Failure of Non-Surgical Periodontal Treatment PDF

Failure of Non -Surgical Periodontal Treatment The non- responding patient GDC Learning Outcomes  1.1.2 Describe oral diseases and their relevance to prevention, diagnosis and treatment  1.1.11 Recognise psychological and sociological factors that contribute to poor oral health, the c...

Failure of Non -Surgical Periodontal Treatment The non- responding patient GDC Learning Outcomes  1.1.2 Describe oral diseases and their relevance to prevention, diagnosis and treatment  1.1.11 Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases and the success of treatment  1.2.2 Recognise the importance of and record a comprehensive and contemporaneous patient history  1.2.3 Recognise the significance of changes in the patient’s reported oral health status and take appropriate action  1.5.3 Plan the delivery of, and carry out, care in the best interests of the patient  1.7.3 Recognise the need to monitor and review treatment outcomes  1.7.8 Recognise the need for and make arrangements for appropriate follow-up care  1.10.5 Assess the results of treatment and provide appropriate aftercare and ongoing preventive advice  1.11.1 Assess and manage the health of periodontal and soft tissues taking into account risk and lifestyle factors 2  1.10.5 Assess the results of treatment and provide appropriate aftercare and ongoing preventive advice  1.11.1 Assess and manage the health of periodontal and soft tissues taking into account risk and lifestyle factors  1.11.2 Explain and take account of the impact of the patient’s periodontal and general health on the overall treatment plan and outcomes  1.11.3 Undertake non-surgical treatments, under prescription appropriate, to remove hard and soft deposits and stains using a range of methods  1.11.4 Monitor and record changes in periodontal health as necessary using appropriate indices  1.11.6 Recognise and appropriately manage the complications associated with periodontal therapy  1.11.7 Recognise the role of surgical management of periodontal diseases, apply antimicrobials, and provide appropriate patient care. 3 Learning Outcomes for today At the end of the session, you will be able to:  Explain the aims of non surgical periodontal treatment  Identify the clinical indications that treatment has been unsuccessful  List the common reasons why treatment may fail  Describe the possible future treatment options to address non responding sites.  List the factors to be included in a supportive periodontal therapy appointment. 4 What is the primary objective of periodontal treatment ?  To slow down/halt the progression of disease and minimise tooth loss. Image credit hawkinsfamilydental.com 5 What are the aims of treatment?  Bleeding on probing < 10%  Plaque Score < 15%  Periodontal Probing Depths < 4mm  No furcations probeable  Maintain function  Maintain aesthetics Image credit Dr Ian Dunn, Periocourses. as defined by the British Society of Periodontology. 6 What are the clinical indications that treatment has been unsuccessful?  High PS  High BOP  Pockets > 5mm  There may be more than one response in the same patient – a “mixed response” 7 What are the phases of periodontal treatment ? 3 phases of periodontal therapy: Supportive periodontal Corrective therapy periodontal Initial therapy periodontal therapy 8  Initial periodontal therapy  Plaque and bleeding indices following BPE  OHI  Smoking cessation advice  Manage other risk factors  Instrumentation/RSD/removal of overhangs  Extract teeth with a hopeless prognosis, other dental work  Monitor response to initial therapy  If pockets over 4mm with BOP remain, move to corrective therapy  If no pockets over 4mm or with no bleeding, move to supportive therapy  https://www.gskhealthpartner.com/en-sa/oral-health/ conditions/gum-health/diagnosis/ 9 Corrective Periodontal Therapy  More NSPT  +/- adjunctive antimicrobials  Periodontal surgery  Restore function/ aesthetics – definitive restorative treatment - implants - orthodontics Supportive Periodontal Therapy (AAP 1998, Lang et Al. 2008) embraces the philosophy that both the patient and dental professional are involved in maintaining the patient’s periodontal health. It is weighted heavily towards the contribution of the patient. 10 Common reasons that treatment may fail  Operator Factors  Patient Factors Image credit: Google  Site Factors Image credit:reenawadia.com 11 Operator Factors  Poor instrumentation technique  Poor instruments  Inexperience  Time constraints Image credits: Melonie Prebble 12 Patient Factors  Poor OH  Smoking Image credit: moffitt.org  Systemic disease/impaired host response – stress, nutrition  Co – operation for treatment, eg: LA, access Image credit: roselanedentalpractice.co.uk 13 Site Factors  Very deep pockets  Infra-bony pockets  Tooth and root morphology Image credit Dr Charlotte Spedding “Failure of treatment” may reflect the severity and complexity of the case rather than any inadequacies. 14 How do you address operator factors?  Practice  Advice from more experienced clinicians Image credit: todaysrdh  Appropriate instruments – sharp - good condition  Time Image credit: Swallow Dental Supplies 15 How do you address the non-responding patient? Investigate why non-responding -  Motivation – are there any compounding factors?  Reinforce OH  Continue to review 16 How do you address the non responding sites? Corrective periodontal therapy:  Referral to specialists periodontist  Further NSPT +/- antimicrobials  Perio surgery  Extraction  Accept and move to supportive periodontal therapy:  Pockets 4-5 mm with good OH and no BOP can usually be maintained  Pockets > 6mm have an increased risk of progression and tooth loss. 17 What factors should be included in the supportive periodontal therapy appointment?  PS  BOP  Motivation  OH reinforcement  Intervention/ disruption of the biofilm 18 Thank you! 19