systemic phase of periodontal treatment

Phase I therapy or Etiotropic Phase. supportive. Several elements in the general health history can point to concerns that may affect the delivery of dental care. [16] using a much lower oral/systemic dose of CMT-3 (i.e., 10mg/day), rather than the 50-150mg/day in the phase I and II studies on cancer patients [33-35] did appear to reduce IL-1β and MMP-8 in human periodontal pockets [36]. In the private practice setting, the treatment of patients with periodontal disease is best accomplished within the structure of a uniform and consistent Peri-odontal Treatment Protocol (PTP). However, some essential issues associated with the use of these antibiotics remain unanswered, such as the ideal time of administration during the course of periodontal treatment. Obtaining vital signs, the most common of which are blood pressure and pulse rate, represents one objective method. At one end of the spectrum is the patient with few, if any, health problems, who takes no medications, and who requires only preventive services and no invasive dental treatment. The dentist is primarily concerned when the patient has high blood pressure. 11. Periodontal status should be thoroughly reassessed at four to six weeks following the nonsurgical phase of treatment, as the greater part of healing is completed by six weeks, but collagen maturation might continue for up to nine months. When a potentially life-limiting disease, such as cancer or severe congestive heart failure, has been diagnosed, the long-term prognosis for the patient should be determined because that information may influence decisions regarding which treatment options are most appropriate. Phases of treatment plan. E ect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis J Appl Oral Sci. The past health history will reveal diseases and conditions that may or may not be significant to the dentist when providing treatment. Principally, the comprehensive periodontal therapy can be divided into four main phases followed by any dental emergency 7. �5~a��n��!|��m�: �P��Dވ�`,8�"F �τںi �P�Ax �n��}��{��Q�'{%Nַ�؁�b�Z�t�W�ˠz.��M�:~�^Őc4E�P��ϲ�N��4�@�� {�wG��R�&��x(�$�2��\�� x��2'�75�-�g-�.��xӨ��ʵ�QZ��Q^4�Q�/\��%hɰ�0 :�2��QrJĕ=@C�l��2�[oo�*z >2�HX� ��ӆ�F��o4� The “Periodontal Treatment Guide” is the result of a consensus established by a group of experienced and highly renowned periodontists who based their recommendations for these guidelines on the sys-tematic assessment of the available literature. The tooth becomes loose as the disease progresses, and may even lead to extraction. When adequate precautions are taken, most dental procedures can be provided safely in a general dentistry setting. So, the phases of treatment plan are, Emergency phase. An Initial periodontal phase of treatment: with oral hygiene instructions followed by periodontal debridement combined with adjunct antimicrobials. Number of times cited according to CrossRef: 19. With the advent of accurate electronic blood pressure measuring devices, measuring blood pressure and pulse rate has become a relatively easy procedure (Figure 5-1). 2001;28:411–418. In addition to discovering past health problems, the dentist needs to investigate findings related to conditions that are currently present. We report on outcomes evaluated, categorizing them as biomarkers, and surrogate or clinical endpoints. 12. Performing this service is important for the well-being of the patient and for overall risk management in the dental practice. There may be some overlap of procedures and differences in the length of the three phases for different patients and the endpoint of a specific phase of treatment may not always be clear. For example, the patient with kidney failure presents several concerns that must be appreciated when providing dental treatment. Conclusions This review identifies systemic diseases and conditions that can affect the periodontal attachment apparatus and cause loss of periodontal supporting tissues and, where possible, presents case definitions for these. Some problems, such as AIDS or sexually transmitted diseases, carry with them a social stigma, making patients reluctant to reveal them to the dentist. x��}m�\�u�wU�?��I��w �J�_�I%묵��kkD �Y�ff(��~��=�F��L � ��s |��WW/V��_��V��}��wW�o�_=�ܾ��}��q��_�j��o~�V��bZ�V��ʻ��a��:4{��-��/��V~�k_��S�V\��K�֧u��)�ۼNq�Z[��_Vo��nI�u�[��m�� The practitioner should pay particular attention to any past hospitalizations, including outpatient surgery. ��7�mU��@=@��8#[��r�9C��[�(ځo1Z&��$�A��+А�@Q��f�Ka�x�Lt~��+�ͯF"�C1Q(��%�Abp�d�c��'8)k��k��UKU(΍$� 65j��Ԯ=�bSub*д ; 0��BWF��!Sl�Qg��3�zŀk�B��mh�`�[²?��j�.+[}��Vؘ�{�lku For example, a patient who cannot climb a flight of stairs without resting and complains of occasional chest pain on exertion may be referred to a physician to evaluate for ischemic heart disease. Some conditions, such as mitral valve prolapse with regurgitation, will trigger certain automatic modifications antibiotic prophylaxis to prevent bacterial endocarditis to the way dental care is delivered. To determine the impact of periodontal treatment on systemic markers of inflammation in patients with metabolic syndrome (MetS) and periodontitis. <>/Metadata 704 0 R/ViewerPreferences 705 0 R>> Following restorative or endodontic treatment, individual teeth may be sensitive to heat, cold, or chewing pressure. second phase is usually completed within 1-2 months; therefore, at around 3 months after the final periodontal surgical session, a reassessment is done to enable drugs.9 Furthermore, the ineffectiveness of non-surgical periodontal therapy in patients with diabetes has been debated as one of the major confounders of the association between the two disorders. Most patients expect some minor discomfort after receiving dental treatment. The dentist also will be concerned when the patient reports a history of systemic disease that has now reappeared or is worsening. • Systemic phase of therapy including smoking counseling • Initial (or hygiene) phase of periodontal therapy, i.e. The patient should be given instructions describing the kinds of discomfort that may occur after treatment and in what kinds of situations the office should be contacted. Dialysis patients receive the drug heparin during dialysis treatment to prevent coagulation of blood in the dialysis machine. Here are the four phases of periodontal therapy. Does the patient see a physician or other heath professional regularly? As a result, those patients who are hospitalized generally suffer from more serious conditions and have more complex treatment requirements. The need for systemic therapy must be evaluated when the patient first presents for treatment and at every appointment thereafter. The administrative assistant should be alert to the health status of every patient entering the office. Some patients are sensitive to latex products and others to certain metals in dental restorations. A careful review of the patient’s general and dental health history may suggest ways to alter treatment delivery and prevent problems. ,�O[!