However, the FDA clearance process did not determine that any specific medication delivered via tray delivery systems has been proven to be a safe or effective way to treat gum disease. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994 [published corrections appears in: J Periodontol. New patients commonly react by becoming defensive, saying, “How come my former dentist didn’t diagnose this?” In cases such as this, it is important to respond tactfully: “That is a very good question, Mrs. Smith. Did Dr. Jones do all of the same assessments that we did here today, with measurements, and bleeding points, and pocket depths?” Inevitably, the patient responds “no,” but in the unlikely event they do say “yes,” that is fine, too. Non-surgical periodontal treatment does have its limitations. All rights reserved. Remember that the most important member of the treatment team is you. Your dentist will talk to you about a treatment plan that works best for you, and he or she will recommend a maintenance care schedule that is based on your personal case. 2. discuss methods of encouraging patient at-home compliance. Principles and Phases of Treatment Aim . Note: Dr. Friedman and Dr. Ocampo are actively monitoring the emerging and rapidly evolving COVID-19 outbreak. J Periodontol. However, treating and charging for periodontal disease is very different. Advancing your knowledge of perio-dontal disease treatment is good … It is meant to be a synthesis of the information out there that is most consistent. Doing so is a good way of educating physicians about the systemic links and other emerging research in the dental field. J Periodontol. Therefore, periodontal care must be given serious consideration when developing treatment plans for older adults. 195;55(3):177-180. 2004;31(9):697-707. treatment strategies presented in this guidance are followed by the dental team, patients at risk of developing periodontal diseases can be recognised early and appropriate care (both preventive and treatment-based) can be provided to improve the oral health, and in some cases general health, of the patient population in Scotland. The patient is treated chairside, and the antibiotic is syringed into each pocket, where it stays and continues to provide antibiotic action for up to 30 days.14 Figure 2 depicts the administration of a locally applied antibiotic. Gingivitis means inflammation of the gums. Goodson JM, Gunsolley JC, Grossi SG, et al. The author has no financial interest in any of the manufacturers mentioned in this article. In the case of a crown, once the crown is cemented, the treatment has reached an end point. It will give you an easy to understand foundation of how a periodontal program works. A general practitioner who simply tells the patient, “We’re going to send you over to the surgeon now” is asking for trouble. A Five-Step Plan for Treating Periodontal Disease. However, today’s emerging research indicates that periodontal disease really occurs in spurts, or bursts of activity, that can wax and wane. 6. McLeod DE. Gelatinase destroys the gelatinous matrix that surrounds the biofilm, and proteases destroy proteins. 18 The Journal of Dental Hygiene Special supplement itive diagnosis and a diagnosis-driven treatment plan. Once patients realize that they have active infection in their mouths, it is usually a wake-up call they can understand. The teeth are still firmly seated—there is no attachment loss associated with gingivitis. As mentioned before, compliance can be a problem with prescription medications. Because compliance is clearly a major issue, how do oral healthcare providers encourage it? According to the US Surgeon General’s report on Oral Health published in 2000, the mouth—including the teeth, gums, and supporting bone structures—is a “mirror for general health and well-being.” In the report, periodontal disease is also described as the second most prevalent disease in the United States (the first being heart disease), and the leading cause of adult tooth loss.1, In addition, a 2002 poll of 1,000 people over the age of 35 conducted by Harris Interactive Inc (Rochester, NY) found that 60% of adults surveyed knew little, if anything, about gum disease, the symptoms, available treatments, and—most importantly—the consequences. In this case, the periodontist could explain: “Dr. This may include additional nonsurgical therapy sessions, supportive periodontal care and maintenance, or surgical treatment. Oral Health in America: A Report of the Surgeon General. Periodontal therapy is often referred to by patients as a dental deep cleaning. Consider using an electric toothbrush, which may be more effective at removing plaque and tartar. Use a mouth rinse to help reduce plaque between your teeth, if recommended by your dentist. Smith did what he could within the limits of his practice, but now we are going to do it in a specialty practice at a level that is pre-surgical.”, Both the periodontist and general practitioner should always know exactly what the other is going to say on the matter. The fact is, the less a patient is asked to do, the greater the compliance. After reading this chapter the practitioner should be aware of how to plan periodontal … Undiagnosed and untreated periodontal disease is one of the fastest growing areas of litigation and complaints in dentistry. When locally administered antibiotics such as minocycline hydrochloride are used, there are no compliance concerns. This One Page Periodontal Protocol Cheat Sheet is a quick overview of how to identify symptoms, diagnose, treat, and maintain various stages of periodontal disease. The aim of this study was to determine whether the care plan could improve the oral health-related quality of life of patients with PD.. Scaling and Root Planing. If it is recommended that a patient do too many things (ie, brushing, flossing, irrigation, using tongue scrapers, rubber tips, electric toothbrush, etc), they will inevitably do only one or two of those things and let the others fall by the wayside. 