Expected+Outcomes+of+Phase+I+Therapy

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 * Expected Outcomes of Phase I Therapy on Early, Moderate and Advanced Periodontal Disease **

Maria: Phase I therapy is the first step of periodontal treatment. The objective of this therapy is to alter or eliminate the microbial etiology and contributing factors of gingival and periodontal disease. Phase I therapy includes radiographs, periodontal assessments, obturation of carious lesions and recontouring defective restorations, oral hygiene instruction, full mouth or quadrant scaling, nutritional counseling, tobacco cessation, and 4-6 week re-evaluation. The expected outcome of phase I therapy in patients with early, moderate, and advanced periodontal diseases is reduction of periodontal pathogens, pocket reduction, lower MBI, BOP, and PI, and bone level maintenance. Factors that can influence the outcomes of phase I therapy includes operator technique, patient systemic risk factors, patient compliance with oral hygiene, and technology incorporated in the dental practice.

Reina: Phase I therapy describes the procedures that are designed to control or eliminate the etiologic factors of periodontal disease. This stage is referred to as initial therapy, nonsurgical therapy, cause-related therapy, or the hygiene phase after treatment. Included procedures are plaque biofilm control, diet control for patients with a high caries risk, scaling and root planing to remove bacterial plaque biofilm and calculus, correction of contributing restorative and prosthetic factors, removal of caries and restoration of teeth (temporary or final, depending on whether a definitive prognosis for the tooth has been arrived and on the location of the caries), local or systemic antimicrobial therapy, occlusal therapy, minor orthodontic movement, provisional splinting, and the 1-month or longer after evaluation of response to Phase I after completion involving a reassessment of the gingival condition, pocket depth, attachment loss, gingival inflammation, plaque biofilm, calculus, and caries. This phase is different from Phase IV in that Phase IV includes plaque biofilm and calculus removal and the monitoring of occlusion and tooth mobility, other pathologic changes, and periodontal conditions involving pockets, clinical attachment loss, and inflammation. It is important to critically think about the assessments gathered in order to predict the patient’s prognosis and outcome. This will aid with patient education and the creating the treatment plan.

Newman, M. G., Takei, H. H., Klokkevold, P. R., & Carranza, F. A. (2006). // Carranza’s clinical periodontology // (10th ed.). St. Louis : Saunders Elsevier.

Perry, D. A. & Beemsterboer, P. L. (2007). // Periodontology for the dental hygienist // (3rd ed.). St. Louis : Saunders Elsevier.

Diem Phase I therapy is non-surgical phase, including scaling and root planning, nutritional counseling, tobacco cessation, and pt education. The expected outcomes of Phase I therapy should be that the pocket depth should reduce from 6mm to 4mm or from 4mm to 2mm. The gingival will get pale pink, firm, scalloped and smooth or stippled instead of erythemic, edematous, friable, and shinny. Patient education on OHI and expected outcomes are important to have ideal outcomes. In addition, successful outcomes of Phase I therapy are depended on instrument selection, clinician experience, time allowance, and available dental modalities.

McLeod, D., Lainson, P., & Spivey, J. (1997). The effectiveness of periodontal treatment as measured by tooth loss. //The Journal of American Dental Association, 128//, 316-324. Newman, M. G., Takei, H. H., Klokkevold, P. R., & Carranza, F. A. (2006). Carranza’s clinical periodontology (10th ed.). St. Louis: Saunders Elsevier.

Dorinda Phase I therapy can include oral health patient education (OHI), nutritional counseling, tobacco cessation and full mouth scale including any chemotherapy treatment if necessary. When providing Phase I therapy to patients the expected outcome is a reduction in bleeding, gingival description to have healthy characteristics, reduction in pocket depths and plaque control.

The purpose of phase I therapy is to get rid of bacterial plaque ,the etiology of periodontal diseases. It is an initial therapy, nonsurgical therapy, plaque biofilm control, diet control for patients with a high caries risk, scaling and root planing to remove bacterial plaque biofilm and calculus, correction of contributing restorative and prosthetic factors. Then 4-6 weeks re-evaluation is performed. It is crucial to predict the patient’s prognosis and outcome. This will aid with patient education and the creating the treatment plan. There is difference in periodontal health and microbiological parameter between patients who have had phase I therapy and came back for the follow up and maintenance. Therefore, appropriate recall system is very important to achieve the goal set for each patient. Heasman, P.A., Wasserman, B. (December, 2005). The relationship of initial clinical parameters to the long-term response in 112 cases of periodontal disease. Journal of Clinical Periodontology. 15(1), 38-42. Cugini M., Haffajee, A., Smith, C., Kent, R. L., and Socransky S. S. (2000). The effect of scaling and root planing on the clinical and microbiological parameters of periodontal diseases: 12-month results. Journal of Clinical Periodontology, 27(1), 30-36.
 * Noo :**

Jennifer Phase I therapy is the initial therapy containing the removal of supra and sub gingival calculus and plaque removal, biofilm control, as well as nutritional counseling. The re-evaluation is part of this phase. This phase does not include surgery. This phase is the Dental hygienist specialty including OHI. Perry,D., Beemsterboer,P. Periodontology for the dental hygienist.(2007).Saunders Elsevier.203.

