待”原则universal precaution
即假定每位患者均有血源性传播的感染性疾病，诊治中一律严格防交叉感染，必要时作有关的
化验检查。
治疗器械的消毒 按器械分类、分别用不同的方法消毒。 “双消毒”：对使用过的器械应实行消毒液浸泡、超声波或手工清洗、清水冲净干燥、高压灭菌或其他消毒方法。大型设备如综合治疗台表面等，可用可靠的消毒剂进行表面擦拭等。
治疗器械的消毒 按器械分类、分别用不同的方法消毒。 “双消毒”：对使用过的器械应实行消毒液浸泡、超声波或手工清洗、清水冲净干燥、高压灭菌或其他消毒方法。大型设备如综合治疗台表面等，可用可靠的消毒剂进行表面擦拭等。
应尽量使用已消毒的一次性用品(如检查器、吸唾器、注射器等 ) 。
一人一机。也可 2%碘酊擦拭手机的各部位，酒精脱碘 2次，
也可用 1%碘附消毒。
应尽量使用已消毒的一次性用品(如检查器、吸唾器、注射器等 ) 。
一人一机。也可 2%碘酊擦拭手机的各部位，酒精脱碘 2次，
也可用 1%碘附消毒。
保护性屏障口罩、帽子、防护眼镜、面罩、手套、工作服等
治疗过程中，污染的手套不得任意触摸周围的物品，
治疗结束后应清洗手套上的血污后再摘除手套，书写病历等。
保护性屏障口罩、帽子、防护眼镜、面罩、手套、工作服等
治疗过程中，污染的手套不得任意触摸周围的物品，
治疗结束后应清洗手套上的血污后再摘除手套，书写病历等。
尽量使用脚控开关来调节治疗椅照明灯扶手、开关等可用一次性覆盖物覆盖。一次性器械及覆盖物在用毕后应妥善、单独回收，作必要的销毁。
尽量使用脚控开关来调节治疗椅照明灯扶手、开关等可用一次性覆盖物覆盖。一次性器械及覆盖物在用毕后应妥善、单独回收，作必要的销毁。
减少治疗椅周围空气中的细菌量治疗前 1%过氧化氢或 0.12%氯己定液鼓漱一分钟，减少患者口中的细菌数量、治疗时的
气雾污染。诊室内应有良好的通风。
不在诊室内饮水和进食。
减少治疗椅周围空气中的细菌量治疗前 1%过氧化氢或 0.12%氯己定液鼓漱一分钟，减少患者口中的细菌数量、治疗时的
气雾污染。诊室内应有良好的通风。
不在诊室内饮水和进食。
治疗台水管系统的消毒、阻止水回流的装置；
在每位患者治疗结束后，再空放水 30秒；
每天开始工作前再冲水一至数分钟。国外建议超声波洁牙机使用单独的净水储水器，并每周用 1:10 的次氯酸钠液冲储
水系统，随后立即用蒸馏水冲洗。
治疗台水管系统的消毒、阻止水回流的装置；
在每位患者治疗结束后，再空放水 30秒；
每天开始工作前再冲水一至数分钟。国外建议超声波洁牙机使用单独的净水储水器，并每周用 1:10 的次氯酸钠液冲储
水系统，随后立即用蒸馏水冲洗。
严格遵守控制医院感染的原则，使病原微生物的扩散和环境的污染降低到最小的程度。保护患者和医务人员的利益安全。
严格遵守控制医院感染的原则，使病原微生物的扩散和环境的污染降低到最小的程度。保护患者和医务人员的利益安全。
Treatment can alter prognosis. Treatment can alter prognosis.
Prognosis has different connotations and nuances. Prognosis has different connotations and nuances.
The patient has every right to know the answers to these questions. The patient has every right to know the answers to these questions.
Question ？Question ？Is my disease fatal?Will I lose my teeth?Will your treatment help me?What can you do to help me?
Is my disease fatal?Will I lose my teeth?Will your treatment help me?What can you do to help me?
What are the therapeutic "odds"?What are the financial risks? What are the chances that the treatment will be of benefit?
What are the therapeutic "odds"?What are the financial risks? What are the chances that the treatment will be of benefit?
Prognosis has
three meanings in dentistry.
Prognosis has
three meanings in dentistry.
Diagnostic prognosis. Diagnostic prognosis. What are evaluations of the course of the disease without treatment? What is the status of the teeth nowWhat is the anticipated future of these teeth?
What are evaluations of the course of the disease without treatment? What is the status of the teeth nowWhat is the anticipated future of these teeth?
