The dentist is primarily concerned when the patient has high blood pressure. First, the patient may accidentally or intentionally fail to report a significant health problem when completing the health questionnaire. Some patients are sensitive to latex products and others to certain metals in dental restorations. Systematic reviews and studies that evaluated subjects with systemic diseases and those that used subantimicrobial doses of antibiotics were excluded. The classification of blood pressure in adults is listed in Table 5-2. • Systemic phase of therapy including smoking counseling • Initial (or hygiene) phase of periodontal therapy, i.e. Systemic Biomarkers in 2-Phase Antibiotic Periodontal Treatment: A Randomized Clinical Trial. More recently, probiotics has also been suggested as a promising adjunctive treatment for periodontitis due to their antimicrobial and anti … Certain habits, such as tobacco use, alcohol consumption, and substance abuse, can influence both systemic and oral health. 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. The primary outcomes assessed were differences in clinical changes in periodontal pocket depth and clinical attachment loss at all … Prevention. • The long term success of periodontal treatment depends on maintaining the results achieved with phase1. 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. American Society of Anesthesiologists (ASA) Physical Status Classification With Examples. 2 0 obj If, for example, the patient has signs or symptoms suggestive of hypertension, diabetes, hyperthyroidism, or cancer, further investigation is warranted. So, the phases of treatment plan are, Emergency phase. Many medications reduce the volume of saliva produced and predispose the patient to increased risk of caries, periodontal disease, and mucosal diseases. For those patients who are immunocompromised because of systemic disease or because of immunosuppressive drugs, untreated periodontal disease, deep carious lesions, and pathologic periapical conditions represent potential sources for serious, even life-threatening, infections. Phases of treatment plan. The Systemic Phase of Treatment. Slots J. For example, aspirin or anticoagulant drugs may promote excessive bleeding during periodontal or oral surgical procedures. �RW.Lk�ؚ*?���_'����������!�U�mX��ڞ��Ъ�8���vNg}����Xي����r~��.�j��e���g���q~e��Kk���4�T�&��\�5�3^z�q��� Several of these systemic therapies are discussed in the next section. Photo Credit: enot-poloskun / iStock / Getty Images Plus. When medical or surgical procedures are part of a patient’s history, the dentist will want to know whether such complications as excessive bleeding and pain, poor healing, or adverse reactions to drugs occurred during treatment. 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. Occasionally the patient may be taking drugs for conditions not originally identified on the health questionnaire. All drugs should be carefully documented and monitored, including prescription drugs, over-the-counter products, health and nutritional supplements, and herbal medicines. 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. This has resulted in controversy as to the role of systemic antibiotics in the treatment of periodontal diseases. endobj 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. Once the symptoms or signs of systemic disease are recognized, the dentist is responsible for making a timely referral to an appropriate medical colleague so that treatment can be undertaken. [42] The administrative assistant should be alert to the health status of every patient entering the office. We conducted a systematic review of reviews that studied the effect of nonsurgical periodontal treatment on systemic disease outcomes. The dentist and staff will want to avoid obtaining blood pressure measurements or placing IV medications in this arm. 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 . J Clinical Periodontology 2007; 34:243-253. December 2007; DOI: 10.1016/B978-0-323 -03697-9.50009-0. In addition, periodontal treatment may have a positive effect on glycemic control in diabetic patients [7, 8]. This information should corroborate findings from the health questionnaire and provide some insight into the severity of a particular disease. J Dent Res. The test group received quadrant periodontal flap surgery as required. It is important to note, however, that the dentist has a professional responsibility to share all reasonable treatment options with any patient, regardless of age, physical condition, or financial status. 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. Background: The combination of systemic metronidazole (MTZ) and amoxicillin (AMX) with scaling and root planing (SRP) has shown to be an effective periodontal treatment. 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. To determine the impact of periodontal treatment on systemic markers of inflammation in patients with metabolic syndrome (MetS) and periodontitis. The association of scaling and root planing (SRP) with systemic metronidazole (MTZ) and amoxicillin (AMX) has been advocated as one of the most promising therapeutic protocol for the treatment of advanced periodontitis, since the early 2000's. 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. 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�� [email protected]����H���. Any dental emergency is treated first to achieve patient comfort. 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. 