Materials and Methods . For instance, the patient who contracted rheumatic fever as a child may have residual heart damage, predisposing the individual to an infection of the heart, infective endocarditis, after certain types of dental treatment. B. Nonsurgical Phase (Phase I Therapy) Plaque control and patient education: Diet control (in patients with rampant caries) Removal of calculus & root planing Correction of … The various points of entrance to the mainte- nance phase are shown in Fig. The patient who reports a heart attack less than 1 month ago is at greater risk for having a second attack or a significant episode of arrhythmia during a stressful dental visit than an individual who had an attack 3 years ago. Start studying Systemic Phase of Treatment- EXAM 2. The non-surgical phase is the initial phase in the sequence of procedures required for periodontal treatment. Many more examples of modifying or limiting treatment can be found in the chapters discussing elderly patients and patients with special needs (Chapters 10 and 16). Before engaging in active therapy, the dentist must consider what impact the patient’s overall general health may have on the delivery of dental care and how it may affect the outcome of treatment. Pregnancy, hormonal imbalances, and some diseases such as leukemia can trigger gum … In its early stage, called gingivitis, the gums become swollen, red, and may bleed. 35 Post-therapy reevaluation is a critical step in determining the status of gingival inflammation, oral hygiene and healing. Specific items to focus on include: The clinical assistant should begin observing patients as they are escorted to the treatment area. Prevention. The systemic health problems of most ambulatory patients relate directly or indirectly to chronic conditions, such as heart and lung disease, diabetes, hypertension, endocrine disorders, anemia, arthritis, or psychological illness. A history of such events should suggest the possibility of similar occurrences associated with dental treatment. This type of fainting may be caused by stress and fear associated with receiving dental treatment or simply by rapid positional changes, such as sitting or standing up quickly. The clinician must evaluate both the severity of the problem and how recently it occurred. An important source of information about the patient’s current health is an evaluation of the drugs he or she is taking on a regular basis. An assessment of the patient’s general health and capacity to withstand the rigors of dental treatment physically and psychologically should be performed at every appointment. • Systemic phase of therapy including smoking counseling • Initial (or hygiene) phase of periodontal therapy, i.e. A core function of the systemic phase is to evaluate the severity and complexity of this set of health issues and to assess how those issues may affect dental treatment. The non-surgical phase is the initial phase in the sequence of procedures required for periodontal treatment. Until relatively recently, individuals with such severe systemic illnesses as liver, kidney, or cardiac failure did not seek dental services unless they had an acute dental problem. Background: The relationship between systemic antioxidative status and periodontal condition has been investigated in epidemiologic studies. corrective. Performing this service is important for the well-being of the patient and for overall risk management in the dental practice. The use of stress reduction procedures, including prescribing medications to alleviate anxiety, may have additional preventive value. Other problems, more episodic in nature, may not be associated with a chronic disease. The systemic phase of treatment provides an opportunity for the dentist to establish and maintain the best possible state of physical health for the patient before, during, and after treatment. Systemic phase of therapy including smoking counseling Initial (or hygiene) phase of periodontal therapy – cause related therapy Corrective phase of therapy – surgery, endo therapy, implant, restorative, ortho/ prosthetic T/t Maintenance phase (care) – SPT • Salvi, Lindhe & Lang 2008 47 42. - Treatment must address all problems to the greatest extent possible (Ask yourself how you would like to be treated) - A phased, i.e., sequenced, plan of treatment must be developed and recorded, even for the simplest case. Arweiler et al (2013) randomized, group Many more physicians, especially those involved with treating patients with cancer or acquired immunodeficiency syndrome (AIDS), now appreciate the impact that preventing dental problems can have on the overall prognosis for their patients. J Dent Res. Improving the Accuracy and Reliability of the Health Questionnaire. We report on outcomes evaluated, categorizing them as biomarkers, and surrogate or clinical endpoints. The dentist may require an ASA category III or IV patient to seek medical consultation before treatment. Some problems, such as AIDS or sexually transmitted diseases, carry with them a social stigma, making patients reluctant to reveal them to the dentist. Some patients are sensitive to latex products and others to certain metals in dental restorations. The best and safest method to resolve any acute dental problems must be determined in light of the patient’s overall condition. Each patient has his or her own unique set of health issues and dental needs. Phase I therapy has many specific objectives • 1.Evaluation and alteration of patient systemic risk factors. However, a pilot study by Ryan et al. The classification of blood pressure in adults is listed in Table 5-2. Systematic reviews and studies that evaluated subjects with systemic diseases and those that used subantimicrobial doses of antibiotics were excluded. 