1999;70(1):13-29. 2007;78(8):1568-1579. Sign up today! Washington, DC: May 2000. Patients use the tray at home to deliver medications that have been prescribed by their dentist. Then remove the floss and let them smell it. Local antimicrobial therapies in periodontal disease. A systematic review. Periodontal Treatments and Procedures Periodontists are dentistry's e xperts in treating periodontal disease. How come all of a sudden I have this problem?”, That is a legitimate question that requires a compelling answer. Compliance with medical regimens: An annotated bibliography. Without treatment, the alveolar bone … Key finding: The periodontal treatment is perceived more as a standardised workflow than as an individually tailored treatment. Periodontal disease is known as a “silent” disease because patients do not know they have it (or simply ignore the symptoms) until it has reached an advanced state. The patients’ oral hygiene and self-awareness are experienced as crucial parts while the mechanical infection control is perceived as successful but … The results of these studies, where tray drug delivery systems were used as adjunct to non-surgical periodontal therapy, provide no strong evidence that show adjunctive use of tray delivery systems is more effective than traditional non-surgical periodontal therapy alone. After scaling and root planing in the office, the patient is sent home and the healthcare provider hopes for the best. Selection of antimicrobial agents in periodontal therapy. Additionally, 39% do not visit a dentist regularly.2, Across all demographic categories in the United States, 50 million people have some form of gum disease, and another 85% to 90% of the population has gingivitis, which may be a precursor to periodontal disease.3,4. In advanced (severe) periodontal diasease, furcation probing is important and a reliable diagnostic technique. FDA Consum. Theoretical Medicine and Bioethics 1983;4(2). The author has spoken with periodontists who say that their general practitioner has sent patients to them for periodontal surgery, however the patients were not ready for surgery because there was inflammation and disease that needed to be addressed beforehand. Many practices are realizing there’s more to the treatment of periodontal disease than just cleaning and polishing. 2000;131:483-491. Clinical findings, including probing depths, from the patient’s initial examination are compared to the reevaluation findings. Failure to control active periodontitis can result in acute exacerbations and bone loss during tooth movement. It has a unique position in the periodontal treatment plan, as it should be undertaken only after active periodontal disease has been controlled . For many general practitioners, referring a patient to a periodontist is a limited option because many dental practices have not taken the time to build a solid working relationship with periodontists. And that’s an important thing for us to know as we go forward to take care of your gum disease.”. 1999;70(3): 351]. Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. J Clin Periodontol. Ann R Australa Coll Dent Surg. For example, some insurance companies, particularly Aetna Dental and CIGNA, are now paying for additional and adjunct periodontal maintenance therapies because it may reduce the cost of more significant treatments for heart disease, pre-term birth, and other systemically linked illnesses. J Am Dent Assoc. Dental insurance is “payment assistance;” it is meant to help offset the cost of treatment, not pay for it entirely. 1. Creating Your Plan After considering all of the information the dental team has gathered, the team can begin to create an individualized dental treatment plan for each patient. The author advises against prescribing too many systemic antibiotics when there are other infection treatment modalities, including locally administered antibiotics such as minocycline hydrochloride 1 mg which is proven safe and effective, without building up antibiotic resistance.5,13 Other site-specific antibiotics for the treatment of periodontal disease include doxycycline hyclate, 10 mg, and chlorhexidine gluconate, 2.5 mg. Patients will often go months and months with bleeding gums and not seek treatment, while bleeding from any other body orifice would immediately send them to their physician. 5. The treatment plan should be used to establish the methods and sequence of delivering appropriate periodontal treatment. This care ranges from routine treatment of gums to assisting those diagnosed with gum disease. 4. Another scenario involves examining new patients, and discovering they have periodontal disease. 4. Antibiotic resistance of subgingival species during and after antibiotic therapy. Subsequent treatment can proceed in several ways, depending on the initial response. A review. Dean JW, Branch-Mays GL, Hart TC, et al. 2000;321(7252):36-39. When patients start to hear about the oral/systemic connection not only from their dentist, but their doctor, too, it adds emphasis and another dimension of credibility: “My dentist always told me I needed to take better care of my teeth and gums, and now my doctor is telling me the same thing—I better start taking this more seriously.”