Outcomes of NSPT GN PDF

23/01/2024 Outcomes of Non-surgical Instrumentation Stabilise disease to stop it progressing any further. Once a periodontal patient, always a periodontal patient. Some outcomes are desirable and some are not desirable - important to inform patients so they know what to...

23/01/2024 Outcomes of Non-surgical Instrumentation Stabilise disease to stop it progressing any further. Once a periodontal patient, always a periodontal patient. Some outcomes are desirable and some are not desirable - important to inform patients so they know what to expect after NSPT 1 Intended Learning Outcomes By the end of this session students should be able to: ▪ Briefly explain the four Steps recommended by the British Society of Periodontology in relation to periodontal treatment delivery. ▪ Describe the main desired outcomes from delivery of non-surgical periodontal therapy. ▪ Describe the potential risks associated with delivery non-surgical periodontal therapy. ▪ Explain how this has an impact on patient consent and patient management. 2 2 1  23/01/2024 GDC Learning Outcomes ▪ 1.1.8 Describe the properties of relevant medicines and therapeutic agents and discuss their application to patient management ▪ 1.7.3 Recognise the need to monitor and review treatment outcomes ▪ 1.7.7 Refer to other members of the dental team or other health professionals ▪ 1.10.2 Provide patients with comprehensive and accurate preventive education and instruction in a manner which encourages self-care and motivation ▪ 1.10.3 Underpin all patient care with a preventive approach that contributes to the patient’s long-term oral health and general health ▪ 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 plans and outcomes ▪ 1.11.5 Recognise and appropriately manage the complications associated with periodontal therapy 3 3 Always need to identify risk factors associated What are you trying to achieve? Four Steps BSP UK CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT OF PERIODONTAL DISEASES Patient is the biggest factor in managing the disease Educate patient about their disease Step 1 Step 2 Step 3 Step 4 Assessment OH, risks Manage non- Maintenance Education responding sites PMPR, H&U Targeted PMPR Risk factors Re-treat OH coaching Adjunctive OH, Risk factor antimicrobials Refer Reevaluate and review Reevaluate/reassess OH, risks Active phase of to see how step 1 treatment (PMPR) and 2 went well and 4 not so well 4 2  23/01/2024 By acknowledging of these steps we are working towards minimally invasive dentistry and periodontics ▪ Kebschull, M., Chapple, I. Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines. Br Dent J 229, 443–449 (2020). https://doi.org/10.1038/s41 415-020-2173-7 5 5 Main aims of treatment Removal of Pocket depth Reduced Maintenance of Recession secondary local reduction Plaque/bleeding OH regime factors Minimising Addressing of Addressing Increase impact of non- modifiable risk patients cleansability modifiable risk factors complaint factors 6 6 3  23/01/2024 Aims of treatment Pocket depth reduction Reduce bleeding As gingivae gets inflammed, will turn into true Bleeding is active sign of disease 7 pocket overtime due to apical migration of Aim is less than 10% 7 junctional epithelium, breeding ground for Plaque primary aetiological biofilm (difficult for patient to clean) cause By reducing pocket depth, lower chances of bacterial biofilm and patient can clean more effectively Recession Removal of secondary local factor Gingivae has receded down to where bone is Naturally: Outcome is to reduce plaque 8 Easier for patient to clean and access Calculus load, and secondary local 8 Root morphology factor increases plaque Iatrogenic: Restorations 4  23/01/2024 Once a perio patient, always a periodontal patient Need to understand a long term maintenance required Making oral cavity easier to clean and manage Maintenance of OH Increased cleansability 9 Different OH aids 9 Reducing pocket depths Diet OH routine Addressing of modifiable risk factors Minimising impact of non-modifiable risk factors Age Raise concern 10 Family history 10 Ethnic group 5  23/01/2024 Patient complaint 11 11 Risks and additional outcomes C-Section Stitching Face lift 12 12 6  23/01/2024 Benefits of accepting non-surgical periodontal therapy Increased chance of keeping teeth Treating periodontal disease