Therapeutic prognosis. Therapeutic prognosis. Given the state of the art and science of periodontics and the knowledge and skill of the practitioner, what effect will periodontal treatment have on the course of the disease?
Given the state of the art and science of periodontics and the knowledge and skill of the practitioner, what effect will periodontal treatment have on the course of the disease?
Prosthetic prognosis. Prosthetic prognosis. What is the forecast for the success of the prosthetic restoration?Will the prosthesis be therapeutic or detrimental?What specific needs dictate that it be prescribed?
What is the forecast for the success of the prosthetic restoration?Will the prosthesis be therapeutic or detrimental?What specific needs dictate that it be prescribed?
Judgement of the severity depends on ：Judgement of the severity depends on ：
1. pocket depth, 2. degree of bone loss,3. tooth mobility,4. crown-root ratio.
1. pocket depth, 2. degree of bone loss,3. tooth mobility,4. crown-root ratio.
generalized or localizedgeneralized or localized
The distribution of disease ：Inflammatory factors ：Traumatic factors ：
The distribution of disease ：Inflammatory factors ：Traumatic factors ：
Individual tooth therapeutic prognosisIndividual tooth therapeutic prognosis
includes such factors as ：
Percentage of bone loss; Probing depth;
includes such factors as ：
Percentage of bone loss; Probing depth;
Distribution and type of bone lossPresence and severity of furcation involvementsMobility
Distribution and type of bone lossPresence and severity of furcation involvementsMobility
Crown-root ratioPulpal involvementTooth position and occlusalStrategic value
Crown-root ratioPulpal involvementTooth position and occlusalStrategic value
Following are factors included in overall prognosis:Following are factors included in overall prognosis:
AgeMedical statusAgeMedical status
Individual tooth prognoses (distribution and severity)
Degree of involvement, duration, and history of the disease (rate of progression)
Individual tooth prognoses (distribution and severity)
Degree of involvement, duration, and history of the disease (rate of progression)
Patient cooperationEconomic considerationsKnowledge and ability of the dentist
Etiologic factors
Patient cooperationEconomic considerationsKnowledge and ability of the dentist
Etiologic factors
Accuracy and completeness of the information gathered at the examinationDentist's ability to recognize and eliminate or control the factors causing the disease
Accuracy and completeness of the information gathered at the examinationDentist's ability to recognize and eliminate or control the factors causing the disease
the patient's ability and determination in maintaining the health of the periodontium and teeth.
the patient's ability and determination in maintaining the health of the periodontium and teeth.
The overall prognosis depends on the prognoses of the individual teeth.
The overall prognosis depends on the prognoses of the individual teeth.
PAST HISTORY (RATE OF DESTRUCTION)
PAST HISTORY (RATE OF DESTRUCTION)
Probably the most important factor in forecasting the future health status of a dentition is knowledge of its past health status.
Probably the most important factor in forecasting the future health status of a dentition is knowledge of its past health status.
Speed of breakdown under controls or uncontrols The location, shape and depths of the pockets
Speed of breakdown under controls or uncontrols The location, shape and depths of the pockets
Tooth mobility can be controlled or eliminated, the prognosis is better.The greater the bone loss, the poorer the prognosis.
Tooth mobility can be controlled or eliminated, the prognosis is better.The greater the bone loss, the poorer the prognosis.
As bone loss exceeds 50%, the prognosis worsens rapidly.The more irregular the bone loss, the poorer the prognosis.
As bone loss exceeds 50%, the prognosis worsens rapidly.The more irregular the bone loss, the poorer the prognosis.
the pattern of bone loss: horizontal, vertical or infrabony defects.the age of the patient and the etiologic factors involved in the patient's disease.
the pattern of bone loss: horizontal, vertical or infrabony defects.the age of the patient and the etiologic factors involved in the patient's disease.
poorer prognosis: tilted, drifted, or rotated, hygiene difficult, elimination of pockets impaired
poorer prognosis: tilted, drifted, or rotated, hygiene difficult, elimination of pockets impaired
periodontal disease is complicated by active systemic factors and traumatism
periodontal disease is complicated by active systemic factors and traumatism
morphologic in nature and include the number and distribution of teeth, tooth morphology, furcation involvement.
morphologic in nature and include the number and distribution of teeth, tooth morphology, furcation involvement.
Extent of involvement. Is the furcation partially or totally involved?Status of bone support. If the bone levels are relatively sound, the effort to save may be justifiable.
Extent of involvement. Is the furcation partially or totally involved?Status of bone support. If the bone levels are relatively sound, the effort to save may be justifiable.
