decision making in periodontics
DESCRIPTION
To save or to extract teeth based on periodontal healthTRANSCRIPT
DECISION MAKING IN PERIODONTICS
Dr. Pinak Kapadia
When to save When to extract When to advise flap When to advise for implants When to wish the patient runs away….
A TYPICAL CONSULTATION/REFERRAL
THE DIRTY PICTURE
A TYPICAL CONSULTATION/REFERRAL
A TYPICAL CONSULTATION/REFERRAL
AN IDEAL CONSULTATION
Typical cases that periodontists treat in India are much worse than those treated by periodontists in US/Europe
Early intervention can give better results and avoid dirty picture!
WHAT IS DIFFERENT?
Diagnosis Prognosis Treatment planning Rehabilitation
Decision making
The denier The convincer The banker The trader The hysteric The ideal patient
◦ Accepts/Understands/Gets treatment/PAYS!!!
Psychology of patients in perio
1 treatment plan for all categories of patients???
In the real world, Decisions of periodontics depend upon the psychology of the patient along with the clinical picture
Especially for perio DO WE GIVE PATIENTS THE CHOICE OF
TREATMENT, OR DO WE DECIDE THE TREATMENT FOR THEM?
In other words, IDEAL TREATMENT OR NEED BASED TREATMENT?
A chicken or egg question
Do we periodontists treat patients or teeth?
Another question
Diagnosis Prognosis Treatment planning Rehabilitation
Decision making
DIAGNOSIS
Gingivitis/Periodontitis
POCKETS MOBILITY BONE LOSS
Factors in diagnosis
Periodontal probe – A simple instrument worth using in EVERY patient in EVERY site
Highest returns on investment!!!!
Gingivitis/Periodontitis
Chronic/Aggressive periodontitis
Age of the patient Habit/ Diabetes
Why???
FACTORS IN DIAGNOSIS
Mismatch between signs and symptoms
What matters to us
What matters to patients
Pockets Mobility Bleeding on probing Recession Bone loss on OPG
Bleeding gums Bad breath ‘GAPS’ between teeth Pain during
chewing/inability to chew
Sensitivity to cold
This complete mismatch between the patient’s symptoms, and the signs observed by the dentist leads to misconceptions about periodontal treatment
Finding common ground for treatment is very necessary.
Responsibility of educating the patients lies with each and every one of us.
MISMATCH
Endo Perio Lesions Caries/Crestal bone/Periodontal condition of
adjacent teeth # tooth
FACTORS IN DIAGNOSIS
If the tooth is nonvital, there will always be endo first.
Adequate time for endo lesion to heal before thinking of perio treatment
If origin is perio, endo can be delayed
Endo Perio lesions
PROGNOSIS
Prognosis cannot be predicted with any certainty without seeing the results of phase 1 therapy.
The only certain prognosis are Good and Hopeless
Many teeth fall in doubtful category
Factors in prognosis
Similar professions to perio
PROGNOSIS
80% of Gr II mobile teeth last for atleast 3 years
50% of Gr III mobile teeth last for atleast 1 year
95% of Gr I mobile teeth last for atleast 5 years
SOME STARTLING RESEARCH FINDINGS
In mobile teeth, FPD >>>> RPD Differentiate between increased mobility
and increasing mobility
FOLLOW UP
MORE STARTLING RESEARCH FINDINGS
TEETH VS IMPLANTS Rate of bone loss = 0.1 mm per year
STARTLING FINDINGS # 3
Consequences of not saving teeth
Consequences of not saving teeth
Co-ordination between the periodontist and the general dentist
TREATMENT PLANNING
Each case has separate rules whether to save or extract the teeth
If 1 or 2 teeth are hopeless/doubtful, better to extract and replace
If many teeth are doubtful, better to attempt to save
Not an exact science, but saving teeth is immensely gratifying
TAKE HOME MESSAGE
Showing pockets in a mirror/ drawing pockets
NOT prescribing gum paint NOT prescribing antibiotics for bleeding
gums without any diagnosis
How can we educate?
