Factors affecting decision making at reassessment of periodontitis. Part 4: treatment options for residual periodontal pockets.

This paper is the final in a four-part series outlining treatment planning at periodontal reassessment. The first article (part 1) focused on the information that should be gathered at the reassessment appointment. Parts 2 and 3 discussed systemic and local factors that can relate to residual periodontal probing depths. Treatment can involve a range of non-surgical and surgical approaches. A variety of general, practical and local site factors can affect the choice of one option over another in choosing the most predictable treatment option. Decision-making can be challenging and this paper aims to aid this process by discussing the assessment of prognosis, factors that need to be considered in decision-making and treatment options available. A flow chart to summarise this process is presented.

Initial periodontal therapy before referring a patient: an audit.

Introduction The extent to which initial therapy has been provided prior to referral for periodontal disease remains unclear despite guidance provided by the British Society of Periodontology.Aim This audit aimed to assess the information given in the referral letter, how this compared to patients' perception of treatment received, the referrers' reports of treatment provided and findings at consultation. The gold standard was taken from the British Society of Periodontology referral criteria which states that all patients should undergo initial periodontal therapy prior to referral.Method Data were collected via questionnaires from 100 randomly selected patients referred for periodontal treatment from patients at consultation and subsequently from the referring practitioners.Results All 100 patients had incomplete referrals with 12 patients having Basic Periodontal Examination (BPE) scores corresponding to those at consultation. Eighty-five patients reported receiving oral hygiene instructions (OHI) and 91 patients root surface debridement (RSD), prior to referral. Twenty-five dentists participated in the survey and reported spending more time providing initial therapy than the patients.Discussion and conclusion Most patients reported having undergone initial periodontal treatment, however, the extent was at variance to the referrers' reports. BPE scores were inaccurate and the majority of referrers failed to provide a diagnosis, with incorrect terminology used. The study highlights the need for improving the management of periodontal disease in primary care.

Factors affecting decision making at reassessment of periodontitis. Part 2: interpretation of clinical findings - systemic factors.

This paper is the second in a four-part series outlining treatment planning at periodontal reassessment. The first article focussed on the information that should be gathered at the reassessment appointment. Treatment can involve a range of non-surgical and surgical approaches. A variety of general, practical and local site factors can affect the choice of one option over another in choosing the most predictable treatment option. Residual periodontal probing depths can be associated with both systemic and local factors. This article (part 2) outlines systemic factors that need to be assessed when faced with residual periodontal probing depths.

Factors affecting decision making at reassessment of periodontitis. Part 1: history and examination at reassessment.

Periodontal therapy aims to arrest the disease while maintaining function and aesthetics. Reassessment allows an opportunity to assess the periodontal status and need for further treatment. This is distinct from initial assessment in that the patient's response to initial therapy will be apparent and many treatment options other than non-surgical therapy require consideration. This series of papers outlines the processes to undergo at periodontal reassessment in order to assess viable treatment options and decide on a plan. This first article focuses on the information that should be gathered at the reassessment appointment in order to allow a full view of a case to aid decision-making. Subsequent papers in this series discuss the systemic and local factors that can account for residual probing depths, assessment of prognosis and treatment planning. Reassessment should be undertaken in a detailed manner to establish the reasons for any residual periodontal probing depths which will lead to the appropriate treatment option.

Alveolar ridge preservation: why, when and how.

Alveolar ridge preservation (ARP) is a method of decreasing bone resorption following tooth extraction and facilitating prosthetically-driven implant placement. An understanding of the physiological responses occurring after extraction and the effects of ARP are important in order to implement clinical procedures. ARP is a predictable way to reduce undesirable horizontal and vertical ridge reduction following extraction when dental implant treatment is to be delayed. Guided bone regeneration, socket fillers, socket sealers and growth factors have been used satisfactorily. However, there is currently no consensus on case selection, best clinical technique and material choice. Management of tooth extraction sockets is presented, with a focus on decision-making.

Clear cell odontogenic carcinoma: a rare neoplasm of the maxillary bone.

Clear cell odontogenic carcinoma (CCOC) is an extremely rare neoplasm, with only 74 cases in the English-language literature. It displays a propensity for the mandible, most commonly presenting in the fifth to seventh decades. Histopathologically, CCOC is characterized by sheets and islands of vacuolated and clear cells. The aggressive nature of CCOC was noted in its first description in 1985, although it was not formally classified as malignant by the World Health Organization until 2005. This report describes a case of CCOC presenting atypically in a young patient and at an uncommon site. The authors review the details of this case, outlining management strategies referencing their experience and that described in the other limited cases in the literature.