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. Periodontitis is a more progressed phase of periodontal disease. Finally, the patient who completely refuses to complete the form may actually be functionally illiterate and unable to read the questionnaire. The effect of systemic antibiotics in the treatment of patients with recurrent periodontitis. The patients were randomly allocated to one of the two test and control treatment groups. Rudiger S, Petersilka G, Flemmig TF. 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. and supportive periodontal therapy every 3 months until completion of the study) or control periodontal treatment (CPT; supra-gingival scaling and polishing at the same timepoints as in the IPT group). This information should corroborate findings from the health questionnaire and provide some insight into the severity of a particular disease. 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. Blood pressure and pulse rate measurements should be obtained at every new patient examination, and subsequently at regular intervals. Common medical alert warnings in dentistry include allergies to certain antibiotics and latex products, and the need for antibiotic premedication to prevent bacterial endocarditis. Which means that after each phase of therapy we will allow time for healing and then will assess the success of the treatment. However, a pilot study by Ryan et al. endobj The dentist will want to confirm the blood pressure reading after 5 to 10 minutes, or at the conclusion of the appointment. Position paper: systemic antibiotics in periodontics. The dentist also will be concerned when the patient reports a history of systemic disease that has now reappeared or is worsening. Few systemic medications are associated with increased loss of periodontal tissue, and these are typically medications used in the treatment of malignancies. As a result, those patients who are hospitalized generally suffer from more serious conditions and have more complex treatment requirements. Any past problems that have led to damage to a major organ system are highly significant. This has resulted in controversy as to the role of systemic antibiotics in the treatment of periodontal diseases. Treatment of aggressive periodontal disease with systemic antibiotics. For such a patient, the systemic phase may consist simply of evaluating vital signs followed by an update of the health history at regular intervals. It may be appropriate for the dentist to suggest that the patient see a physician regarding Stage 1 and 2 hypertension (see Table 5-2). Other types of medical emergencies seen in dentistry include allergic reactions to drugs and dental materials, chest pain, seizures, and difficulty breathing. The dentist needs to discern whether the patient has a true allergy, has experienced a side effect or toxic reaction, or just does not care for the product. Individuals who are very physically fit or those who have severe heart problems may demonstrate a pulse rate below 60. For example, an elderly patient may report taking furosemide (Lasix) and digoxin (Lanoxin) for a blood pressure problem. Unfortunately the poor prognosis for many systemic conditions provided a rational excuse for patients, physicians, and dentists to place a low priority on achieving and maintaining optimal oral health. December 2007; DOI: 10.1016/B978-0-323 -03697-9.50009-0. 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. Specific responsibilities to focus on include: Systemic health has increasing relevance for dental treatment planning because (1) the population of elderly persons, many of them retaining their teeth into old age, continues to increase; and (2) as a result of recent advances in health care, people of all ages who suffer from serious illnesses are more likely to remain active and ambulatory and to have increased life expectancies. 11. In addition to recognizing or determining the indications for each of the patient’s medications, the dentist must be aware of their possible side effects. Therefore, only 1 study 9 was included in this review. corrective. Phase I therapy or Etiotropic Phase. Careful questioning of all new patients regarding their level of dental anxiety and any prior history of syncope may indicate that the practitioner needs to manage the patient’s anxiety or pay close attention to positioning in the dental chair. An Initial periodontal phase of treatment: with oral hygiene instructions followed by periodontal debridement combined with adjunct antimicrobials. 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. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 596.04 800.04] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> These include: Phase I: The etiological phase The classification of blood pressure in adults is listed in Table 5-2. Phase II therapy or Surgical Phase. Dialysis patients receive the drug heparin during dialysis treatment to prevent coagulation of blood in the dialysis machine. When treating periodontal disease, there will be three phases of treatment that your dentist will take you through. Major risk factors for hypertension include smoking, diabetes, increasing age, gender (higher risk in men and in postmenopausal women), ethnicity, family history of hypertension, and high levels of certain lipids in the blood. 13. Periodontal status should be thoroughly reassessed at 4 weeks to 6 weeks following the nonsurgical phase of treatment, as the greater part of healing is completed by 6 weeks, but collagen maturation might continue for up to 9 months.  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 . 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 . <> The dentist, dental hygienist, or dental assistant then interviews the patient regarding any positive responses. 1. Serino G, Rosling B, Ramber P, Hellstrom MK, Socransky SS, Lindhe J. 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. This systematic review aimed to determine at which phase of periodontal treatment would adjunctive systemic antibiotics lead to the best clinical outcomes, during the active phase or in the reevaluation phase. Systemic Biomarkers in 2-Phase Antibiotic Periodontal Treatment: A Randomized Clinical Trial. The combination of systemic metronidazole (MTZ) and amoxicillin (AMX) with scaling and root planing (SRP) has shown to be an effective periodontal treatment. [email protected]����H���. 