List+and+describe+different+treatment+options+for+periodontal+disease.

= Treatment Options =

**Phases of Periodontal Therapy:** After establishing the diagnosis and the prognosis a treatment plan is developed. periodontal treatment requires a long range planning. There are many factors that influence the treatment options for example the presence of local factor (calculus), systemic factors (diabetes), patient's age, and the degree of the disease.   The treatment options for periodontal disease include:


 * 1- Preliminary phase: ** Treatment of an emergency such as a periapical, or periodontal and or exctraction of hopeless teeth
 * 2- Non-surgical phase: ** This is phase I therapy including patient education and plaque control, calculus removal and gingival pocket measurements
 * 3- Surgical phase: ** Endodontic therapy and implants placement
 * 4- Restorative phase: ** Periodontal examination, fixed or removable prosthetic appliances
 * 5- Maintenance phase: ** Clinical conditions inflammations and pocket recheck.


 * Treatment Options for Periodontal Disease: **

<span style="font-family: 'Comic Sans MS',cursive;"> <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">
 * <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">**Periodontal Therapy in Female Patients:**
 * <span style="font-family: 'Comic Sans MS',cursive;"> <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Hormonal changes affects the therapeutic decisions in disease. Some of the female cyclic phases include: puberty, menses, pregnancy, menopause, and oral contraceptives.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Puberty
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Education of the parent or the caregiver
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Preventive care including OHI
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Scaling and root planing with frequent OHI
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Antimicrobial mouthwashes
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Susceptible eating disorders; therefore clinician must be aware of signs gastric content on the intraoral tissue.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Menses
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Increase gingival bleeding and tenderness is associated with menstrual cycle. Antimicrobial rinses before cyclic inflamition is indicated 3-4 interval should be recommended.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Oral hygiene should be emphasized.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Schedule appointments for surgical visits after menstruation
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Anemia is common so keep in contact with physican. Clinician should be aware of NSAIDs and infection and acidic foods exacerbate GERD.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Fluoride rinse in trays and frequent perio debridement.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Avoid mouthwashes with high alcohol content.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Pregnancy
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">A thorough medical assessment in essential with women that are pregnant
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Plaque Control; tendency of increased gingival inflammation
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Scaling, polishing, and root planning should be done whenever necessary.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Prenatal fluoride treatment
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">ADA does not recommend the use of fluoride prenatally.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Avoid elective dental care in the first trimester and the last half of the third trimester.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Radiographs:When needed during pregnancy the most important age for patient is to wear a lead apron.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Drug thearpy in pregnant women is controversial.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Oral Contraceptives
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Treatment of gingival inflammation exaggerated by over the counter should include establishing an oral hygiene program and eliminating predisposing factors.
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Menopause
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Review medical history and maintaine current information
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Dentist needs to be in contact with the physician for patients with osteoporosis.
 * <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">**Periodontal Therapy in Medically Compromised Patients:**
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Cardiovascular Disease
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Endocrine Disorders
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Renal Diseases
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Liver Diseases
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Pulmonary Diseases
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Immunosuppresion and Chemptherapy
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Radiation Therapy
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Prosthetic Joint Replacement
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Pregnangy
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Hemmoragic Disorders
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Blood Dyscrazias
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Infectious Diseases

