There is increasing recognition, made explicit in the new classification for periodontitis, that periodontitis is a lifelong disease that is not ‘cured’ but rather ‘managed’. This paper focuses on how the response to periodontal treatment is ideally measured and how decisions are made as to whether the treatment has been ‘successful’ or not. The roles of both the patient and practitioner in the maintenance of periodontal health for those patients who respond to initial therapy are crucial. Patients not responding to initial, non-surgical periodontal therapy also need to be appropriately managed, as outlined in this paper.
CPD/Clinical Relevance: This paper highlights the importance of maintenance of periodontal health, as an integral part of the overall management of patients with periodontitis, in order to minimize further periodontal breakdown and eventual tooth loss.
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In this paper, it be will assumed that the steps outlined in the previous papers have been followed and the patient with unstable periodontitis is adequately motivated, has had an initial course of periodontal treatment, and is now being reviewed after a period of at least 8−10 weeks (commonly at the 3-month time point). For the purposes of this paper, the terms ‘periodontal treatment’ or ‘periodontal therapy’ may be used instead of the longer (and more accurate) ‘non-surgical root surface debridement (NS-RSD)’. This paper will discuss:
For most practitioners, the Basic Periodontal Examination (BPE) would be a familiar screening tool for entry into periodontal therapy. There is growing recognition, now reaffirmed by the 2017 World Workshop Classification and its UK adoption,1 that periodontitis is a lifelong condition. Once a patient has periodontitis, he/she is always more susceptible to this disease and therefore remains classified as a periodontitis patient. However, with adequate treatment, risk factor management and home care, the patient may be classified as having periodontitis which is ‘currently stable’.2 The benefits of the BPE as a quick and simple screening test are self-evident but its shortcomings as a tool to assess periodontal treatment response do need to be addressed. The BPE does not provide the practitioner or patient with site-specific information on key measures of periodontal health in a way that a Detailed Pocket Chart (DPC) can. The DPC allows the practitioner to review, for example, the mesio-buccal site on the UR6 to see if the site is changing in its appearance or phenotype with regard to probing depth, bleeding on probing, suppuration and other measures detailed below. Having this site-specific information, as opposed to the less detailed information contained in the BPE, allows practitioners to monitor the periodontal health of their patients with a history of (and therefore a susceptibility to) periodontitis appropriately, therefore allowing for early intervention, if needed.
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