Root length and crown-root ratio must be consideredRoot length and crown-root ratio must be considered
Angulation of root spread. Health of neighboring teeth.
Angulation of root spread. Health of neighboring teeth.
The number and distribution of teeth presentcrown-root ratio,shape and number of the root
The number and distribution of teeth presentcrown-root ratio,shape and number of the root
the height of the alveolar crestpersonal psychologic and sociologic, financial considerations.
the height of the alveolar crestpersonal psychologic and sociologic, financial considerations.
OTHER CONSIDERATIONS IN ESTABLISHING PROGNOSIS
OTHER CONSIDERATIONS IN ESTABLISHING PROGNOSIS
The performance of home care is acceptable and the caries incidence is low,
the prognosis is better
The performance of home care is acceptable and the caries incidence is low,
the prognosis is better
The prime consideration is the preservation of the dentition as a functioning unit.
The prime consideration is the preservation of the dentition as a functioning unit.
In some instancesthe extraction of a single tooth will make the whole situation untenable.
In other situations isolated extractions will simplify the problem.
In some instancesthe extraction of a single tooth will make the whole situation untenable.
In other situations isolated extractions will simplify the problem.
what is considered to be a hopeless tooth. This will make treatment planning simpler.
what is considered to be a hopeless tooth. This will make treatment planning simpler.
the characteristics of hopeless perio
dontally involved teeth:
the characteristics of hopeless perio
dontally involved teeth:
Associated with intractable pain relieved, massive infection reduced by extractionMobility beyond 3 degrees
Associated with intractable pain relieved, massive infection reduced by extractionMobility beyond 3 degrees
Furcation involvement with little or no interradicularboneBone loss beyond the apexBone loss to the apex on one side of the tooth
Furcation involvement with little or no interradicularboneBone loss beyond the apexBone loss to the apex on one side of the tooth
Generalized circumferential bone loss to within 3 mm of the apexPocket depth to the apex without pulpal involvementVertical cracks or fractures
Generalized circumferential bone loss to within 3 mm of the apexPocket depth to the apex without pulpal involvementVertical cracks or fractures
Inaccessible perforations or accessory canalsNumber and position of remaining teeth precluding prostheticExtreme caries susceptibility
Inaccessible perforations or accessory canalsNumber and position of remaining teeth precluding prostheticExtreme caries susceptibility
Objectivesof treatmentObjectives
of treatment
Treatment goals should be
evaluated in every case.
Treatment goals should be
evaluated in every case.
Can treatment objectives of a firm non-retractable gingiva that does not bleed be reached? Can the pocket be eliminated? Will the bone regenerate? Can the tooth be stabilized?
Can treatment objectives of a firm non-retractable gingiva that does not bleed be reached? Can the pocket be eliminated? Will the bone regenerate? Can the tooth be stabilized?
Can tooth be restored?Can the patient tolerate the treatment?
Can tooth be restored?Can the patient tolerate the treatment?
If you believe the answers to these questions to be "yes," then plan and proceed with the treatment. If “no,” alternative treatment, compromise, or extraction is advisable.
If you believe the answers to these questions to be "yes," then plan and proceed with the treatment. If “no,” alternative treatment, compromise, or extraction is advisable.
As definitive laboratory tests are
developed to make diagnosis more accurate, and as further knowledge concerning the etiology and pathogenesis of periodontal diseases is developed, prognosis will
change from a qualitative to a quantitative judgment.
As definitive laboratory tests are
developed to make diagnosis more accurate, and as further knowledge concerning the etiology and pathogenesis of periodontal diseases is developed, prognosis will
change from a qualitative to a quantitative judgment.
TREATMENT PLANTREATMENT PLAN
PresentationPatient consentOrder of treatmentPhase IPhases Il and IIIMaintenance therapyProsthetic prescription
PresentationPatient consentOrder of treatmentPhase IPhases Il and IIIMaintenance therapyProsthetic prescription
Alternative treatment plansTreatment criteriaQuality of carePhilosophy of treatmentRecord keepingReferral
Alternative treatment plansTreatment criteriaQuality of carePhilosophy of treatmentRecord keepingReferral
PresentationPatient consentAfter hearing the presentation, the patient must decide whether to undergo treatment.
PresentationPatient consentAfter hearing the presentation, the patient must decide whether to undergo treatment.
PHASE IPHASE I
First steps (The initial effort) should be directed toward the elimination of inflammation and the institution of a program of plaque control.
First steps (The initial effort) should be directed toward the elimination of inflammation and the institution of a program of plaque control.