��i��*��v@xo[S��P��]��F��,`��}hK��: \��w�K}Gq�Nn]Ѱ�aqa݄�٫= S�z�gX�T�PeԲك��`�|]��M��E+nz�x��$�dx��t2hD=� >��ߘh4� Although the potential is low for these problems occurring as a result of dental treatment, the dentist will want to consult with the patient’s physician. In fact, some patients with normal blood pressure may exhibit high readings because of stress associated with anticipating dental treatment. In a single-center, randomized, placebo-controlled, and double-masked clinical trial, 80 patients with chronic or aggressive periodontitis were randomized into 2 treatment groups: group A, receiving systemic amoxicillin and metronidazole during the first, nonsurgical phase of periodontal therapy (phase 1), and group B, receiving the antibiotics during the second, surgical phase (phase 2). Occasionally the patient may be taking drugs for conditions not originally identified on the health questionnaire. J Periodontolgy #2004; 75:1553-1565. The interpretation of a high blood pressure measurement can be more difficult. The dentist will want to confirm the blood pressure reading after 5 to 10 minutes, or at the conclusion of the appointment. The use of stress reduction procedures, including prescribing medications to alleviate anxiety, may have additional preventive value. To ensure the safe delivery of dental treatment and to minimize postoperative problems, the dentist must be able to recognize when a patient needs or will benefit from systemic phase treatment. The classification of blood pressure in adults is listed in Table 5-2. The American Society of Anesthesiologists (ASA) has adopted a widely used classification system for estimating patient risk status (Table 5-1). Blood loss can be significant when the patient does not have normal clotting mechanisms because of the use of anticoagulant medications or because of failing liver function associated with long-term alcohol use. Are the medications effective in treating the conditions they were prescribed for? Patients exhibiting a systolic blood pressure >180 mm Hg or a diastolic pressure >110 mm Hg should be referred to a physician for immediate follow-up.2, Blood Pressure Classification for Adults1. Treatment of dental problems for this group can be challenging because hospitalized patients are often significantly debilitated, bedridden, and unable to be treated in a traditional dental setting. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Patients who appear to be in relatively good health may have systemic problems that can be aggravated by seemingly routine dental treatment. This has resulted in controversy as to the role of systemic antibiotics in the treatment of periodontal diseases. The alveolar bone, together with other tissues that support teeth, is damaged. Rudiger S, Petersilka G, Flemmig TF. 1; 39% entered after the first round of systemic antimicrobial treatment; 1% after the second round of systemic treatment; 20% after the first round of local antimicrobial treatment; 14% after the second round of local treatment; and 7% after the third round of local treatment. Although dental implants may be an ideal long-term solution, a less expensive and immediate solution, such as a provisional removable partial denture, may be more appropriate. The test group received quadrant periodontal flap surgery as required. endobj Failure to discover important health information can occur for two reasons. diabetes, circulatory problems, etc.) Systemic Biomarkers in 2-Phase Antibiotic Periodontal Treatment: A Randomized Clinical Trial. For example, an elderly patient may report taking furosemide (Lasix) and digoxin (Lanoxin) for a blood pressure problem. Slots J. Background: The relationship between systemic antioxidative status and periodontal condition has been investigated in epidemiologic studies. If, for example, the patient has signs or symptoms suggestive of hypertension, diabetes, hyperthyroidism, or cancer, further investigation is warranted. endobj Reviewing the health history with the patient is an important rapport-building exercise. Once this is determined, a medical alert label or warning message should be prominently displayed in the record. Figure 5-1 An automated blood pressure cuff is convenient to use and provides accurate measurements that can be used to evaluate patients for hypertension. Other causes of gingival hyperplasia are more physiologic. 4 0 obj Abnormal pulse measurements that cannot be explained by findings from the health history or from such circumstances as those previously listed may be significant. The practitioner can prevent such severe complications by being knowledgeable about the patient’s general health and the potential for more significant postoperative problems to occur. The non-surgical phase is the initial phase in the sequence of procedures required for periodontal treatment. More recently, probiotics has also been suggested as a promising adjunctive treatment for periodontitis due to their antimicrobial and anti … Blood pressure and pulse rate measurements should be obtained at every new patient examination, and subsequently at regular intervals. Randomized Clinical Trials (RCT) that evaluated the systemic administration of antibiotics as adjuvants to scaling and root planning (SRP) at different phases of periodontal treatment were included. Once this information has been gathered, the dentist needs to evaluate whether the patent’s systemic problems present a risk to providing dental care or will adversely affect the prognosis for the proposed dental treatment. Systematic reviews and studies that evaluated subjects with systemic diseases and those that used subantimicrobial doses of antibiotics were excluded. American Society of Anesthesiologists (ASA) Physical Status Classification With Examples. 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