<span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Considerations for each specific disorder/disease should be addressed. A med consult would be indicated for many of these disorders. It is important to identify whether or not the patient is stable. Therapeutics administered by clinicians should be assesed closely. There could be possilbe drug interactions due to the medications the patient is already prescribed.
 * <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">**Periodontal Treatment for Older Adults:**
 * <span style="font-family: 'Comic Sans MS',cursive;">An 85 year old man is brought in by his caregiver for a 6 mos recare visit. His cheif complaint is that "he is having a hard time brushing his teeth"
 * <span style="font-family: 'Comic Sans MS',cursive;">To treat this patient our main concern would be to decrease bacteria through oral hygiene and mechanical debridement.
 * <span style="font-family: 'Comic Sans MS',cursive;">OHI would include an electric toothbrush and a daily fluoride rinse.
 * <span style="font-family: 'Comic Sans MS',cursive;">The following are general considerations and recommendations to treat older patients:
 * <span style="font-family: 'Comic Sans MS',cursive;">Short appointments, late morning or early afternoon appointments, possible use of sedative oral medications or nitrous oxide/oxygen
 * <span style="font-family: 'Comic Sans MS',cursive;">If patient suffers from stress, to reduce a cardiovascular eve
 * <span style="font-family: 'Comic Sans MS',cursive;">Change chair position slowly, assist, and support
 * <span style="font-family: 'Comic Sans MS',cursive;">Syncope, Patients with disabilities, orthostatic hypotension, dexterity
 * <span style="font-family: 'Comic Sans MS',cursive;">Medical Consult
 * <span style="font-family: 'Comic Sans MS',cursive;">For patients with systemic diseases, drug to drug interactions with anesthesia, change in medications during treatment, use of vasoconstrictors. Older patients are at greater risk for infections and reduced healing
 * <span style="font-family: 'Comic Sans MS',cursive;">Evaluate medical history to identify and assess medical and mental status, medications, funtional status, and lifestyle behaviors that influence periodontal treatment outcome, or progression of disease, ability to tolerate treatment.
 * <span style="font-family: 'Comic Sans MS',cursive;">Clinical evaluation to assess periodontal disease severity, ability to perform oral hygiene procedures, remaining periodontal support, past periodontal destruction, occlusion.
 * <span style="font-family: 'Comic Sans MS',cursive;">Address both surgical and nonsurgical procedures.
 * <span style="font-family: 'Comic Sans MS',cursive;">Age is not a contraindication for periodontal treatment. It is based on the individual patients health status.
 * <span style="font-family: 'Comic Sans MS',cursive;">Age is not a risk factor for recession. It is often seen in older individuals, but it is not directly related to age.

<span style="font-family: 'Comic Sans MS',cursive;">
 * <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">**Treatment of Aggressive and Atypical Forms of Periodontitis:**
 * <span style="font-family: 'Comic Sans MS',cursive;">A 20 year old patient presents in chair with no signs of inflammation and no recession, upon probing the patient there was minimal bleeding on probing, low bleeding index and generalized probing of 3mm with localized areas of 9-11mm probing in the 1st molar areas and the incisors of the mandibular right quadrant. Patient's FMX reveals localized severe bone loss. You look at patients previous radiographs which were taken two years ago and there were no signs of bone loss. Patient states that her "mother had long teeth too." Patient presented with localized aggressive periodontitis, treatment options for this patient includes: Surgical resection- this would be best for a patient who presented with deep pockets.
 * <span style="font-family: 'Comic Sans MS',cursive;">Surgical regeneration- this would be best for a patient that presented with angular bone defects and/or infrabony pockets.
 * <span style="font-family: 'Comic Sans MS',cursive;">Systemic antibiotics-these would be best for patients who present with localized or generalized aggressive periodontitis.
 * <span style="font-family: 'Comic Sans MS',cursive;">Full mouth disinfection-this would be best for patients who present with localized or generalized aggressive periodontitis.
 * <span style="font-family: 'Comic Sans MS',cursive;">Patient education- This would be beneficial for every patient so they can understand their condition and how to best manage it.
 * **<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">Treatment of Acute Gingival Disease: **<span style="color: #800080; font-family: 'Comic Sans MS',cursive;">
 * <span style="font-family: 'Comic Sans MS',cursive;">This condition is usually identified as acute necrotizing ulcerative gingivitis (ANUG). This condition usually results from an impaired host response to a potetntially pathogenic microflora. Depending on how immunicompromised the patients is, that will determine the severity of ANUG and any other underlying chronic gingival disease that may be present. The primordial important treatment of this condition is to alleviate the symptoms and to possibly correct any existing chronic gingival disease.


 * <span style="font-family: 'Comic Sans MS',cursive;">Treatment includes and is not limited to the following:
 * <span style="font-family: 'Comic Sans MS',cursive;">A health history should be completed by asking any of the following: current illness, dietary background, type of employment, living conditions, hours of rest, cigarette smoking, risk factor for HIV, and possible stress or depression.
 * <span style="font-family: 'Comic Sans MS',cursive;">Observe any of the following: palpations of swollen lymp nodes (submaxillary/suglingual), presence of halitosis, general appearance, any skin lesions, vital signs possible temperature.

<span style="font-family: 'Comic Sans MS',cursive;">No periodontal probings at this time, subgingival scaling and/or curettage, or any extractions and/or periodontal surgery (TOO PAINFUL). This must be postponed until 4 weeks after the patient has been symptom free otherwise this can exacerbate the acute syptoms.


