Timing For Comprehensive Periodontal Charting

QUESTION: Do patients need to be comprehensively charted at each periodontal maintenance visit?

ANSWER: Periodontal maintenance (PM) is started after the completion of active periodontal therapy and continues for the life of the patient. PM is an extension of active periodontal therapy and includes maintenance of dental implants. Dental hygienists play a critical role in this phase of periodontal therapy. An excellent resource on this topic is the American Academy of Periodontology’s (AAP) “Position Paper: Periodontal Maintenance.”¹

The main objective of the maintenance phase of treatment is to monitor the risk for periodontal disease recurrence and progression. The components of a PM visit should include an update of medical/dental histories, extraoral exam, intraoral exam, mechanical tooth cleaning, clinical exam, periodontal exam, and radiographic exam, as indicated. For most patients with a history of periodontal disease, a 3-month interval has been found to be effective in maintaining gingival health.

Concerning charting, there is no standard of care regarding frequency of full periodontal charting. This is because each patient has a unique periodontal history and set of risk factors for disease recurrence. However, in 2011, the AAP published the statement “Comprehensive Periodontal Therapy” recommending that patients receive a comprehensive periodontal exam annually. New paradigms for managing periodontal disease are based on the fact that not all patients are equally susceptible. Therefore, patients who are at high risk should be charted more frequently so that early signs of disease recurrence can be detected.

The essential components of a comprehensive periodontal charting are probing depths, bleeding on probing, evaluation of plaque and calculus, degree of furcation involvement, gingival recession, tooth mobility, occlusal factors, and tooth-related factors, such as open contacts or malpositioned teeth. Recording clinical attachment levels is ideal, yet many clinicians find it difficult to accomplish in a typical private practice setting. Disease status is then determined by reviewing the clinical, patient, and radiographic data and comparing to previous visits. For example, in my practice the dental hygienist always has the patient’s original and most recent radiographs side by side for comparison. This allows for rapid assessment of rates of tooth loss over time, stability of bone levels, outcomes of therapy, caries risk, and possible future treatment directions. It is also a very powerful way to demonstrate to patients their individual course of history. The successful long-term control of periodontal disease and implant complications depends on active PM care and, if indicated, additional therapy.

Upon completion of periodontal therapy, patients should enter into a maintenance program. Typically, PM patients are comprehensively charted on an annual basis. However, new paradigms for managing periodontal diseases are based on the fact that not all patients are equally susceptible. Therefore, patients who are at increased risk should be charted more frequently so that early signs of disease recurrence can be detected.

References

1. Cohen RE, Research, Science and Therapy Committee, American Academy of Periodontology. Position paper: periodontal maintenance. J Periodontol. 2003;74:1395–1401.
2. Comprehensive periodontal therapy: a statement by the American Academy of Periodontology. J Periodontol. 2011;82:943–949.

From Dimensions of Dental Hygiene. September 2016;14(09):68.