Resources
- EFP Clinical Practice guideline on Treatment of stage I-III periodontitis
- OCHWA Perio Treatment Protocols
Assessment Phase - Perio
This is also when you do :
- Comprehensive history
- Radiography Extra-oral, intra oral periodontal examination
- Periodontal Diagnosis
- Periodontal Risk Assessment
Codes
- 221 Clinical Periodontal Analysis and Recording
Perio Acute Phase/ Step 0 Emergency Care phase
- Address any Acute Conditions Causing pain/ or infection
- This may include acute periodontal abscess, necrotizing periodontal disease or irreversible pulptitis
Warning
- The patient has none of these
ADA codes considered
| ADA codes | Description |
|---|---|
| 013 | Oral examination limited |
| 213 | Treatment of acute periodontal infection – per appointment |
| 419 | Extirpation of pulp or debridement of root canal(s) |
| 311/324 etc | Extraction of teeth associated with acute pain/infection |
Perio Systemic Phase / Step 1 Phase
- Risk Factor control Falls here while the biolfilm and OHI fall under disease control
-
- Aim to guide behavioural change by motivating patient
- Dietary Analysis
- Diabetes
- Tobacco smoking (Ask,Advice,Help, quitline )
-
Codes considered
131 - Dietary Analysis and Advice 142 - Tobacco sussation advice
Perio Disease Control Phase / Step 1 & 2A Systemic Phase and Cause related therapy phase & Step 2B Re-Evaluation
Step 1 portion
- Removal of supragingival biofilm:
- Oral hygiene practices are established here and reinforced at all stages of treatment
- Professional mechanical plaque removal and control of plaque retentive factors
ADA codes considered
| ADA codes | Description |
|---|---|
| 111 | Removal of plaque or stain |
| 113 | Recontouring and polishing pre-existing restoration – per tooth |
| 114 | Removal of calculus – first appointment |
| 115 | Removal of calculus – subsequent appointment (where extent or degree of calculus cannot be corrected in first 114 appointment) |
| 131 | Dietary analysis and advice |
| 141 | Oral hygiene instructions |
| 142 | Tobacco counselling |
| 311/324 etc | Extraction of asymptomatic hopeless teeth |
Step 2a Cause related portion
All periodontal patients receive non-surgical instrumentation to reduce/eliminate subgingival biofilm and calculus deposits.
- This may be completed with either hand or powered instruments, either alone or in combination.
- Non-surgical treatment may be performed with either traditional quadrant-wise or full mouth delivery.
- Chlorhexidine mouthrinse may be considered for limited time periods as an adjunct to instrumentation.
- Gross caries control and initiation of endodontic procedures.
- Management of peri-implant disease requires referral to Periodontal department.
ADA codes considered
| ADA codes | Description |
|---|---|
| 222 | Periodontal debridement per tooth |
| 250 | Active non-surgical periodontal therapy per quadrant (at least 3 teeth in quadrant CAL ≥ 3mm or PD ≥ 4mm). |
Step 2b Revaluation portion
After 8 weeks the patient is re-evaluated.
If the following endpoints are met, the therapy is deemed successful and the patient may be enrolled in supportive periodontal care maintenance program and proceed with subsequent restorative/prosthetic therapy:
- No pockets ≥ 5mm with BOP
- No pockets ≥ 6mm
- Full mouth bleeding score ≤ 20%
ADA codes considered
| ADA codes | Description |
|---|---|
| 221 | Clinical periodontal analysis and recording |
| 022 | Intraoral radiograph per exposure |
| Any applicable codes from Step 1 |
graph TD A[Start] --> B{Endpoints achieved?}; B -- Endpoints achieved --> D[STEP 4 - SUPPORTIVE PERIODONTAL CARE]; B -- Endpoints not achieved --> C[STEP 3 - CORRECTIVE PHASE];
Perio Definitive Treatment Phase/ Step 3 Corrective phase
Only if the clincal endpoints are not achieved!
STEP 3 - CORRECTIVE PHASE
Endpoints not achieved
- Residual pockets 4-5mm should have repeated non-surgical instrumentation.
- Residual pockets ≥ 6mm are indicated for surgical therapy, with referral made to Periodontal department.
- Localised residual pockets (<30% sites) may be re-instrumented by DMD, generalised (>30% sites) must be referred to Periodontal department.
- If persistent deep periodontal pockets are present and the student is unable to determine the underlying cause, they should not simply re-instrument these sites or defer management by referring the case to incoming students in the following year. Referral must be made to the Periodontal department for specialist evaluation and management.
- Management of peri-implant disease requires referral to Periodontal department.
ADA codes considered
| ADA codes | Description |
|---|---|
| 222 | Periodontal debridement per tooth |
| 250 | Active non-surgical periodontal therapy per quadrant (at least 3 teeth in quadrant CAL ≥ 3mm or PD ≥ 4mm). |
| 019 | Referral |
Perio Definitive Phase / Step 4 - Supportive Periodontal Care
Endpoints achieved
- SPC intervals between 3 & 12 months, patient dependent based on risk assessment tool https://www.perio-tools.com/pra/en/
- Professional mechanical plaque removal
- Repeated individually tailored oral hygiene instructions
ADA codes considered
Any applicable codes from Step 1
| Image | Technique | Image | Technique | Image | Risk assessment tool |
|---|---|---|---|---|---|
| Flossing Technique | Brushing Technique | https://www.perio-tools.com/pra/en/ |