Prevention and Monitoring of periodontal disease.pptx

Prevention and Monitoring of periodontal disease

1. PERIODONTAL DISEASE PREVENTION AND MONITORING Group B Euro Undisa Keziah Mwangi Kituzi Emmanuel

2. Contents:

3. Introduction: Periodontal health across the human lifespan is a key component of oral health and an important component of general health and well-being for individuals and the population as a whole. Periodontitis affects more than 50% of the adult population and its severe forms affect 11% of adults, making severe periodontitis the 6th most prevalent disease of mankind. Such a high burden of disease and its social, oral and systemic consequences are compelling reasons for increased attention from individuals, professionals and public health officials.

4. Prevention: Prevention of periodontal disease encompasses a set of various actions which ultimately aim at preventing or controlling the disease. It may apply to any point of the disease process.

5. Objectives of prevention: To promote optimum health of periodontium To prevent initial lesions To intercept hard and soft tissue lesions already in progress in order to restore health and prevent further damage

6. Traditional approach:

7. Today’s approach:

8. Prevention in practice – forming a bridge to the patient: The strategy for the prevention at the patient level has to be global and comprehensive. Preventive interventions should be oriented towards influencing patient behavior.

9. Motivational interviewing: Motivational interviewing may be a useful tool for the clinician to assist the patient to adopt proper health behaviors (primary prevention) or to modify lifestyle and inappropriate behaviors (secondary and tertiary prevention). Motivational interviewing has been defined as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence”. Motivational interviewing is designed as a brief, nonconfrontational, counseling method.

10. Preventive strategies :

11. Levels of prevention:

12. Levels of prevention:

13. Primary prevention

14. Health promotion: It is process of enabling people to increase control over and to improve health. It is not directed against any particular disease, but is intended to strengthen host through a variety of approaches like- a. Health education b. Nutritional intervention c. Environmental modification d. Lifestyle and behavior changes

15. Health education: Health education is fundamentally a learning process, which aims at favorable changing attitudes and influencing behavior with respect for health practices. Health education is vital for prevention. It is the channel for reaching the people and alerting them to the doctor’s services and to all other community health resources. True health education is an active process that involves changed behaviour. It can help to increase knowledge and to reinforce desired behaviour patterns

16. Educational aids:

17. Methods of health communication: Individual: Personal contact Home visits Personal letters Group: Lectures Demonstrations Discussions Mass approach: radio, television, posters, internet, printed material, direct mailing, posters, health museums and exhibition s and folk methods

18. Specific protection: To avoid disease altogether is the ideal but this possible only in a limited number of cases. The following are some of the currently available intervention aimed at specific protection – a. Immunization b. Chemoprophylaxis c. Protection against occupational hazards d. Use of specific nutrients

19. Disclosing agents: Disclosing agents can be used in oral health prevention programs, both for more effective guidance on the use of oral hygiene tools and for their evaluation. Nepale et al. studied the role of disclosing agents in asseing patient compliance through a prospective study and concluded that it improves the quality of daily oral hygiene practice and home care study by lee et al in 2018 concluded that the correlations between the plaque indices measured for each tooth surface area using QLF-D and the clinical indices assessed were significantly high, and it allowed objective determination of the gingival status

20. Primary Prevention : Patient level: Oral hygiene practices. Habits Diet Dentist level: Professional mechanical plaque removal Patient education and motivation.

21. No smoking strategies: Meta-analyses reported that the degree of success was related to the length of the intervention, with rates of 13.4% for brief intervention and 22.1% for intensive intervention

22. Diet recommendations of 2011 European workshop on Periodontology

23. Role of health care professional:

24. Professional mechanical plaque removal: One of the most commonly performed preventive measures in adults in countries with organized dental services is professional mechanical plaque removal (PMPR), with or without concomitant oral hygiene instructions (OHI). PMPR comprises supra-gingival and sub-marginal plaque and calculus removal using hand instruments (scalers, curettes), or powered instruments (sonic, ultrasonic, rotating devices, air polishing). The intention is to remove deposits from the tooth surface, extending into the gingival sulcus. This is done to allow adequate patient-performed oral hygiene

25. Correction of malaligned teeth: primary prevention also includes the correction of mal aligned teeth.

26. Secondary prevention

27. Secondary prevention: It includes early diagnosis and prompt treatment. Regular PMPR with respect to secondary prevention. Life-long individualized supportive periodontal care based through an efficient recall system may be necessary, in order to establish the prerequisites for secondary prevention. Risk assessment tools may help to group patients in different risk levels, and predict the probability of disease recurrence, yet until today their clinical benefits have not been proven at an individual level

28. Early diagnosis: The first two aspects of prevention, prevention of occurrence and prevention of progression, are closely linked. In order to evaluate the effectiveness of prevention or to determine the need for more aggressive measures, early recognition of disease patterns is necessary. Signs and symptoms of disease- One of the most reliable clinical signs of gingival inflammation remains the bleeding response of the gingiva following gentle probing. While bleeding on probing has approximately a 30% predictive power for future loss of attachment, the negative predictive power of 98% makes bleeding following probing a very useful tool

29. Diagnostic tools:

30. Periodontal screening and recording: Developed by American academy of periodontology. By following the recommendations of the Periodontal Screening and Recording system, the practitioner can focus on those areas that begin to present evidence of inflammation and follow the progress of therapy to completion.

