Periodontics for the General Dental Practitioner

Abstract

Transitioning to clinical care can be difficult for the new practitioner. Didactics provide a great breadth of information and scientific studies; however, this chapter aims to condense this information into an easy-to-use guide for clinical use. Using scientific research and clinical experience, the topics of this chapter will guide a new practitioner through one of the most important foundational aspects of oral health. Beginning with classifying periodontal needs and diagnosing periodontal disease, this chapter outlines steps needed in the clinical evaluation of the patient. Risk factors for periodontal disease and practical aspects of non-surgical periodontal instrumentation are discussed. The text addresses decision-making at periodontal re-evaluation, periodontal maintenance and advanced periodontal needs including surgical therapy. Finally, periodontal emergencies such as abscess and necrotizing ulcerative gingivitis are reviewed with recommended treatment options.

Appendix: Oral Hygiene and Smoking Cessation

1.1 Oral Hygiene and Prevention

The most critical part in treatment is educating our patients to control progression of their disease. Refer to Chap. 3 “Caries Prevention for Caries” risk assessment in conjunction with oral hygiene instructions given to patients. Some of the common oral hygiene aids are listed below. Oral hygiene instructions should be customized for every patient in order to address their specific needs.

Oral hygiene aids	Common uses
Dental floss threaders	Helpful when flossing under a bridge and under orthodontic wires while the patient is in braces
Flossers	Floss is already threaded and may be easier to use with patients who lack dexterity
Superfloss	Same uses as a floss threader but conveniently contains a threader and floss as one unit
Soft picks	Can be inserted between teeth and in difficult to reach recesses of the teeth and gums to clean away plaque and food debris
Stim-U-Dent	Balsa wood picks to remove plaque and to gently massage gingival tissues
End-tufted brush	Cleans surfaces not accessible by a toothbrush of floss
Interdental/Proxabrushes	May be used in large embrasure spaces, root furcation areas, orthodontic appliances, and bridges. Interchangeable brushes come in a variety of sizes
Gauze	In large edentulous areas bordered by teeth, gauze can be rolled and used to clean the proximal surfaces of teeth that border these edentulous spaces
Oral irrigator	Oral irrigation unit for flushing debris from the oral cavity and delivering antimicrobial rinses to specific tissues within the mouth. This is not a substitute for flossing

Fig. 13.9

A Selection of hygiene aids used to provide individualized oral hygiene instruction to patients

1.2 Smoking Cessation: The 5 As

There are many resources to assist patients in smoking cessation. For patients and healthcare workers, the Unites States Department of Health and Human Services has a comprehensive website on this topic: http:///www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/index.html.

1.2.1 Ask

• Ask all patients about smoking status and tobacco use and record in the chart. For current smokers, this should be done at every visit.

• Questions: “What do you smoke?” “How many per day?” “How long have you been a smoker?” “How long after waking do you take your first cigarette?” “Have you ever tried to quit?”

1.2.2 Advice

• Advise all smokers to quit.

• Using simple language, explain the oral health effects of tobacco and benefits of quitting.

• For those not ready to quit: advice that you would like to help when patient is willing.

• Provide motivational literature.

1.2.3 Assess

• Assess readiness to quit. Ask the patient simply if they want to quit and record the reply.

• If not, help motivate the patient to quit:

  • Identify patient’s reasons to quit (health, costs, children, etc.). Help build confidence to quit. Make note to ask again at the next visit.

• If yes, provide resources and assist!

1.2.4 Assist

• Reinforce the reasons to quit (patient motivations) and benefits.

• Discuss any past attempts and why patient feels they may have failed.

• Help patient to set a quit date (soon – ideally within 2 weeks). Write this down.

• Recommend patient to utilize a support structure (family/friends/colleagues) and avoid factors that stimulate tobacco use from their environment.

• Provide resources (self-help and information regarding nicotine-replacement therapy).

1.2.5 Arrange

• Review progress at follow-up visits.

• If relapse, review reasons for failure and plan for next quit attempt.

• Refer for help from quit line/smoking cessation programme.