. It is also important to explain to patients that the health of their gums is assessed every time they come in; but at this point in time, there are some areas of bleeding on probing, with pockets of disease around their teeth greater than 3 mm deep. Periodontitis, or gum disease, is a common infection that damages the soft tissue and bone supporting the tooth. The best way to prevent periodontitis is to follow a program of good oral hygiene, one that you begin early and practice consistently throughout life. Again, the treatment plan will vary and should be based on ongoing clinical assessment and individual patient response to treatment. Oral Microbol and Immunol. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health. Because, in the minds of the patients, if it is just a cleaning or a check-up, they may procrastinate on accepting and following through with the recommended treatment plan. Periodontal insurance refers to dental plans that include benefits for periodontal care. An approximate fee can usually be determined during the initial visit; but on occasion, some initial treatment or further diagnostics must be completed before the final periodontal treatment plan can be established. For example, elastase and collagenase break down and destroy elastin and collagen, which are the primary structural components of the periodontium. Locally administered antibiotics have an advantage in that they are targeted right at the source of infection: the antibiotic is absorbed right through the epithelium on contact, so there are effective therapeutic levels exactly where they are most needed.15,16 Systemic antibiotics pass through the digestive system, where much of the active medication is absorbed and metabolized before it even reaches the target area. 1990;5(4):219-222. 11. 10. Collective experience indicates that patients do not comply, and non-compliance is a critical underlying issue. One reason for this is that, once periodontal disease is diagnosed, the patient may ask, “I come in every 6 months. 1. The prevalence of periodontal disease is quite significant. 2002;37(5):389-398. Click Here! In the author’s opinion, in the early 1980s, the profession became accustomed to using a great “closer” to get patients to accept dental treatment: “Don’t worry, your insurance will pay for that.” That statement worked back then because, for the most part, insurance coverage was closest to actual fees for service. In addition to soft tissue evaluation, one of the most common and accurate methods is to use a periodontal probe in affected areas and record probing depths. 17. Periodontal Gum Treatment (for gum disease) is the treatment of swelling, soreness or infection of the tissues supporting the teeth. This is another aspect of periodontal disease that the profession must change—it has been downplaying the disease as a whole and glossing over it; instead of explaining it to the patient, it is simply called a “cleaning.” A cleaning is covered twice a year, but it is obviously not comprehensive periodontal treatment. Another reason oral healthcare professionals avoid or delay treating periodontal disease is the fact that the success of the treatment depends so much on the success of patients’ compliance with bacterial control at home: plaque control, brushing, flossing, etc. 2003;24(4):247-257. Subantimicrobial dose doxycycline as adjunctive treatment for periodontitis. As oral healthcare providers, it may be easier to elevate a personal standard of care by adopting a simple five-step plan that includes diagnosis, treatment, appropriate fees, and referrals. For periodontal disease treatment to be as successful as possible, patient compliance with respect to diligent home care is a major factor. While this might seem like a less important section of the treatment plan, it is, in fact, one of the key solutions. Registration on CDEWorld is free. One effective way to charge patients to do their part is to scrape the dorsum of their tongue with a plastic spoon, or even a mirror, and allow them smell it. Lewis C. Fighting gum disease: how to keep your teeth. In addition to a prescribed home care regimen, antibiotics may be prescribed. New Study Suggests the Ideal Sequence for Removing Plaque, American Academy of Periodontology 2017 World Workshop Proceedings, American Academy of Periodontology Publishes Proceedings from Best Evidence Consensus Meeting on Lasers, American Academy of Periodontology, SUNSTAR Announce 2018 Innovation Grant Recipients, World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, Best Evidence Consensus Meeting on Cone-Beam Computed Tomography (CBCT), American Academy of Periodontology Installs New President, Officers in Boston, American Academy of Periodontology Announces 2017 Award Winners, American Academy of Periodontology Announces First Recipient of SUNSTAR Innovation Grant, American Academy of Periodontology Names New Executive Director, Marijuana Use Linked to Increased Gum Disease Risk, Gum Disease Experts: Floss or Risk Losing Your Teeth, Statement from the AAP on Flossing Efficacy, Study: Gum Disease May Increase Lung Cancer Risk, CDC Estimate: New Mexico, Hawaii Have Highest U.S. Development of a logical and properly sequenced treatment plan is a derivative of the periodontal assessment and diagnosis. Next, take a thick piece of floss and take several passes in between the first and second upper molars. Counting and tracking bleeding points is another strong compliance motivator. Now is the time to take a closer look at the specific “fears” surrounding the failure to diagnose, treat, charge, and refer patients with periodontal disease; recognize the areas in need of improvement; and focus on implementing this five-step plan for elevating and committing to your personal standard of care. This simple process will enable professionals to navigate within this vast and often complex territory called periodontal disease and ensure better patient outcomes. Compend Contin Educ Dent. Periodontal procedures to be performed. With periodontal disease, the imperative need for treatment is not as obvious. Again, the treatment plan will vary and should be based on ongoing clinical assessment and individual patient response to treatment. Different from a regular cleaning, this treatment involves scaling and root planning which is important for re-gaining loss of attachment, treating gum recession, and preventing tooth loss resulting from periodontitis or … 8. 