Supportive Periodontal Therapy Question And Answers
- The 3rd World Workshop of the American Academy of Periodontology (1989) named the
maintenance phase of periodontal therapy as supportive periodontal therapy (SPT). - Supportive periodontal therapy is an incredibly important facet of total periodontal care. It deals with the follow-up program of the treated periodontal patient.
- The SPT covers the regimen drawn up for those patients who have received the initial phase covering nonsurgical or surgical and/or any other treatment related to rectifying the balance of periodontium in a clinically non-diseased state.
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Question 1. What are the rationale and goals for SPT?
Answer:
- Several studies have shown that tooth loss is inversely proportional to the frequency of maintenance visits and patients who received periodic supportive care exhibited decreased probing depth over a period of ten years.
- Periodontal patients tend to slacken their oral hygiene habits between maintenance visits.
- Hence periodic recall will motivate them to perform better oral hygiene. Regular maintenance program has shown to decrease the incidence of recurrent periodontitis as it reduces the risk of future attachment loss.
Therapeutic Goals
- Eradication of bacteria from the gingival tissues is necessary for a stable periodontal result.
- Scaling and root planing including flap surgery may not eliminate all the subgingival bacteria, which can recolonize the periodontal tissues in 9 to 11 weeks and cause recurrent disease.
- Periodic mechanical instrumentation results in the alteration of the subgingival flora to a healthy type.
- Mechanical debridement and reinforcement of oral hygiene methods at each appointment are necessary to maintain a stable periodontium and minimize the recurrence and progression of periodontal disease following treatment, thus, reducing the incidence of tooth loss.
- It also increases the probability of locating and treating, in a timely manner, other diseases or conditions found within the oral cavity.
Question 2. Write the treatment considerations in SPT.
Answer:
Patients who have been treated for deep pockets and who exhibit a very rapid rate of plaque accumulation need to be kept under constant observation to evaluate the stability of clinical attachment gained following periodontal therapy.
The following items need to be included in a periodontal maintenance visit.
- Review of medical and dental history.
- Clinical examination which is compared with previous baseline measurements.
- Extraoral examination.
- Dental examination (tooth mobility, caries assessment, restorations, etc.).
- Periodontal examination (probing depth, bleeding on probing, exudation, levels of plaque and calculus, evaluation of furcation involvement, gingival recession, occlusal examination, other signs and symptoms of disease activity).
- Examination of Dental implants and peri-implant tissues.
- Radiographic examination.
Assessment:
-
- Assessment of disease status by reviewing the clinical and radiographic examination findings compared with baseline.
- Assessment of personal oral hygiene status.
- It is in the initial appointment that the patient is told about being a partner in the success of the periodontal therapy. At the SPT stage, the performance of the clinician is evaluated with a backdrop of the patients’ involvement of the home care and adherence to the instructions.
- Treatment:
- Removal of subgingival and supragingival plaque and calculus.
- Behavior modification:
- Oral hygiene reinstruction.
- A lot of user-friendly methods for plaque control have to be devised and innovated. An
easy-to-follow mechanical tooth cleansing regimen, backed up by safe and efficacious chemical plaque control measure should be laid out. - An auto-detection (disclosing solution or tablets) and autoregulatory formula has shown good involvement by the patient. This brings us to the level of P and P (patient-professional) treatment option.
- Compliance with suggested periodontal maintenance intervals.
- Counseling on control of risk factors.
- Antimicrobial agents as necessary (mouthwash, local drug delivery, systemic antibiotics)
- Surgical treatment of recurrent disease
- Communication
- Inform the patient of his current periodontal status and if any alterations in treatment is indicated.
- Consultation with other health care practitioners who will provide additional therapy.
- Planning of supportive therapy: For most patients with a history of periodontitis, visits at 3-month intervals are effective in the maintenance of the established gingival health. Based on clinical findings and assessment of disease status, periodontal maintenance frequency may be modified.
Question 3. Describe Merin’s classification of patients for SPT.
Answer:
The recall interval can be modified depending on the class of recall patients.
- Class 1: These patients show excellent results following 1 year follow-up. They display good plaque control, minimal calculus no complicated prosthesis, no remaining pockets. These patients may be recalled at 6 months to 1 year intervals.
- Class 2: These patients show good results for over 1 year but are inconsistent in their oral hygiene, show heavy calculus formation, systemic disease, have some remaining pockets, occlusal problems, positive family history of tooth loss due to periodontal disease, smokers, and bleeding on probing. These patients may be recalled at 3–4 months intervals.
- Class 3: These patients show poor results after periodontal therapy. They demonstrate poor plaque control, many remaining pockets, complicated prostheses, and teeth with less than 50% bone support, smoking and bleeding on probing in 20% of the pockets. Such patients may be put on a 1–3 months recall visit.
Outcome Assessment
- The periodontal health status obtained following active periodontal therapy is maintained:
- Inadequate periodontal maintenance or noncompliance may result in recurrence of the disease.
- Patients may demonstrate recurrence of disease, despite adequate periodontal maintenance and patient compliance.
Conclusion
- Periodontal disease is a chronic disorder, unlike most other chronic illnesses (diabetes, CVD, etc.) requires constant monitoring to ensure maintenance of health.
- As it is very difficult to eliminate the offending etiologic agent (dental plaque) the need for SPT is critical for prevention of reinfection and maintenance of periodontal health.
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