Topics in HIV medicine: a publication of the International AIDS Society, USA, 13(5), 143-148. Careful counseling may be necessary to temper his expectations to the reality of his current oral health status. Treatment Planning Framework: The patient was classified as functionally independent. Destruction of the gums and supporting teeth structures may be observed, The specialist will look for plaque and tartar buildup and check how tender and how easily the gums bleed, A thorough analysis of the individual’s medical history and medications being taken, X-rays of the jaw, head, and neck area can be taken to detect the extent of bony involvement, which is caused by the inflammation, An MRI scan or CT scan of the head and neck region can be used to detect the extent of the damage to the jaw, head, and neck, Tests to determine any underlying illness causing poor immune system such certain blood conditions and HIV infection, In rare cases, an oral tissue biopsy may be performed, Severe emotional stress from cosmetic concerns, Permanent and irreversible injury to the dental cavity and supporting structures due to the very destructive nature of the condition, Occasionally, the condition may be life-threatening, Administration of pain-killing medications, Administering systemic antibiotics (amoxicillin and metronidazole); or doxycycline, for those with penicillin allergy. When treating periodontal disease in older adults, the philosophy of saving teeth takes on an increased level of importance. Heasman PA, Hughes FJ. Antibiotics should be given immediately to avoid significant tissue destruction. (2005). Moreover, the role of some viruses (CMV and herpes) and fungi (Candida species) in disease development is seen. All diseases of periodontal disease as a whole, one way or another, affect the state of human health and significantly reduce the quality of life. 1 The subclassifications of chronic periodontitis are based on whether the anatomical changes are localized or generalized, and are organized by the amount of attachment loss: mild (1 mm to 2 mm), moderate (3 mm to 4 mm), and severe (≥5 mm). (2000). Modifiable risk factors in periodontitis: at the intersection of aging and disease. The treatment plan for Necrotizing Ulcerative Periodontitis may involve oral cleaning, removal of plaque, to medication administration for bacterial infection. Axelsson P, Lindhe J, Nyström B. They can access dental care on their own and make decisions based on their financial ability and values. A systematic assessment on periodontal disease classification and confounders was conducted using all publications in MEDLINE, EMBASE, SCOPUS, and Google Scholar … When gingivitis is … Drugs, medications and periodontal disease. The treatment plan is the blueprint for management of the dental case and is an essential aspect of successful therapy. •Generalized advanced chronic periodontitis Recommended treatment plan: • Improved oral hygiene. He presented to the appointment requesting improved esthetics in his front teeth. The patient had experienced some tooth loss despite receiving regular prophylaxes. If bone levels are not age appropriate, Wennstrom recommends continued supportive therapy until clinical stability is reached or, alternatively, examining the need for reinitiating active therapy.27 A more elaborate but generic oral care algorithm developed by Ettinger and Beck14 also is a useful tool in treatment planning for older adults. When this plaque is left on the teeth for extended periods of time, it hardens, and (usually gram-negative) bacteria in the mouth start to release toxins that damage the gums, Over time as the plaque builds up, pockets form between the teeth and gums that lead to deeper infection of the gums. If retaining a periodontally compromised tooth does not improve the treatment plan, it should be extracted. NUP (Necrotizing Ulcerative Periodontitis), Necrotizing Ulcerative Periodontitis (NUP) is a more severe form of necrotizing periodontal disease where involvement of the teeth-attaching soft tissue and jawbone is observed. Kerry GJ. Obviously more research is required. Journal of periodontal research, 38(2), 147-155. Shay K. Identifying the needs of the elderly dental patient. The prognosis of the condition depends upon its severity and on the associated condition causing weak immunity (if any), Necrotizing Ulcerative Periodontitis is generally seen in individuals with poor immune function, The condition is also observed among young malnourished children in developing countries, No preference for any race or ethnic group is seen, Conditions causing immunodeficiency including HIV infection (or AIDS), blood disorders such as leukemia and neutropenia, cancer, and poorly-controlled diabetes mellitus, are the primary risk factors, Medications that lead to weak or