The “New” Periodontal Disease: navigate the emerging solutions


By Maria Perno Goldie, RDH, MS

This is a course that I presented at the 2011 RDH Under One Roof Meeting with Casey Hein, BSDH, MBA, and Samuel Lowe, DDS, MS, M.Ed. This year we will present at the 2012 ADHA Center for Lifelong Learning, with a slight change in presenters. Casey Hein, BSDH, MBA, and Marie Schweinebraten, DMD, are my colleagues in the didactic and hands-on course. We examined the comments from the 2011 sessions and attempted to make the courses even better!

How do we keep up with the science regarding periodontal treatment? Common issues for clinicians are: How is periodontal status described in terms of disease severity and extent? How has periodontal status changed over time? Has it improved? Has it worsened? Has it remained stable? Did periodontal status improve following treatment? Was the treatment successful?

Periodontal disease severity is typically determined from pocket depth and bone level in a clinical practice setting. AAP Description of Severity is: Slight: CAL* 1-2 mm; Moderate: CAL 3-4 mm; Severe: CAL ≥5 mm; Extent: Localized: ≤30% of sites; And Generalized: >30% of sites. In clinical practice, periodontal charting is not consistently performed in general practices. Pocket depth rather than clinical attachment level (CAL) is measured. 168 pocket depth measurements are needed for a 28-tooth dentition, and radiographs are also utilized for diagnosis.

So how do we know what to do in our practices? We can be guided by the Standards For Clinical Dental Hygiene Practice. (1) One hallmark of a true profession is its willingness to assume responsibility for the quality of care that its members provide. In 1985, the ADHA took a major step toward fulfillment of that responsibility with the development of Applied Standards of Clinical Dental Hygiene Practice.(1)

This document builds on those Standards and promotes dental hygiene practice based on current and relevant scientific evidence.(2) The primary purpose of the Standards for Clinical Dental Hygiene Practice (the Standards) is to assist dental hygiene clinicians in the provider-patient relationship. In addition, dental hygienists employed in other professional roles such as educator, researcher, advocate, and administrator/manager can use these Standards to facilitate the implementation of collaborative, patient centered care in multidisciplinary teams of health professionals.

This collaboration can occur in a variety of practice settings including community and public health centers, hospitals, school-based programs, long-term care facilities, outreach and home care programs. The Standards outline the expectations of the professional role within which dental hygienists should practice. They promote the knowledge, attitudes, beliefs, practices and behaviors that support and enhance oral health with the ultimate goal of improving overall health.

The secondary purpose is to educate other healthcare providers, policy makers, and the public about the clinical practice of dental hygiene. They provide a framework for clinical practice that focuses the provision of patient-centered comprehensive care.

Other resources are also available to assist us in rendering evidenced based care. The Parameter on Comprehensive Periodontal Examination is one such resource.(3) Another is Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology. It sets forth the scope, objective, and procedures that constitute periodontal therapy.(4) And yet another is the Parameter on Periodontal Maintenance.(5)

Regarding dental implant maintenance, the Consensus of the Seventh European Workshop on Periodontology offers comprehensive information. From understanding the cellular and molecular mechanisms of host-microbial interactions to treatment of peri-implant infections, there is a wealth of information at our fingertips.(6,7,8,9)

We also have a variety of implant maintenance devices and instruments, such as PerioWise from Premier Dental and Hu-Friedy’s Implant Maintenance Instrument system.(10,11)

As well, there are a variety of publications available to assist us.(12,13) Keeping up with the latest research will help us to be better clinicians and render optimal care to our patients.

References
1. Standard of Applied Dental Hygiene Practice. Chicago, Ill. American Dental Hygienists’ Association. 2008. http://www.adha.org/downloads/adha_standards08.pdf.
2. Standard of Applied Dental Hygiene Practice. Chicago, Ill. American Dental Hygienists’ Association. 1985.
3. The Parameter on Comprehensive Periodontal Examination. J Periodontol 2000; 71:847-848. http://www.perio.org/resources-products/pdf/847.pdf.
4. Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology. J Periodontol; July 2011, 943-949. http://www.perio.org/resources-products/pdf/periodontal-therapy_statement.pdf.
5. Parameter on Periodontal Maintenance. J Periodontol 2000; 71:849-850. http://www.perio.org/resources-products/pdf/849.pdf.
6. Sanz M and van Winkelhoff AJ, on Behalf of Working Group 1 of the Seventh European Workshop on Periodontology. Periodontal infections: understanding the complexity – Consensus of the Seventh European Workshop on Periodontology. Journal of Clinical Periodontology. Special Issue: Proceedings of the 7th European Workshop on Periodontology, Volume 38, Issue Supplement s11, pages 3–6, March 2011.
7. Kinane DF, Preshaw PM, and Loos BG on Behalf of Working Group 2 of the Seventh European Workshop on Periodontology. Host-response: understanding the cellular and molecular mechanisms of host-microbial interactions – Consensus of the Seventh European Workshop on Periodontology. Journal of Clinical Periodontology. Special Issue: Proceedings of the 7th European Workshop on Periodontology, Volume 38, Issue Supplement s11, pages 44–48, March 2011.
8. Tonetti, MS and Chapple ILC on Behalf of Working Group 3 of the Seventh European Workshop on Periodontology. Biological approaches to the development of novel periodontal therapies – Consensus of the Seventh European Workshop on Periodontology. Journal of Clinical Periodontology. Special Issue: Proceedings of the 7th European Workshop on Periodontology, Volume 38, Issue Supplement s11, pages 114–118, March 2011.
9. Lang NP and Berglundh T on Behalf of Working Group 4 of the Seventh European Workshop on Periodontology: Periimplant diseases: where are we now? – Consensus of the Seventh European Workshop on Periodontology. J Clin Periodontol 2011; 38 (Suppl. 11): 178–181.
10. www.periowise.com/.
11. http://www.hu-friedy.com/resource/viewResource.aspx?ResourceID=144.
12. http://www.ineedce.com/coursereview.aspx?url=1881%2fPDF%2fImplant+Maintenace+Therapy.pdf.pdf&scid=14300.
13. http://onlinelibrary.wiley.com/doi/10.1111/cid.2010.12.issue-s1/issuetoc.

Maria Perno Goldie, RDH, MS

http://www.dentistryiq.com/articles/2012/06/the-new-periodontal-disease-navigate-the-emerging-solutions.html

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About ebdentalgroup

Director & Dentist of East Bentleigh Dental Group
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