In summary, our expected outcomes for Phase I Therapy for Chronic Periodontitis are many. We expect a reduction of 1-2mm in pocket depths for pockets deeper than 4mm. Deeper pocket have greater reduction whereas in pockets of 1-3mm, we will not find a statistically significant reduction in pocket depths. We should also expect to see a reduction in bleeding on probing and a change towards health in their gingival description. As part of Phase I therapy, we will reevaluate their assessments and gingiva. The BOP and unhealthy gingival areas will help to identify where calculus or plaque reside and have not been removed. The reevaluation will also allow us to gauge the patient compliance to at-home oral hygiene. In addition, we should expect to see recession due to shrinking pocket depths. Often accompanied with recession is post SRP tooth sensitivity. Although no studies have confirmed post SRP sensitivity, many patients claim to have sensitivity for 1-2 weeks after SRP. As dental hygienists, it is important to warn our patients prior to treatment about possible sensitivity, to treat existing sensitive areas with in-office therapies and to prescribe at-home treatments. The expected outcomes for Phase I therapy differs due to the disease progression, at-home patient oral hygiene compliance and the skill of the clinician. As dental professionals, we should educate and inform our patients of the expected outcomes of the Phase I therapy.
 * //Natalie//**:

After phase therapy, class III furcation may need a soft tissue surgery to turn them into class IV furcations for better cleansable furcated tooth. After removing the etiological factor causing the periodontal loss the gingiva turns healthy and the bone stops resorption. Healing at the gingival margin after removing the irritants turns into a healed tissue that is closed and tight around the tooth. Question: Why not do the same for a class II furcation to prevent it from turning into a class three furcation? Vandersall, D., & Detamore, R. (2002). The mandibular molar class III furcation invasion a report of treatment options and a case report of tunneling. //The Journal of the American Dental Association, 133// (1), 55-60. Wilkins, E. (2005). Non surgical periodontal instrumentation, 645-676. //Clinical Practice of the// //Dental Hygienist, (9th Ed)//. Dietz, K., & Define, C. (Ed).Lippincott Williams & Wilkins. Baltimore, MD: Lippincott Williams & Wilkins.
 * Jackie**

Marcia- ** Phase I therapy in periodontal disease is getting rid of the etiologic factors which is calculus, and bacteria. This phase is given to every patient, from early to advance periodontitis. The outcome of phase I therapy is good for all stages; this step is might only be indicated if the periodontal tissue heals and no longer is diseased. The patient will have to follow up with OHI to keeping the tissues from getting diseased again. Patients with moderate and advance periodontitis expected outcomes are not as good as those with early periodontitis. These patients may not be able to obtain effective OHI without surgical intervention. Many oral hygiene devices are not designed to get into deep pockets, making OHI difficult. Phase I therapy also involves correction of overhang margins of restorations, rough surfaces of restorations, caries, traumatizing occlusal contact and its effects on surrounding tissue. All these factors have a affect on the periodontal tissue. Patients are evaluated in 4-6 weeks to see outcomes of phase I therapy. If there are good results the general dentist may keep the patient to provide routine maintenance for these patients, others may have to be referred to a specialist. **     George, G., Darbar, U., Thomas, G. (2006). Inflammatory external root resorption following surgical treatment for intra-bony defects; a report of two cases involving emdogain and a review of the literature. Journal of clinical periodontology33, 449-454. Retrieved on May 14, 2009 from http://www3.interscience.wiley.com.lib-proxy.fullerton.edu/cgi-bin/fulltext/118621904/PDFSTART Newman, M. G., Takei, H. H., Klokkevold, P. R., & Carranza, F. A. (2006). Carranza’s clinical periodontology (10th ed.). St. Louis: Saunders Elsevier.

Drina: Phase 1 therapy is an important aspect of the diagnosis & treatment of perio disease. Phase 1 therapy in most cases will control the disease in mild cases or slow progression and maintain periodontal stability in severe cases. Once a scaling and root planning have been done another part of phase 1therapy is a 4-6 week re-evaluation. At this appointment, it can be determined the interval of cleaning appointments or if treatment is not successful and further action needs to be taken. The problem with this is that some people don’t come back for this appointment and so the patient is not truly evaluated. References: []

McLeod, D.E. (2000, April). A practical approach to the diagnosis and the treatment of periodontal disease. The Journal of the American Dental Association, 131: 483-491.

The outcomes of Phase I therapy on periodontal disease are quite predictable. There is an expected decrease in inflammation and a halt in the destruction of the periodontium, with proper at home oral hygiene following therapy. The long term outcome of the therapy is highly dependent on patient motivation to form excellent at home oral hygiene habits. Plaque, being the causative agent in periodontal disease needs to be controlled and this is part of phase I therapy. Educating the patient about plaque the importance of removing it and how to effectively remove it are a big part of arresting periodontal disease. The therapy also includes removing hard deposits, supragingival and subgingival. Through these procedures and patient compliance, periodontal disease can be expected to be controlled. Reference: Gera, I. (2004). The stages of comprehensive periodontal therapy-diagnosis driven treatment planning. Fogorvosi Szemle, 97(3): 103-111. Retrieved, May 17, 2009 from: http://www.perlan.co.uk/dentists-info/periodontal-therapy/index.html
 * Expected Outcomes of Phase I Therapy on Early, Moderate and Advanced Periodontal Disease - Stacy**