To reduce pocket depthTo minimize periodontal
traumatismOrthodontics(may precede or follow any surgical interventions)
To reduce pocket depthTo minimize periodontal
traumatismOrthodontics(may precede or follow any surgical interventions)
Extractions(Teeth with hopeless prognoses)
RestorationsUsually periodontal therapy should precede
restorative interventions. the restorations should be temporary
Extractions(Teeth with hopeless prognoses)
RestorationsUsually periodontal therapy should precede
restorative interventions. the restorations should be temporary
The provisional splinting during the treatment period should be evaluated.
The provisional splinting during the treatment period should be evaluated.
Scheduling of restorative treatment
should be done according to the following general rules:
Scheduling of restorative treatment
should be done according to the following general rules:
Normal patients. (Restorative treatment starts immediately.)
Class I (ADA periodontal disease classification)
Normal patients. (Restorative treatment starts immediately.)
Class I (ADA periodontal disease classification)
Without occlusal treatment need
Caries control and scaling and root planning. including plaque control, may be simultaneous. Definitive restorative treatment should follow co
mpletion of scaling and plaque control.
Without occlusal treatment need
Caries control and scaling and root planning. including plaque control, may be simultaneous. Definitive restorative treatment should follow co
mpletion of scaling and plaque control.
With occlusal treatment need Definitive restorativ
e treatment may immediately follow completion of scaling, plaque control, and occlusal adjustm
ent.
With occlusal treatment need Definitive restorativ
e treatment may immediately follow completion of scaling, plaque control, and occlusal adjustm
ent.
With surgical treatment need
Definitive restorative treatment should not be instituted for at least 4 to 6 weeks after the patient has
healed.
With surgical treatment need
Definitive restorative treatment should not be instituted for at least 4 to 6 weeks after the patient has
healed.
Splinting(Wire ligation and composite acid-etch splinting)
Emergency (pain, swelling, infection, and discomfort)
The emergencies all take priority ove
r other treatment scheduling.
Splinting(Wire ligation and composite acid-etch splinting)
Emergency (pain, swelling, infection, and discomfort)
The emergencies all take priority ove
r other treatment scheduling.
Medical status a systemic condition that would complicate treatment, a medical
consultation is necessary.
Medical status a systemic condition that would complicate treatment, a medical
consultation is necessary.
PHASES II AND IIIPHASES II AND III
Phase II surgery permits pocket elimination / reduction The restoration of normal osseous form ostectomy-osteoplastyosseous surgery combined with grafting procedures
Phase II surgery permits pocket elimination / reduction The restoration of normal osseous form ostectomy-osteoplastyosseous surgery combined with grafting procedures
root resectionsmucogingival and gingivect
omyperiodontal-endodontic res
torative treatmentprovisional splinting.
root resectionsmucogingival and gingivect
omyperiodontal-endodontic res
torative treatmentprovisional splinting.
Maintenance therapyThe specialist may see the patient once a year
or every other year for the less involved cases, whereas the generalist maintains the patient in
the recall system. Advanced cases may be seen alternately at 2-
to 4-month intervals.
Maintenance therapyThe specialist may see the patient once a year
or every other year for the less involved cases, whereas the generalist maintains the patient in
the recall system. Advanced cases may be seen alternately at 2-
to 4-month intervals.
PROSTHETIC PRESCRIPTION
Waiting for a period of at least 2 months after periodontal surgery.
Partial dentures or a fixed prosthesis
PROSTHETIC PRESCRIPTION
Waiting for a period of at least 2 months after periodontal surgery.
Partial dentures or a fixed prosthesis
ALTERNATIVE TREATMENT PLANS
ALTERNATIVE TREATMENT PLANS
Alternative treatment plans
should be prepared for the patient who elects to forego splinting and surgery when these are indicated.
Alternative treatment plans
should be prepared for the patient who elects to forego splinting and surgery when these are indicated.
In this case the patient may be treated through phase I therapy and be placed on a maintenance schedule. The establishment of an alternative plan generally calls for a rigorous maintenance schedule with scaling and planing performed more frequently than is otherwise usual.
In this case the patient may be treated through phase I therapy and be placed on a maintenance schedule. The establishment of an alternative plan generally calls for a rigorous maintenance schedule with scaling and planing performed more frequently than is otherwise usual.