3. Forgot your password? However, it appears that tetracycline-resistant strains of pathogenic bacteria are beginning to emerge10,11 and, hence, some patients will respond better to a combined course of amoxycillin (250 mg three times a day) and metronidazole (200 mg three times a day) for 7 days.12. Adults are Dishonest with Dentists about How Often They Floss Their Teeth, Oral Hygiene Habits and Hypertension Risk, Periodontal Disease More Prevalent among Ethnic Minorities, Proceedings from the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions, Insurance Reimbursement and Third Party Issues, Periodontal Literature Review: The Next Generation. For example, in a study of people taking medication for cardiovascular conditions, the average adherence was 95% for once-per-day dosing, 84% for two- and three-times per day dosing, and 78% for those taking four pills per day.9 Subjects who were on a once-a-day regimen had an average compliance rate of 83% compared to 53% for those on a twice-daily regimen and 27% for those on a four-times-per-day regimen.9. US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research. The inflammatory response is precipitated by a release of certain enzymes that rush to the infected areas to combat the bacteria and their bacterial endotoxins. But the end result is that, over time, the disease continues to get worse.”. The AAP has reviewed several studies about the treatment of periodontal disease using tray drug delivery systems. Even though oral healthcare providers and medical professionals know the potential health consequences of periodontal disease, there are certain things that can be done to elevate the standard of care when it comes to treating periodontal disease. Gingivitis usually precedes periodontitis, but not all gingivitis progresses to periodontal disease. Nevertheless, a periodontitis patient is always considered as having a chronic condition and requires a lifelong regimen of regular, professional care in the dental practice. When gingivitis is included, close to 100% of the population is affected. Personal reasons, including fear and embarrassment, may also come into play. 737 N. Michigan Ave., Suite 800, Chicago, IL 60611312-787-5518, AAP Foundation       American Board of Periodontology, American Academy of Periodontology and American Dental Association Mourn the Loss of Robert J. Genco, DDS, PhD, Should You Brush or Floss First? J Periodontal Res. Not seeking care is likely a result of a number of factors. Radiographs can be used, but they have limitations in initial diagnosis because bone loss is typically associated with severe and chronic periodontal disease; therefore, radiographs are better used to confirm diagnosis. Try these measures to reduce or prevent periodontitis: 1. Smith, this is a primary bacterial population that is growing on your tongue, and it is the same bacteria that is growing in your gums.”. Journal of Public Health Dent. 2000;15:57-60. There will likely be more compliant flossers when patients smell how much halitosis is coming from those areas. 9. Gluck G, Aroskar M, Arthur N. Cost containment in dentistry and its impact on the distribution of services. Patients in the Type II through V range will initially require scaling and root planing, in addition to oral hygiene instructions and patient education. American Academy of Periodontology. The cost of periodontal surgery varies greatly depending on the type of procedure and the severity of your disease. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. Another insurance hurdle is the fact that most dentistry is done “one tooth at a time,” and most dental care can be characterized as the “crown-of-the-year club,” meaning that dental insurance will cover about one crown a year, so dentists will find the worst tooth and crown it this year. A comprehensive plan for periodontal disease (PD) care in Taiwan provides non-surgical and supportive periodontal treatment. Consideration of adjunctive restorative, prosthetic, This is often accomplished through non-surgical periodontal treatment. Hanes PJ, Purvis JP. With the advent of PPO and DMO plans, the fees paid for dental services to participating dentists are effectively reduced by contract as a cost containment measure.17 Today, insurance companies continue to try to reduce their own costs by attempting to alter treatment plans and thus limit treatment by raising the patients’ financial contribution.18 However, there has been some progress made with insurance companies, as reported by The New York Times in November 2006. Treatment protocol in place this process will help to ensure better patient outcomes, Tonetti M. ABC of health... The least invasive and most cost-effective manner be confused and upset, because they had been led believe... Down and destroy elastin and collagen, which can vary from tooth to tooth the non-surgical medical treatment, curettage... The best ways possible to relieve stress individually tailored treatment vertical bitewings taken over time, the treatment periodontal. 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