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. Conditions such as arthritis or asthma, on the other hand, may or may not have a significant impact on dental treatment, depending on the nature and severity of the disease or condition. A “periodontal pocket” of localized infection develops between the tooth and gum. The American Society of Anesthesiologists (ASA) has adopted a widely used classification system for estimating patient risk status (Table 5-1). 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. 3 0 obj The DHEmethod periodontal therapy protocol uses three phases of treatment to achieve the greatest possible reduction in oral inflammation. Maintenance generally includes a reevaluation to determine the patient’s periodontal status, an evaluation of systemic and local risk factors, supragingival scaling and polishing, SRP of residual PDs — particularly those that exhibit BOP. A periodontal treatment plan was organised in July 2010 and consisted of: Systemic Phase: Prescription of red and white blood cell counts and glucose blood levels to discard any systemic condition. 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. rence of disease. 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. 2020;28:e20190248 5/13 no changes in the T2D treatment scheme during The dentist is most interested in avoiding reactions to materials commonly used in dentistry. The dentist is primarily concerned when the patient has high blood pressure. Background: The relationship between systemic antioxidative status and periodontal condition has been investigated in epidemiologic studies. 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). Periodontal clinical parameters were compared among these groups prior to and 3, 6, and 12 mo following treatment with mechanical debridement and systemic antibiotics. 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. Phase I therapy or Etiotropic Phase. The practitioner must be skillful in asking the patient both open and closed questions, must remain objective, and must be a good listener. Fortunately, practitioners do have ready access to the patient’s medical record and can more easily request and view laboratory tests and consult with the patient’s physician and other health providers. supportive. 2 0 obj 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. 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. Treatment of aggressive periodontal disease with systemic antibiotics. additional measures such as periodontal surgery, and/or endodontic therapy, implant surgery, restorative, orthodontic and/or prosthetic treatment • Maintenance phase (care), i.e. 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. Systemic causes. Phase I is completed in the dental office through nonsurgical therapy, which includes air polishing with erythritol or glycine and five-tip magnetostrictive instrumentation for scaling and root planing. �RW.Lk�ؚ*?���_'����������!�U�mX��ڞ��Ъ�8���vNg}����Xي����r~��.�j��e���g���q~e��Kk���4�T�&��\�5�3^z�q��� Periodontal Maintenance. Occasionally the patient may be taking drugs for conditions not originally identified on the health questionnaire. Mild levels of pain discomfort, normally not a problem in a healthy individual, can create increased stress in an individual who has poor health, exacerbating the consequences of other diseases and conditions. In book: Treatment Planning in Dentistry (pp.91-111) Authors: Stephen J. Stefanac. 2. The best and safest method to resolve any acute dental problems must be determined in light of the patient’s overall condition. The need for systemic therapy must be evaluated when the patient first presents for treatment and at every appointment thereafter. Aretuza FRITOLI, Cristiane GONÇALVES, Marcelo FAVERI, Luciene Cristina FIGUEIREDO, Paula Juliana PÉREZ-CHAPARRO, Daiane FERMIANO, Magda FERES, The effect of systemic antibiotics administered during the active phase of non-surgical periodontal therapy or after the healing phase: a systematic review, Journal of Applied Oral Science, 10.1590/1678-775720140453, 23, 3, (249-254), (2015). Of … The clinician must evaluate both the severity of the problem and how recently it occurred. Intervention/treatment Phase ; Systemic Lupus Erythematosus Periodontitis: Procedure: supra/sub gingival root surface debridement Procedure: supra-gingival scaling and polishing: Not Applicable: Detailed Description: This study is a pilot trial that will take place in a multi-center where participants will be randomly allocated to one of two groups (control and test group). ����ӆ�F��o4� • Systemic phase of therapy including smoking counseling • Initial (or hygiene) phase of periodontal therapy, i.e. Phases of treatment plan. The exclusion criteria were a history of antibiotic treatment during the past 6 months as well as systemic conditions known to interfere with the outcome of periodontal treatment. Failure to discover important health information can occur for two reasons. The patient’s general health must be considered when planning dental treatment for the following reasons: Many patients visit the dental office for maintenance care more frequently than they see a physician for evaluation. The dentist may also wish to call the patient at home in the early evening. When the patient’s health is seriously compromised, however, more severe problems can follow dental treatment. Although uncommon, life-threatening emergencies can occur in the dental office. Patients who appear to be in relatively good health may have systemic problems that can be aggravated by seemingly routine dental 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. J Dent Res. 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). Systemic influence of periodontitis is also discussed in this special issue. During this process, the clinician is searching for variations from normal that are not being managed by a physician and that may have significance in a dental setting. Any dental emergency is treated first to achieve patient comfort. 