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. After examining the health questionnaire and medication list, the dentist needs to interview the patient. In book: Treatment Planning in Dentistry (pp.91-111) Authors: Stephen J. Stefanac. Systematic reviews and studies that evaluated subjects with systemic diseases and those that used subantimicrobial doses of antibiotics were excluded. 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. 12. Other types of medical emergencies seen in dentistry include allergic reactions to drugs and dental materials, chest pain, seizures, and difficulty breathing. Gomi et al 2007: Azithromycin (500) SRP: PCR: Severe chronic periodontitis: 3 The American Society of Anesthesiologists (ASA) has adopted a widely used classification system for estimating patient risk status (Table 5-1). Number of times cited according to CrossRef: 19. Some patients may believe that information about their general health has no relevance to receiving dental treatment or that the questionnaire takes too much time to complete. 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 pulse rate can be measured either manually or automatically with an electronic blood pressure cuff. Still others may not fully understand a health question, answering it incorrectly. Well-controlled diabetes, controlled hypertension, history of asthma, mild obesity, pregnancy, smoker, extreme anxiety or fear towards dentistry, A patient with moderate to severe systemic disease that limits activity but is not incapacitating; the patient can walk up one flight of stairs or two level city blocks, but stops at times because of distress, Stable angina, postmyocardial infarction, poorly controlled hypertension, symptomatic respiratory disease, massive obesity, A patient with severe systemic disease that is life threatening; the patient is unable to walk up a flight of stairs or two level city blocks; patient is in distress at rest, Unstable angina, liver failure, severe congestive heart failure, or end-stage renal disease. The service also discharges a professional responsibility that is inherent in the practice of dentistry as a health care profession. 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. 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. The practitioner has two tools available to assist in this endeavor: (1) a thorough review of the general health history and (2) an examination of the patient for signs of systemic disease. On the other hand, a healthy patient who had syphilis 30 years ago and was treated promptly with antibiotics is probably not at risk for systemic complications during dental treatment. The tooth becomes loose as the disease progresses, and may even lead to extraction. Beside the previously mentioned study (Novak et al 1987), that almost exclusively relied on systemic antibiotics, Slots and colleagues (Slots and Rosling 1983) described the clinical and microbiological changes of patient diagnosed with juvenile form of periodontal disease (today would be classified as aggressive) … 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. �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[email protected]�l��2�[oo�*z >2�HX� <> The effect of systemic antibiotics in the treatment of patients with recurrent periodontitis. The patient is able to walk up a flight of stairs or two level city blocks without difficulty. endobj 4 0 obj Few systemic medications are associated with increased loss of periodontal tissue, and these are typically medications used in the treatment of malignancies. How severe are the reported health problems? This patient may require a multifaceted systemic phase of care that includes consultation with the patient’s physician and pharmacist, laboratory testing, possible modification of dental treatment, and careful monitoring of the patient’s health before, during, and after each dental visit. An Initial periodontal phase of treatment: with oral hygiene instructions followed by periodontal debridement combined with adjunct antimicrobials. 2001;28:411–418. When treating periodontal disease, there will be three phases of treatment that your dentist will take you through. 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). The competent practitioner will be attentive to changes in the patient’s appearance or general health at each dental visit. J Periodontolgy #2004; 75:1553-1565. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Phases of treatment plan. cause-related therapy • Corrective phase of therapy, i.e. 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. In addition, and of at least equal importance, the dentist also needs to discover, investigate, and document any previously undiagnosed health problems. 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. 11. Step 1. The non-surgical phase is the initial phase in the sequence of procedures required for periodontal treatment. Patients with immune system deficiencies, poorly controlled diabetes, or kidney failure may be more susceptible to postoperative infection, and consequently, will experience more severe pain and swelling. 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. 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). However, some essential issues such as the ideal time of their administration during periodontal therapy remain unanswered. The dentist is most interested in avoiding reactions to materials commonly used in dentistry. An advantage of manual measurement, typically obtained by palpating the radial artery, is that the character of the pulse in terms of regularity and strength can also be detected. 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