Periodontal Maintenance Therapy,Evaluation and Care,Learning Outcomes,Determine appropriate intervals for supportive periodontal care for clients presenting with gingival and/or periodontal conditions Outline a periodontal maintenance therapy program based on a clients compliance with home care and risk of disease recurrence Determine reasonable outcomes reflective of the periodontal maintenance plan that will promote client compliance Accurately document new clinical findings and revise the care plan as required,Introduction,Clients with persistent or chronic periodontal problems are in need of professional care at regular intervals Serves as an extension of the initial periodontal therapy For those at risk: Stable dental condition, reduce active episodes Re-educate, support clients involvement,Risk Assessment,Clients who have experienced gingival and/or periodontal disease are at risk for future disease Clients with increased risk: Attachment loss of 2 mm or more Clients over 70 years of age Clients who use tobacco Pathologically mobile teeth Poor oral care, systemic involvement,Objectives of PMT,Primary objective prevent recurrence or development of disease affecting dentition & soft tissues This is accomplished by: Maintaining attachment levels & alveolar bone height Controlling inflammation Maintenance of oral health Reducing incidence of tooth loss,Objectives of PMT,Secondary objectives: Early recognition & treatment of conditions affecting oral cavity Reinforce oral self-care techniques Reinforce value of continuous oral care,Need for Continuous Periodontal Care,Rationale: Client susceptible to periodontal breakdown Client not a candidate for periodontal surgery Health reasons Financial reasons Client refuses Improves prognosis for periodontally involved teeth,Need for Continuous Periodontal Care,Rationale: Reduce stress on immune system Improve clients plaque control,Client Compliance,Compliance: “the consistency & accuracy with which a client follows the regimen prescribed by a health professional” (1997) Stedmans Concise Medical Dictionary for the Health Professions (3rd ed.) ,Edited by John Dirckx Baltimore: Williams & Wilkins. Compliance can by assessed in 2 ways: Evaluating clients compliance with home care Clients compliance with a continuous care regimen,Client Compliance,Factors that interfere with compliance: Education, economic problems Values, culture Fear, self-destructive behaviour Perceived indifference on part of clinician Lack of understanding of disease process Oral care too demanding, inconvenient Client unconvinced of necessity,Client Compliance,Strategies to improve compliance: Positive reinforcement Promote oral health as part of an overall healthy lifestyle Simplify information Easy verbal & written instructions Involve client when setting goals “Reminders”,Initial Therapy Evaluation,Evaluation of initial therapy necessary to determine: Length of interval Necessity of surgery Evaluation 4-6 weeks following active treatment,Initial Therapy Evaluation,Response of tissues to initial therapy dictates options available: Further treatment 3 month PMT interval Use of antimicrobials/antibiotics Surgery not indicated for at least 3 months following initial therapy,Periodontal Maintenance Therapy,Recommended average interval for periodontal clients is 3 months Lengthened or shortened as necessary,PMT Intervals,Factors to consider when selecting an interval: Clients risk for soft & hard tissue disease Clients risk for oral cancers Factors that predispose client to disease Client compliance Intraoral factors, rate of deposit formation History of soft tissue disease,PMT intervals,Clients who may have special requirements: Diabetic client Extensive prosthetic/restorative dentistry Rampant decay Orthodontic clients Disability Health concerns,PMT Procedures,Client involvement a must! Recognize outcomes modification required? Specific components: Review of health history Smoking status, stress levels Systemic concerns New medications and/or conditions,PMT Procedures,Specific components: Dental history Sensitivity Compliance New concerns Intraoral & extraoral exam New medications xerostomia,PMT Procedures,Specific components: Periodontal exam Gingival tissues Probing depths, recession Attachment loss Bleeding on probing Furcation involvement, mobility Suppuration Deposit accumulation,PMT Procedures,Specific components: Radiographic assessment Diagnosis Sites that responded to therapy vs. those that didnt Type of disease present (refractory) Type of therapy required Surgery Debridement Antimicrobials/antibiotics,PMT Procedures,Therapy: Review of home care Debridement as required Deplaquing, polishing Desensitization Appointment scheduling: 1 hour minimum Assessment & therapy may take 1-2 appointments,Guidelines for PMT Intervals,Shortened intervals may be required: PSR score of 3+ & poor OH Mod-severe perio & poor OH 2 month interval 3 month interval: Moderate perio involvement Early-mod perio & fair OH Early perio & stress,