Treatment criteria
Treatment criteria
Quality of careIn general, periodontal care seeks the following:
Removal of known etiologic factorsReduction of all pockets to a minimal depth to facilitate maintenance by the patient and the dental hygienistCreation of a maintainable gingival and osseous
architecture
Quality of careIn general, periodontal care seeks the following:
Removal of known etiologic factorsReduction of all pockets to a minimal depth to facilitate maintenance by the patient and the dental hygienistCreation of a maintainable gingival and osseous
architecture
Restoration of a functional and esthetic dentition
Maintenance of the resulting
health by the patient, doctor, and hygienist
Restoration of a functional and esthetic dentition
Maintenance of the resulting
health by the patient, doctor, and hygienist
PHILOSOPHY OF TREATMENT
PHILOSOPHY OF TREATMENT
periodontal diseases can be treated successfully the health of the diseased periodontium can be restored and the teeth maintained.
periodontal diseases can be treated successfully the health of the diseased periodontium can be restored and the teeth maintained.
The therapeutic concept of today includes all forms of therapy, conservative and complex selected and blended for the successful management of the individual patient.
The therapeutic concept of today includes all forms of therapy, conservative and complex selected and blended for the successful management of the individual patient.
Therapy must be tailored to the needs, both physical and psychologic, of the patient.
Therapy must be tailored to the needs, both physical and psychologic, of the patient.
RECORD KEEPINGThe treatment performed should be recorded carefully at each visit.
RECORD KEEPINGThe treatment performed should be recorded carefully at each visit.
ReferralThere are three basic reasons for referral:(1) professional, (2) moral an ethical, and (3) legal.
ReferralThere are three basic reasons for referral:(1) professional, (2) moral an ethical, and (3) legal.
Professional: Professional referrals are classified as follows:
1. Medical:Referral/consultation is indicated when a patient's medical history discloses significant information that may contribute to or influence the course and outcome of the treatment or when the dentist suspects illness.
Professional: Professional referrals are classified as follows:
1. Medical:Referral/consultation is indicated when a patient's medical history discloses significant information that may contribute to or influence the course and outcome of the treatment or when the dentist suspects illness.
2.Dental: Referral/consultation is indicated when the dentist cannot provide the entire dental therapy the patient needs. When the examination reveals periodontal disease that the generalist cannot or does not wish to treat, referral to a periodontist is in order. Equally the periodontist is obligated to refer patients for treatment to the general practitioner or other specialists.
2.Dental: Referral/consultation is indicated when the dentist cannot provide the entire dental therapy the patient needs. When the examination reveals periodontal disease that the generalist cannot or does not wish to treat, referral to a periodontist is in order. Equally the periodontist is obligated to refer patients for treatment to the general practitioner or other specialists.
3.Moral and ethical: 3.Moral and ethical:
The specialists or consulting dentists upon completion of their care shall return the patient, unless the patient expressly reveals a different preference, to the referring dentist, or if none, to the dentist of record for future care.
The specialists or consulting dentists upon completion of their care shall return the patient, unless the patient expressly reveals a different preference, to the referring dentist, or if none, to the dentist of record for future care.
The specialists shall be obligated when there is no referring dentist and upon a completion of their treatment to inform patients when there is a need for further dental care.
The specialists shall be obligated when there is no referring dentist and upon a completion of their treatment to inform patients when there is a need for further dental care.
Other reasons for referral include:
patient relocation, dentist-patient personality conflict, and dentist's preference.Some dentists do not use specialty, do not use specialty service
Other reasons for referral include:
patient relocation, dentist-patient personality conflict, and dentist's preference.Some dentists do not use specialty, do not use specialty service
CommunicationInforming the patient about the disease condition;a recall-maintenance schedule should be made.
CommunicationInforming the patient about the disease condition;a recall-maintenance schedule should be made.
DocumentationAll communication, written or verbal, must be properly documented on the patient’s chart.Patients have the right of access to their records and may acquire copies of the original documents, not original documents.
DocumentationAll communication, written or verbal, must be properly documented on the patient’s chart.Patients have the right of access to their records and may acquire copies of the original documents, not original documents.
SummarySummary
It is difficult for the dentist or specialist to possess expert knowledge and skill in all areas of dentistry because of the ever-expanding scope and complexity of dental therapy.
It is difficult for the dentist or specialist to possess expert knowledge and skill in all areas of dentistry because of the ever-expanding scope and complexity of dental therapy.
Today's dentist is confronted with a wide range of treatment procedures and available alternatives. At all times during the course of treatment, the primary focus is the patient's welfare.
Today's dentist is confronted with a wide range of treatment procedures and available alternatives. At all times during the course of treatment, the primary focus is the patient's welfare.
Effective communication and interaction among the dentist, the patient, and the specialist are vital elements of proper treatment.
Effective communication and interaction among the dentist, the patient, and the specialist are vital elements of proper treatment.