can impact systemic disease/general health Reduced pain opportunity Financial impact in long run due to modified risk factors. Positive health messages Create behaviour change within family Improvement of quality of life 13 13 Linked to Consent Lecture More risks than benefits but benefits out weighs the risks Whether there is a benefit there is always a ‘risk’ 14 14 7  23/01/2024 Risks of Non-Surgical Periodontal Therapy Pain discomfort Bleeding Infection Recession Sensitivity Increase risk of Lost restorations Food trapping Black triangles Non-response caries / margins 15 15 Risks of Non-Surgical Periodontal Therapy Discomfort Bleeding Understandable due to manipulation of soft tissue Encourage to maintain OH 16 Depends on inflammation levels Reassure bleeding is fine 16 Usual pain relief can manage this Encourage to keep up with OH 8  23/01/2024 Linked to Recession Lecture Linked to Aesthetics Lecture Recession Periodontal Abcess Can be aesthetically challenging for patient Can cause this by inappropriate debridement 17 Can induced sensitivity 17 Sensitivity Increased risk of caries Due to recession and exposed dentine tubules Due to recession and exposed dentine 18 Higher critical pH than enamel - demineralises quicker 18 9  23/01/2024 Linked to Aesthetics Lecture Food trapping Black triangles Due to reduction of interdental papilla Due to reduction of interdental papilla 19 Annoying for patient Not suitable for floss 19 Increased caries risk Aesthetics Linked to Non-responding site Lecture Non-responding site Lost restoration Always a chance of lost restoration Patient not responding to treatment 20 Remember that restoration would have come off Bleeding continues 20 eventually Complicated disease and difficult to clean Can deal with issue Ref to why treatment might fairly NSPT 10  23/01/2024 Information leaflets 21 21 Recommended Reading ▪ Wong LB, Yap AU, Allen PF. Periodontal disease and quality of life: Umbrella review of systematic reviews. J Periodontal Res. 2021 Jan;56(1):1-17. doi: 10.1111/jre.12805. Epub 2020 Sep 23. PMID: 32965050. ▪ Kebschull M, Chapple I. Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines. Br Dent J. 2020 Oct;229(7):443-449. doi: 10.1038/s41415-020-2173-7. Epub 2020 Oct 9. PMID: 33037364. ▪ Kebschull, M., Chapple, I. Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines. Br Dent J 229, 443–449 (2020). https://doi.org/10.1038/s41415-020-2173-7 22 22 11  23/01/2024 Image References ▪ The Age at Which You Are Officially Old (aarp.org) ▪ https://www.jisponline.com/viewimage.asp?img=JIndianSocPeriodontol_2014_18_3_346_134573_u5.jpg ▪ https://www.researchgate.net/figure/Bleeding-on-probing-in-the-diagnosis-of-periodontal-diseases_fig1_236058243 ▪ https://www.researchgate.net/figure/Mahajans-Class-IV-gingival-recession-defects_fig4_261762021 ▪ https://www.chellastondental.co.uk/treatments/preventative-care/keeping-your-mouth-clean/ ▪ https://diabetestimes.co.uk/criticism-over-eatwell-plate-amid-calls-for-low-carb-approach/ ▪ https://pocketdentistry.com/1-diagnosis-and-treatment-planning-in-restorative-dentistry/ ▪ https://www.girlsgonestrong.com/blog/articles/your-c-section-scar-a-users-guide/ ▪ https://www.drhungmd.com/blog/3-ways-to-minimize-mohs-surgery-scars/ ▪ https://www.lookrefreshed.com/blog/aesthetic-surgery/are-all-facelift-incisions-results-the-same/ ▪ https://www.medicalnewstoday.com/articles/swollen-gums ▪ https://neighborhooddentalcare.com/main/myth-monday-bleeding-gums-are-normal/ ▪ https://www.perioimplantadvisory.com/clinical-tips/hygiene-techniques/article/14177420/the-importance-of-periodontal-treatment-in-postcovid19- dentistry ▪ https://www.aegisdentalnetwork.com/special-issues/2008/06/dentin-hypersensitivity-relationship-to-gingival-recession ▪ https://kitchenerfamilydentist.com/blog/a-rational-approach-to-managing-gum-recession/ ▪ https://www.grandviewdentalcare.com/blog/what-is-a-food-trap-and-how-can-your-dentist-fix-it/ ▪ Reena’s Notes: 18 Essential Points on the Successful Management of Unresponsive Periodontitis In Practice with Professor Ian Needleman - Reena Wadia ▪ https://www.reenawadia.com/reenas-notes-18-essential-points-on-the-successful-management-of-unresponsive-periodontitis-in-practice-with-professor- ian-needleman/ ▪ https://www.emergencydentalservice.com/common-dental-emergencies/lost-dental-filling 23 23 12