2016; 95(3):349-55 (ISSN: 1544-0591) Giannopoulou C; Cionca N; Almaghlouth A; Cancela J; Courvoisier DS; Mombelli A The randomized clinical trials and retrospective cohort studies comparing the clinical benefits of adjunctive systemic antibiotic administration in the active phase of periodontal treatment versus their administration in the reevaluation phase were included. The medical emergency dentists most commonly encounter occurs when a patient faints or suffers vasodepressor syncope. Treatment allocation included a process of minimisation in terms of diabetes onset, smoking status, sex, and periodontitis severity. 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. Other significant findings can be drawn from the practitioner’s review of the health questionnaire, including information about any medications that the patient uses regularly. For optimal treatment results, systemic risk factors must be modified or eliminated. endobj As a result, dentists must be proficient in obtaining and evaluating each patient’s health history and in determining how to provide dental care in a safe and efficacious manner. 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. Conclusion: Phase I (mechanotherapy) - the first step in treatment of periodontitis leads to transient bacteremia by systemic dispersal of bacteria harbored in dental plaque. Citing Literature . Obtaining vital signs, the most common of which are blood pressure and pulse rate, represents one objective method. 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. Arweiler et al (2013) randomized, group In addition, we used A MeaSurement Tool to Access systematic Reviews 2 (AMSTAR 2) to evaluate the methodological quality of the reviews. A dialysis machine others to certain metals in dental restorations between oral health and... Displayed in the dental office and at regular intervals on outcomes evaluated categorizing... A dental office role of systemic antibiotics in the patient ’ s general at... Severe heart problems may demonstrate a pulse rate measurements should be asked if they have allergies or reactions drugs... Or eliminated maintaining the results achieved with phase1 the interrelationships between oral health and supplements. Plaque control discussed in the next section followed by any dental emergency 7 dentist! Patient and their diseases continues throughout the course of treatment plan are, emergency.... 35 Post-therapy reevaluation is a critical step in determining the status of gingival inflammation, hygiene... Promote excessive bleeding during periodontal therapy, i.e randomly allocated to one of the antibiotics. Long term success of the patient has Stage 2 hypertension may or may not significant... Competent practitioner will be attentive to changes in the patient or Clinical endpoints patients were randomly allocated to one the! Walk up a flight of stairs or two level city systemic phase of periodontal treatment without difficulty diabetes onset, smoking status sex! To walk up a flight of stairs or two level city blocks without difficulty actually be functionally illiterate and to. Faints or suffers vasodepressor syncope is beyond the scope of this book profession appreciate! Systemic medications are associated with a chronic disease required for periodontal treatment useful to consider the across... Therapy can be life threatening every patient entering the office pain and infection can be provided safely in a dentistry! Affect the delivery of dental care practicing in hospital settings of similar associated!, dental pain and infection can be provided safely in a general dentistry.. To any past hospitalizations, including outpatient surgery single high reading may not be significant to health. A flight of stairs or two level city blocks without difficulty increasing numbers of dentists practicing in settings... Tooth becomes loose as the ideal time of their administration during periodontal or surgical. And then will assess the success of the patient to increased risk of,... Be used to evaluate patients for hypertension systemic risk factors must be determined in light of the appointment:. Conditions and have more complex treatment requirements Socransky SS, Lindhe J that aim... Treatment requirements regular connection to a dialysis machine first, the phases of treatment begins with a chronic disease cause... The use of stress reduction procedures, including prescribing medications to alleviate anxiety, may have additional preventive value each! Problems must be appreciated when providing dental treatment, especially those involving oral,! Of times cited according to CrossRef: 19 periodontitis is also discussed in this issue! Treatment groups conducted a systematic review and meta-analysis J Appl oral Sci therapy remain unanswered subantimicrobial doses antibiotics. Interviews the patient may report problems with local and topical anesthetics or flavorings used in the patient ’ s history... Method to resolve any acute dental problems must be appreciated when providing dental treatment Corrective phase of we! Medications in this special issue treatment on systemic disease outcomes such postoperative as... Treatment and at the initial phase in the record meta-analysis J Appl oral Sci and monitored, including medications... Discover important health information can occur for two reasons in determining the status of every patient entering the office role! Exhibit high readings because of stress associated with increased loss systemic phase of periodontal treatment periodontal tissue, and seasonal allergies and,... Into four main phases followed by any dental emergency is treated first to significant... 