31. PMPR Regular PMPR with respect to secondary prevention includes the same measures as in primary prevention accompanied by evaluation of oral hygiene, and if necessary reinforced OHI. It also encompasses subgingival debridement to the depth of periodontal pocket. Repeated periodontal examinations of residual pockets are necessary for the early detection of deepening pockets (probing depth ≥ 5 mm) that require active therapy. At each appointment, patients should be educated about a healthy lifestyle and smoking cessation45,46.

32. Risk assessment tools: Different individuals demonstrate varying susceptibility to onset and progression of periodontitis ( Loe et al. 1986). It is important to note that in general, prediction tools based on risk factors allow the grouping of patients according to different levels of average risk, they do not however allow the accurate prediction of individual patient outcomes (prognosis). Previous literature shows that risk factors and combinations thereof typically have poor performance for individual risk prediction (Wald et al. 1999, 2005). Nonetheless, the provision of patient care guided by the assessment of patient level risk for the progression of periodontitis may be an advantageous approach for the individual patient ( Rosling et al. 2001).

33. Tertiary prevention: It includes mainly disability limitation and rehabilitation . Supportive periodontal therapy can be a part of tertiary prevention. Disability limitation is mainly directed at reduction of infection, resolution of inflammation, reduction of tooth mobility and prevention of tooth loss. These measures include- Deep curettage. Root planing Splinting Mucogingival and periodontal surgery including crown lengthening procedures, gingivoplasty , osseous recountering , ostectomy and treatment of furcation involvement and root amputation. Cosmetic procedures such as ridge augmentation, subepithelial connective tissue or free gingival grafts and lateral repositioning or pedicle grafts. Regenerative therapies including osseous grafting, GTR growth factors, enamel matrix proteins, etc. Endodontic therapy Selective extractions.

34. Newer trends in treatment : 1. Extracorporeal shock wave therapy 2. Photodynamic therapy 3. Electrical stimulation on osteogenesis of alveolar bone 4. Ultrasonic vibrations 5. Biofilms and bioelectric effect 6. Control of subgingival biofilm with fine grain glycine powder polishing 7. Hyperbaric oxygen therapy 8. Topical and systemic administration of simvastatins . 9. Local and systemic use of bisphosphonates   10. Use of Teriparatide 11. Use of antibiotics as monotherapy 12. Use of herbs, fruits, flowers, foods to resolve inflammation and improve regeneration 13. Gene therapy 14. Use of stem cells 15. Nanotechnology 16. Use of newer molecules to resolve inflammation 17. Therapeutic approaches recently available to control inflammation and bone resorption.

35. Supportive periodontal therapy: Compliance with suggested supportive periodontal treatment schedules. The first study on the degree of compliance with supportive periodontal treatment was published in 1984 (Wilson et al). It reviewed all the patients whose progress could be followed after treatment for periodontitis in a private periodontal office of approximate 1000 patients followed for up to 8 years, only 16% complied with suggested SPT intervals, 34% never came back for maintenance, and the rest complied erratically. In a follow up study for 5 years, the tooth loss was surveyed (non-compliers were not included). Tooth loss frequency was zero teeth per year for complete compliers and 0.06 teeth per patient per year for erratic compliers.

36. Classification of post-treatment patients The first year after periodontal therapy is important in terms of indoctrinating the patients in a recall pattern and reinforcing oral hygiene techniques. Patients who are on a periodontal recall schedule are a varied group and they can improve or may relapse to a different classification, with a reduction in or exacerbation of the disease. Maintenance patients are categorized into classes according to Merin’s classification into classes A, B and C.

37. Rehabilitation:

38. Compliance:

39. Types of Non Compliance 1. Receiving a prescription but not filling it. 2. Taking an incorrect dose. 3. Taking medication at the wrong times. 4. Increasing or decreasing the frequency of doses. 5. Stopping the treatment too soon. 6. Delaying in seeking healthcare.. 7. Non-participation in clinic visits 8. Failure to follow the doctor's instructions. 9. “Drug holidays”, which means the patient stops the therapy for a while and then restarts the therapy. 10. “White-coat compliance”, which means patients are compliant to the medication regimen around the time of clinic appointments.

40. Compliance in periodontics: Strack et al. found that 51% of patients given oral hygiene instructions were in the “high compliant” group; 38% were “moderately compliant,” and 11% “noncompliant” 30 days after instruction. In some surveys the use of a disclosing agent erythrosin was found helpful in improving the efficacy of plaque removal. The use of mechanical toothbrushes has shown an increase of efficiency (decreased Plaque Index score) of 10% in one study. Other groups have suggested that the patients’ beliefs about their health significantly affect compliance or the lack thereof. Stressful life events may also reduce compliance.

41. Why do patients fail to comply?

42. Methods of improving compliance:

43. Conclusion:

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47. Thank you