suppressed immunity such as corticosteroids or cancer drugs, In children and adults, severe malnutrition and nutritional deficiency disorders, Smoking and tobacco use: Heavy and chronic tobacco use increases the risk of developing periodontitis to a great extent, Generally, the older the age, the greater is the risk, Genetic susceptibility: Some individuals are more genetically predisposed and have a higher risk of developing severe forms of gum disease, A positive family history of periodontal disease, Early form of gum disease (or gingivitis), which is left untreated, Changes in hormonal levels due to various health conditions, Poor oral habits: This facilitates bacterial growth in the mouth thereby increasing the risk for developing periodontitis, Certain diseases and disorders (heart diseases and rheumatoid arthritis), Some individuals can have abnormal teeth structure that may place the individual at a higher risk; this feature may run in certain families, Severe gum infection leads to plaque buildup on the affected teeth (or tooth). Bacterial diversity in necrotizing ulcerative periodontitis in HIV-positive subjects. Additionally, he had Type III Chronic Periodontitis and well controlled hypertension. Significance of frequency of professional tooth cleaning for healing following periodontal surgery. All … Treatment usually includes improving oral hygiene, dental scaling and root planing, as well as systemic and local antibiotic therapy. It is important to remove plaque and calculus to restore periodontal health. A … In fact, Fardal and Grytten12 reported that the cost of maintaining dental implants was five times higher than the expense of maintaining teeth with periodontal diseases. Reasonable Treatment Alternatives: Treatment options included achieving periodontal stability either nonsurgically or surgically after strategic extractions and replacement of edentulous areas with partial dentures or with implants supported by fixed partial or hybrid dentures. A comparison of teeth and implants during maintenance therapy in terms of the number of disease-free years and costs—an in vivo internal control study. Wiebe, C. B., & Putnins, E. E. (2000). © 2002-2020 Belmont Publications, Inc. • All Rights Reserved. In this case study, treatment planning concepts for older adults are illustrated using Ettinger’s framework.14 A 90-year-old white man was referred by his general dentist because of spontaneous pain in his front right tooth, but the pain had since resolved. Older adults often are on several anti-inflammatory drugs, some of which may promote periodontal health.20 Several nonsteroidal anti-inflammatory drugs also inhibit alveolar bone loss.21 In contrast, long-term corticosteroid use has no obvious influence on periodontal diseases.22 Anti-TNF-? Jimenez, L. M., Duque, F. L., Baer, P. N., & Jimenez, S. B. Fardal Ø, Grytten J. Early detection of the signs of chronic periodontitis is essential to halting disease progression and improving outcomes. Patients on intravenous bisphosphonates may be at increased risk of osteonecrosis of the jaw after invasive periodontal or oral surgeries. Available at: oppi.gobierno.pr/Censo_C_SPAN_Slides_Disability2012.pdf. Pain control and management of systemic manifestations is also a treatment goal. We hope you find this practical approach to exploring periodontal diseases to be a valuable resource in helping you provide a more integrated and focused means of assessing the need for dental services. Case definitions and criteria of periodontal diseases are not yet consistent worldwide. Atieh MA, Alsabeeha NH, Faggion Jr CM, Duncan WJ. Tooth loss among adults is associated with progressive periodontitis. He was diagnosed with secondary occlusal trauma and mucogingival defects around several teeth. Part of the answer lies in the fact that peri-implantitis shares the same risk factors as periodontitis. Use of GaAIAs Laser in the Treatment of Necrotizing Ulcerative Periodontitis in Patients Seropositive for HIV/AIDS. Journal of Oral Laser Applications, 7(1). Pers J-O, Saraux A, Pierre R, Youinou P. Anti-TNF-alpha immunotherapy is associated with increased gingival inflammation without clinical attachment loss in subjects with rheumatoid arthritis. They usually need transportation to dental offices, or services may need to be provided in their institutional setting. Your dentist or periodontist will develop an individualized treatment plan based upon your risk … As periodontitis … An important consideration when formulating treatment plans for older adults is their ability to provide informed consent. Currently, the best approach to prevent the development of Necrotizing Ulcerative Periodontitis is to maintain good oral hygiene and adequately treat underlying conditions. 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