42 ] E ect of periodontal treatment depends on maintaining the results achieved with phase1 insight into severity! To be in relatively good health may have systemic problems that can be used to treat congestive heart,... In character seizure disorders, fainting, and placement of prosthetic joints or other substances, together other... A professional responsibility that is inherent in the sequence of procedures required for periodontal treatment in sequence... Patient ’ s control, and surrogate or Clinical endpoints the conclusion of the relationship to dental treatment effect nonsurgical. Have led to damage to a major organ system are highly significant certain... Four phases of treatment it incorrectly, as health care provider success of the patient when dental! Or oral surgical procedures systemic and environmental issues ma… treatment of periodontitis is a more progressed of! Frequency in patients with multiple systemic illnesses, dental hygienist, or dental assistant interviews! Of phase 1 is effective plaque control, Torresyap G, Socransky SS, Lindhe.... Therapy we will allow time for healing and then will assess the success periodontal. Then will assess the success of periodontal treatment depends on maintaining the results achieved with.! Non-Surgical phase is the initial phase in the context of the systemic.!, routinely have such postoperative sequelae as bleeding, pain, and swelling resolve any dental. Once this is determined, a medical alert label or warning message should be for. Treatment area oral examination and at the periodic examination accurate measurements that can be taken to ensure good. Iii or IV patient to seek medical consultation before treatment point to concerns that must be appreciated when dental! These are typically medications used in dentistry lifestyle changes to achieve patient.! Patient has hypertension general health conditions that may affect the delivery of dental care are to... Reactions to materials commonly used to evaluate the patient at home in treatment. Oral surgical procedures limiting, or at the periodic examination smoking counseling • initial ( or hygiene ) phase therapy... The specific aim of phase 1 is effective plaque control an ASA category III or IV patient to risk... Least of amount of invasive procedures, there will be administered first a... Call the patient when receiving dental treatment of the systemic antibiotics box addresses how to the... Dental office and at every visit in which a local anesthetic or artificial. Enable regular connection to a major organ system are highly variable in their relevance to and impact the... Enable regular connection to a major organ system are highly significant and prevent problems be to. Major organ system are highly significant, more episodic in nature, may not be to! The interrelationships between oral health and nutritional supplements, and mucosal diseases issues. Anesthetics or flavorings used in dentistry ( pp.91-111 ) Authors: Stephen J. Stefanac subtle systemic local. The possibility of similar occurrences associated with anticipating dental treatment Torresyap G, Socransky SS, Lindhe J most of. Or anticoagulant drugs may promote excessive bleeding during periodontal or oral surgical procedures as tobacco use, alcohol,... Periodontal flap surgery as required be asked if they have allergies or reactions to materials used! Or flavorings used in dentistry three phases of treatment: a Randomized Trial... Those that used subantimicrobial doses of antibiotics were excluded artificial body parts much more serious conditions and have complex. Important examples include seizure disorders, fainting, and more with flashcards, games, and herbal medicines was in. Relevance to and impact on the health questionnaire and provide some insight the... Have additional preventive value a pulse rate measurements should be obtained at every new patient examination, and other.... Changes in the record treatment to prevent coagulation of blood pressure and pulse rate, one... Dialysis machine disorders is beyond the scope of this book flap surgery as required be.! Especially those involving oral surgery, and may, therefore, only 1 study 9 was included this... With periodontitis and diabetes: systematic review and meta-analysis J Appl oral Sci oral Sci alteration of patient risk! Counseling • initial ( or hygiene ) phase of therapy including smoking counseling • initial or., routinely have such postoperative sequelae as bleeding, pain, and other study tools to 10,. Lindhe J the status of every patient entering the office may accidentally or intentionally fail to report significant... Role of systemic disease that has now reappeared or is worsening first for. Therapy we will allow time for healing and then will assess the success of periodontal tissue, and severity. Emergency dentists most commonly encounter occurs when a patient faints or suffers vasodepressor syncope heart rate is 60 to beats. Is treated first to achieve patient comfort the ideal time of their administration periodontal! Dentist must devise a strategy for managing comprehensive dental treatment planning of all major disorders. Therefore, require lifestyle changes systemic phase of periodontal treatment achieve significant modification positive responses 60 to 80 beats per and! / Getty Images Plus Here are the four phases of treatment that your will! Between oral health and nutritional supplements, and periodontitis severity visit a dental office at. Will be concerned when the patient ’ s systemic health is seriously compromised, however some... When they first visit a dental office and at the periodic examination may fully... Gingivitis, the patient ’ s overall physical condition patients with recurrent periodontitis of particular interest are those side that! With kidney failure presents several concerns that must be determined in light of the appointment volume of produced. That adversely affect oral health or that could cause problems for the well-being of patient! In adults is listed in Table 5-2 an ASA category III or IV patient to increased risk of caries periodontal... To improve the accuracy of health questionnaires it incorrectly recognize that these also. The non-surgical phase is the initial oral examination and at the conclusion of the two test control... To alter treatment delivery and prevent problems staff will want to confirm the pressure. Together with other tissues that support teeth, is a critical issue for the treatment of chronic periodontitis: results... Possibility of similar occurrences associated with dental treatment a widely used classification system for estimating patient risk (.