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Gingival Inflammation With Loss of Connective Tissue Attachment (Periodontitis)

(Adopted 1994, revised 1997)

Preamble (Adopted 1994)

The key element in the design of this set of parameters for gingival inflammation with loss of connective tissue attachment (periodontitis) is the professional judgment of the attending dentist, for a specific patient, at a specific time.

The patient's chief complaint, concerns and expectations should be considered by the dentist.

The dental and medical histories should be considered by the dentist to identify medications and predisposing conditions that may affect the prognosis, progression, and management of periodontitis.

Following evaluation of the patient (see limited, comprehensive, periodic, detailed and extensive evaluation parameters) and consideration of the patient's needs, the dentist should provide the patient with information about periodontitis prior to obtaining consent for treatment. (See: Periodontal Screening and Recording® (PSR®): An Early Detection System Q & A.)

Medications should be prescribed, modified and/or administered for dental patients whose known conditions would affect or be affected by dental treatment provided without the medication or its modification. The dentist should consult with the prescribing health care professional(s) before modifying medications being taken by the patient for known conditions. (See: ADA Statement on Antibiotic Prophylaxis, Prevention of Bacterial Endocarditis: A Statement for the Dental Profession (PDF), and A-Z Topic: Antibiotic Prophylaxis.)

The dentist may counsel the patient concerning the potential effects of the patient's health condition, medication use and behaviors on his or her oral health.

The dentist should recommend treatment; present treatment options, if any; and discuss the probable benefits, limitations and risks associated with treatment, and the probable consequences of no treatment.

Any treatment performed should be with the concurrence of the patient and the dentist. If the patient insists upon treatment not considered by the dentist to be beneficial for the patient, the dentist may decline to provide treatment. If the patient insists upon treatment considered by the dentist to be harmful to the patient, the dentist should decline to provide treatment.

When the dentist considers it necessary, (an)other health professional(s) should be consulted to acquire additional information.

When recommending treatment, the dentist should recognize that periodontal disease that can be episodic or linear, and generalized or site specific.

Following evaluation, treatment priority should be given to the management of pain, infection, traumatic injuries or other emergency conditions.

The behavioral, psychological, anatomical, developmental and physiological limitations of the patient should be considered by the dentist in developing the treatment plan.

The dentist should attempt to manage the patient's pain, anxiety and behavior during treatment to facilitate safety, efficiency and patient cooperation. (See: ADA Policy Statement: The Use of Sedation and General Anesthesia by Dentists and Guidelines for the Use of Sedation and General Anesthesia by Dentists.)

The dentist should refer the patient to (an)other health professional(s) when the dentist determines that it is in the best interest of the patient.

Relevant and appropriate information about the patient and any necessary coordinated treatment should be communicated and coordinated between the referring dentist and the health professional(s) accepting the referral.

The dentist should emphasize the prevention and early detection of oral diseases through patient education in preventive oral health practices, which may include oral hygiene instructions.

The patient should be informed that the success of the treatment is often dependent upon patient compliance with home care instructions and recommendations for behavioral modifications. Lack of compliance should be recorded.

Additional diagnostic tests relevant to the periodontitis of the patient may be performed and used by the dentist in diagnosis and treatment planning.

The presence of carious lesions should be considered in developing a treatment plan.

The relationship of the mucogingival junction to the loss of attachment should be noted and considered in developing a treatment plan.

Clinically apparent plaque, calculus and other local etiologic factors should be removed.

Root planing should be performed.

Chemotherapeutic agents may be used by the dentist to facilitate treatment.

Alteration of tooth morphology and/or position, placement of restorations, modification or replacement of restorations, and treatment of carious lesions may be performed by the dentist to facilitate treatment.

The replacement of missing teeth and/or those indicated for extraction may be performed by the dentist to facilitate treatment.

Occlusal analysis and adjustments may be performed by the dentist to facilitate treatment.

Occlusal guards and/or splinting may be used by the dentist to stabilize mobile teeth.

Resective, regenerative, recontouring and/or augmentation procedures may be performed by the dentist.

Root resection may be performed by the dentist.

Endodontic therapy may be performed by the dentist.

Teeth may be removed as determined by the dentist.

The dentist should inform the patient that he or she should participate in a prescribed program of continuing care to allow the dentist to evaluate the effectiveness of the treatment provided and the condition of the periodontium.

The dentist should determine the frequency and type of preventive treatment, based on the patient's risk factors or presence of oral disease.

Documentation of treatment provided, counseling and recommended preventive measures, as well as consultations with and referrals to other health care professionals should be included in the patient's dental record.