 * <span style="font-family: 'Comic Sans MS',cursive;">First appointment: is concentrated in removing as much microbial load and nectrotic tissue by isolating the area with cotton rolls and dried by then leaving topical in the area for 2-3 minutes. Next step is to gently swabb the areas with a wet cotton pallet in small areas. This should remove the pseudomembrane and nonattached surface debri while at the same time profuse bleeding is occuring. Once the area is cleansed with warm water, supracalculus can be removed and an ultrasonic can possibly be used (supra) and aid with washing away some of the area.
 * <span style="font-family: 'Comic Sans MS',cursive;">Some of the patients with severe ANUG can benefit from taking amoxicillin, 500mg orally every 6 hours for ten days or erythromycin 500mg every 6 hours or metronidazole 500mg every 6 hours for 7 days
 * <span style="font-family: 'Comic Sans MS',cursive;">The patient is to avoid tobacco, alcohol, condiments, rinse with 3% hydrogen peroxide and warm water every 2 hours or twice daily with 0.12% chlorhexidine solution. They need to get planty of rest, confine from toothbrushing, and use an analgesic (NSAID) for pain relief.
 * <span style="font-family: 'Comic Sans MS',cursive;">Second visit: should be at 1-2 days after the first visit and the gingival inflammation should be of less degree as well as having less pain.
 * <span style="font-family: 'Comic Sans MS',cursive;">The gingiva may still appear erythematous, but without a superficial pseudomembrane. If the gingiva did reduce, there may be superficial calculus that can be removed at this time and all the post-op instructions are the same as the first appointment.
 * <span style="font-family: 'Comic Sans MS',cursive;">Third visit: 5 days after the second visit which at this point the patient is usually symptom free. This is the appointment where a complete periodontal evaluation takes place. A comprehensive plan for the management of the patient's periodontal evaluation is determined and plaque control instructions are given. Hydrogen peroxide rinses are discontinued, but the chlorhexidine rinses can be continued for 2-4 weeks. Scaling and root planning are done if needed as well as treating chronic periodontitis, pericoronal flaps, and periodontal pockets. Further counceling on smoking cessation, nutrition and other habits or conditions associated with potential recurrence should be continued.
 * <span style="font-family: 'Comic Sans MS',cursive;">Unfortunately, many patients after they are symptom free will not continue treatmen,t but at this time a comprehensive treatment should start based on the patient's chronic periodontal problem.

> <span style="font-family: 'Comic Sans MS',cursive;"> Treatment of abscess:<span style="font-family: 'Comic Sans MS',cursive;">
 * <span style="color: #800080; font-family: 'Comic Sans MS',cursive;">**Treatment of Periodontal Abscess:**
 * <span style="font-family: 'Comic Sans MS',cursive;">Patient Background: Patient received periodontal therapy 2 months ago in Mexico, with no anesthesia. Patient complains of tender gums #24, "pus" #24, swelling #24, sensitive upon pressure and brushing #24.
 * <span style="font-family: 'Comic Sans MS',cursive;">E & I revealed enlarged lymph nodes submandibular region.
 * <span style="font-family: 'Comic Sans MS',cursive;">Clinically the area around #24 was:
 * <span style="font-family: 'Comic Sans MS',cursive;">painful, erythematous, was +2 mobility, slightly elevated in socket, tender to pressure, suppuration, vital pulp test, draining fistula
 * <span style="font-family: 'Comic Sans MS',cursive;">Radiographs reveal large calculus deposit mesial interproximal contact #24, vertical defect on mesial aspect of teeth
 * <span style="font-family: 'Comic Sans MS',cursive;">Probe depths were ; 446 (distal to mesial, buccal) 754 (mesial to distal, lingual)
 * <span style="font-family: 'Comic Sans MS',cursive;">Treat acute symptoms:
 * <span style="font-family: 'Comic Sans MS',cursive;">Drainage through pocket retraction or incision
 * <span style="font-family: 'Comic Sans MS',cursive;">scale and root plane
 * <span style="font-family: 'Comic Sans MS',cursive;">perio surgery
 * <span style="font-family: 'Comic Sans MS',cursive;">antibiotics
 * <span style="font-family: 'Comic Sans MS',cursive;">tooth removal