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. with advanced periodontal disease, systemic antibiotic therapy without subgingival debridement might change the composition of the subgingival microbiota, result-ing in multiple periodontal abscesses. Most patients expect some minor discomfort after receiving dental treatment. 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. Examples include seizure disorders, fainting, and seasonal allergies. The patient is able to walk up a flight of stairs or two level city blocks without difficulty. Identification of specific inflammatory patterns may help to better understand the different phases of periodontitis onset and progression and may also lead to the development of new clinical approaches for the diagnosis and monitoring of periodontitis patients. 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. For example, an elderly patient may report taking furosemide (Lasix) and digoxin (Lanoxin) for a blood pressure problem. Patient with periodontal disease SYSTEMIC PHASE AND PERIODONTAL DIAGNOSIS EVALUATION PPD ≤ 4 mm FMPS ≤ 20% BOP ≤ 20% TO CHECK Oral hygiene Tobacco consumption Periodontal status Furcation involvement X-ray status General health (systemic diseases, e.g. Dialysis patients receive the drug heparin during dialysis treatment to prevent coagulation of blood in the dialysis machine. This has resulted in controversy as to the role of systemic antibiotics in the treatment of periodontal diseases. The systemic use of metronidazole and amoxicillin, when used in conjunction with initial periodontal treatment in adult patients with periodontitis, achieves significantly better clinical and microbiological results than initial periodontal treatment alone. stream endobj Treatment allocation included a process of minimisation in terms of diabetes onset, smoking status, sex, and periodontitis severity. The service also discharges a professional responsibility that is inherent in the practice of dentistry as a health care profession. 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. The administrative assistant should be alert to the health status of every patient entering the office. The In Clinical Practice box addresses how to improve the accuracy of health questionnaires. The patients were randomly allocated to one of the two test and control treatment groups. These include allergies or reactions to drugs such as penicillin, erythromycin, aspirin, NSAIDS, codeine, and other narcotics. Occasionally the patient may be taking drugs for conditions not originally identified on the health questionnaire. Any dental emergency is treated first to achieve patient comfort. of the systemic antibiotics in the treatment of periodontitis. Through this analysis, the dentist determines whether altering, limiting, or even postponing dental treatment will be necessary. Haffajee AD, Torresyap G, Socransky S. Clinical changes following four different periodontal therapies for the treatment of chronic periodontitis: one-year results. • The long term success of periodontal treatment depends on maintaining the results achieved with phase1. A “periodontal pocket” of localized infection develops between the tooth and gum. the treatment are the same as for chronic periodontitis: reducing or eliminating the bacterial load and the contributory risk factors, in addition to regenerating the attachment apparatus as soon as possible. Low blood pressure measurements (<60 mm Hg, diastolic) may be seen in some individuals, but such measurements usually are not significant unless the patient has other health problems or reports symptoms of light-headedness and fainting. The patient’s systemic health is a critical issue for the increasing numbers of dentists practicing in hospital settings. This phase aims to reduce and eliminate any gingival inflammation by removing dental plaque , calculus (dental) , restoration of tooth decay and correction of defective restoration as these all contribute to gingival inflammation, also known as gingivitis . cause-related therapy • Corrective phase of therapy, i.e. Conclusion: Phase I (mechanotherapy) - the first step in treatment of periodontitis leads to transient bacteremia by systemic dispersal of bacteria harbored in dental plaque. The dentist must be aware of the pathophysiology of all the patient’s health problems and the implications that each alone, and in combination, will have for the delivery of dental care. The dentist may detect signs of disease by a systematic evaluation of the patient’s vital signs and overall appearance, including a careful examination of the orofacial structures. To determine the impact of periodontal treatment on systemic markers of inflammation in patients with metabolic syndrome (MetS) and periodontitis. Treatment of aggressive periodontal disease with systemic antibiotics. Gomi et al 2007: Azithromycin (500) SRP: PCR: Severe chronic periodontitis: 3 ����ӆ�F��o4� Repeated high blood pressure readings may signify hypertension, a disease that can lead to such serious health problems as heart failure, stroke, and kidney failure. Nutritional supplements, and swelling form may actually be functionally illiterate and unable to read the.! 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