decision making in periodontics

DECISION MAKING IN PERIODONTICS

Dr. Pinak Kapadia

When to save When to extract When to advise flap When to advise for implants When to wish the patient runs away….

A TYPICAL CONSULTATION/REFERRAL

THE DIRTY PICTURE

A TYPICAL CONSULTATION/REFERRAL

A TYPICAL CONSULTATION/REFERRAL

AN IDEAL CONSULTATION

Typical cases that periodontists treat in India are much worse than those treated by periodontists in US/Europe

Early intervention can give better results and avoid dirty picture!

WHAT IS DIFFERENT?

Diagnosis Prognosis Treatment planning Rehabilitation

Decision making

The denier The convincer The banker The trader The hysteric The ideal patient

◦ Accepts/Understands/Gets treatment/PAYS!!!

Psychology of patients in perio

1 treatment plan for all categories of patients???

In the real world, Decisions of periodontics depend upon the psychology of the patient along with the clinical picture

Especially for perio DO WE GIVE PATIENTS THE CHOICE OF

TREATMENT, OR DO WE DECIDE THE TREATMENT FOR THEM?

In other words, IDEAL TREATMENT OR NEED BASED TREATMENT?

A chicken or egg question

Do we periodontists treat patients or teeth?

Another question

Diagnosis Prognosis Treatment planning Rehabilitation

Decision making

DIAGNOSIS

Gingivitis/Periodontitis

POCKETS MOBILITY BONE LOSS

Factors in diagnosis

Periodontal probe – A simple instrument worth using in EVERY patient in EVERY site

Highest returns on investment!!!!

Gingivitis/Periodontitis

Chronic/Aggressive periodontitis

Age of the patient Habit/ Diabetes

Why???

FACTORS IN DIAGNOSIS

Mismatch between signs and symptoms

What matters to us

What matters to patients

Pockets Mobility Bleeding on probing Recession Bone loss on OPG

Bleeding gums Bad breath ‘GAPS’ between teeth Pain during

chewing/inability to chew

Sensitivity to cold

This complete mismatch between the patient’s symptoms, and the signs observed by the dentist leads to misconceptions about periodontal treatment

Finding common ground for treatment is very necessary.

Responsibility of educating the patients lies with each and every one of us.

MISMATCH

Endo Perio Lesions Caries/Crestal bone/Periodontal condition of

adjacent teeth # tooth

FACTORS IN DIAGNOSIS

If the tooth is nonvital, there will always be endo first.

Adequate time for endo lesion to heal before thinking of perio treatment

If origin is perio, endo can be delayed

Endo Perio lesions

PROGNOSIS

Prognosis cannot be predicted with any certainty without seeing the results of phase 1 therapy.

The only certain prognosis are Good and Hopeless

Many teeth fall in doubtful category

Factors in prognosis

Similar professions to perio

PROGNOSIS

80% of Gr II mobile teeth last for atleast 3 years

50% of Gr III mobile teeth last for atleast 1 year

95% of Gr I mobile teeth last for atleast 5 years

SOME STARTLING RESEARCH FINDINGS

In mobile teeth, FPD >>>> RPD Differentiate between increased mobility

and increasing mobility

FOLLOW UP

MORE STARTLING RESEARCH FINDINGS

TEETH VS IMPLANTS Rate of bone loss = 0.1 mm per year

STARTLING FINDINGS # 3

Consequences of not saving teeth

Consequences of not saving teeth

Co-ordination between the periodontist and the general dentist

TREATMENT PLANNING

Each case has separate rules whether to save or extract the teeth

If 1 or 2 teeth are hopeless/doubtful, better to extract and replace

If many teeth are doubtful, better to attempt to save

Not an exact science, but saving teeth is immensely gratifying

TAKE HOME MESSAGE

Showing pockets in a mirror/ drawing pockets

NOT prescribing gum paint NOT prescribing antibiotics for bleeding

gums without any diagnosis

How can we educate?