Nonsurgical Periodontal Therapy – Flashcards

• Take care of emergencies such as pain, abscesses, NUG and/or injuries (preliminary therapy) • Identify and extract hopeless teeth (preliminary therapy) • OHI • Smoking cessation • Nutritional counseling • Correction of local risk factors (e.g., overhangs or open margins) • Perio therapy (aka scaling and root planing or periodontal dbmt) • Antimicrobial therapy • Fluoride therapy, caries control and temporary restorations • Occlusal therapy • Minor orthodontic therapy • Re-evaluation of Phase I therapy • Take care of emergencies such as pain, abscesses, NUG and/or injuries (preliminary therapy) • Identify and extract hopeless teeth (preliminary therapy) • OHI • Smoking cessation • Nutritional counseling • Correction of local risk factors (e.g., overhangs or open margins) • Perio therapy (aka scaling and root planing or periodontal dbmt) • Antimicrobial therapy • Fluoride therapy, caries control and temporary restorations • Occlusal therapy • Minor orthodontic therapy • Re-evaluation of Phase I therapy

Periodontal surgery, Endodontic surgery and Implant placement

Restorative care

Periodontal maintenance

All patients with chronic periodontitis (early, moderate or advanced) should go through initial therapy and re-evaluation. When determining if a patient would benefit from periodontal therapy the clinician should focus on the periodontal pocket depths. Recession, furcation involvement and mobility are very important to note, however periodontal therapy will not reverse these conditions, but hopefully maintain. Ideally we would like to control the inflammation and pocket depths making the oral cavity more manageable for the patient and hygienist as well as allowing for the tissues to be more manageable during periodontal surgery.

Root planing: the intentional, aggressive removal of cementum and/or dentin providing glossy, smooth root surfaces.

Periodontal therapy or periodontal debridement (not to be confused with full mouth debridement). However, these terms are not currently recognized by the ADA, so we still use the codes associated with the term scaling and root planing.

Prophylaxis includes the removal of plaque, stain and calculus from tooth structures and is intended to control local irritation to gingival tissues, thereby preventing disease initiation. So, the healthy patient would benefit from this type of procedure. Gingivitis patients typically fall under this category as well.

• To aid in performing a periodontal assessment when there is an abundance of plaque and calculus which makes probing difficult and inaccurate (after the initial full mouth debridement (removal of mostly supragingival deposits) and periodontal assessment, the patient will typically be scheduled to follow-up with periodontal therapy/dbmt (local or quadrant SRP) depending on if they have chronic periodontitis • Offices may also use this code/charge for patients who have gingivitis with heavy calculus deposits due to the patient needing more chair time to complete the cleaning. The only issue with doing this is that most insurance companies will not cover a full mouth debridement. Due to this the office may decide to charge out a more expensive prophylaxis or simply place the patient in periodontal therapy if there were some 4mm pockets present since then insurance will cover. • Lastly, offices who accept patients on medical assistance may charge out a full mouth debridement at one appointment and then charge out a prophylaxis at the following appointment a week or two down the road since MA no longer covers periodontal therapy. This is an ethical issue.

STC is a procedure that involves removing the diseased lining of the ST pocket wall, including some of the JE and basal lamina from inflamed gingival tissues and shallow suprabony pockets with the goal of reducing or eliminating inflammation. This procedure is not permitted in the state of MN.

No, polishing is typically done at the re-evaluation appointment 4-8 weeks (ideally 4-6 weeks) after treatment is completed. This is a good way to get your patients to return for their re-evaluation appointment, especially if you have prescribed them a CHX rinse (extrinsic staining will likely result).

1-3 teeth involved per quadrant

4 plus teeth involved per quadrant

• Periodontal assessment should already be complete with an adequate diagnosis made • Treatment options, adverse effects and patients responsibilities (e.g., scheduling periodontal maintenance appts, home care, etc..) presented • Consent given by the patient • Local vs. quadrant SRP • Use of pain control methods (Local, Oraqix and/or N2O/O2) • OHI • Adjunctive treatments (oral irrigation, local drug delivery (Arestin), Rx CHX rinse), possibly systemic antibiotics • No polishing • Schedule re-evaluation appointment for 4-8 weeks (ideally 4-6 weeks) after treatment is complete

Sites with chronic/non-responsive periodontal probing depths that are > 5mm that BOP

It can be placed immediately following SRP as well as at the re-evaluation or periodontal maintenance appointments

Typically used in aggressive, refractory and necrotizing cases. Usually not used in chronic periodontitis unless microbial testing identifies presence of red complex bacteria/bacteria that invades deep within the soft tissues.

• Reduction in probing depth due to gingival recession/tissue shrinkage • Increase in clinical attachment (decreased penetration of the probe) due to the inflammatory infiltrate being replaced by collagen and the formation of a long JE • Decreased inflammation • Decreased bleeding • Shift in the subgingival microbiota from predominately gram negative m/o(s) to gram positive rods and cocci • No regeneration occurs with this phase of therapy

• Tissue recession • Dentinal hypersensitivity (may develop 3-4 days after therapy and decreases a few weeks later) • Increased risk of root caries

4-8 weeks is indicated with the optimal time be 4-6 weeks to assess healing and the patient's home care. If you wait much longer you run the risk of the patient slacking with home care procedures and sites becoming active again. The re-evaluation appointment is a good time to reinforce good home care techniques and perhaps suggest additional adjuncts.

• Medical history update • Periodontal assessment (compare w/ finding prior to perio therapy) • Gingival assessment • Plaque index • OHI • Deplaquing w/ ultrasonics and hand instruments • Additional smoking cessation if needed • Placement of Arestin if appropriate and/or oral irrigation • Decision made regarding if patient needs additional nonsurgical therapy, can be placed on a periodontal maintenance schedule or if the patient requires periodontal surgery (Phase II)

It includes all of the measures used by the dental team and the patient to keep periodontitis under control and prevent recurrence of disease. All patients with chronic periodontitis should be placed on a program of periodontal maintenance following nonsurgical periodontal therapy and/or surgery which is typically every 3-4 months, but may need to be shorter depending on the nature of the disease and systemic implications.

This should be determined on an individual basis. Some factors to consider are the severity of the disease, adequacy of patient self-care and the host response which may be impacted by a number of things including systemic conditions, genetics, smoking, etc.

• Moderate-severe chronic perio • Furcation involvement (can be best treated when in the class II stage) • Vertical defects • Aggressive perio • Periodontal abscesses or other acute periodontal conditions that cannot be fully treated by the general dentist • Progressive AL, BL &/or mobility • MGI • Significant root expo &/or progressive gingival recession • Peri-implant disease • Refractory perio • Pts w/ need for IV sedation to accomplish the indicated perio therapy • Periodontitis with systemic factors that require a specialists care • Any pt with PD, regardless of the severity, whom the referring dentist prefers not to treat

ADA 1110 Adult Prophylaxis (typically patients with gingivitis fall into this category, in addition to healthy individuals. 1120 is used for a child prophy)

ADA 4355 Full Mouth Debridement

ADA 4381

ADA 4341 (code is charged out per individual quadrant)

ADA 4342

ADA 4910

ADA 0180 (In a general dental office 0150 comprehensive dental exam and 0120 periodic dental exam would be utilized most often when the dentist completes an exam. This is different from 0180 periodontal exam which is typically only charged out in the specialist office)

Moderate periodontitis

Embrasure type 2 (type 1 fully intact and type III missing)