FM_IPC_AAP_553430 6/2/00 7:16 PM Page i Volume 71 • Number 5 • May 2000 (Supplement) JOURNAL OF Periodontology CONTENTS Parameters of Care Foreword ...............................................................i Overview...............................................................ii Parameter on Comprehensive Periodontal Examination......................................................847 Parameter on Periodontal Maintenance...............849 Parameter on Plaque-Induced Gingivitis..............851 Parameter on Chronic Periodontitis With Slight to Moderate Loss of Periodontal Support................853 Parameter on Chronic Periodontitis With Advanced Loss of Periodontal Support...............................856 Parameter on “Refractory” Periodontitis.............859 Parameter on Mucogingival Conditions ...............861 Parameter on Acute Periodontal Diseases ..........863 Parameter on Aggressive Periodontitis ...............867 Parameter on Placement and Management of the Dental Implant ..................................................870 Parameter on Occlusal Traumatism in Patients With Chronic Periodontitis .........................................873 Parameter on Periodontitis Associated With Systemic Conditions..........................................876 Parameter on Systemic Conditions Affected by Periodontal Diseases .........................................880 Foreword_IPC_AAP_553430 6/1/00 9:48 AM Page i Foreword The Parameters of Care were developed by the Ad 60611-2690; voice: 312/787-5518; fax: 312/787-3670; Hoc Committee on the Parameters of Care and have e-mail: [email protected]. been approved by the Board of Trustees of the Amer- This material is also accessible through the Acad- ican Academy of Periodontology. This publication has emy’s Web site, www.perio.org, under the Resources been edited to reflect decisions by the Board of and Products Section. Trustees in approving the term “periodontal mainte- Members involved in the development of these Pa- nance” in lieu of “supportive periodontal therapy” (Jan- rameters are: Donald A. Adams; Erwin P. Barrington uary 2000) and a new classification of periodontal dis- (Chair); Jack Caton, Jr.; Robert J. Genco; Stephen F. eases, as published in the Annals of Periodontology, Goodman; Carole N. Hildebrand; Marjorie K. Jeffcoat; December 1999; Volume 4, number 1 (April 2000). Fraya Karsh; Sanford B. King; Brain L. Mealey; Roland Individual copies of this supplement may be pur- M. Meffert; James T. Mellonig; Myron Nevins; Steven chased by contacting the Product Services Depart- Offenbacher; Gary M. Reiser; Louis F. Rose; Paul R. ment, American Academy of Periodontology, 737 Rosen; Cheryl L. Townsend (Chair); and S. Jerome North Michigan Avenue, Suite 800, Chicago, Illinois Zackin. i Overview_IPC_AAP_553430 6/1/00 9:49 AM Page ii Overview In response to increasing concerns on the part of ical conditions. Although the parameters vary in their health care providers, third-party payers, and con- specificity and research base, they incorporate the best sumers about the quality, cost, and access to dental available knowledge on the diagnosis, prevention, and care, the American Academy of Periodontology has treatment of periodontal diseases. developed practice parameters on the diagnosis and Each parameter should be considered in its entirety. treatment of periodontal diseases. These parameters It should be recognized that adherence to any para- are strategies to assist dentists in making clinical deci- meter will not obviate all complications or post-care sions from a range of reasonable treatment options to problems in periodontal therapy. A parameter should achieve a desired outcome. Practice parameters are not be deemed inclusive of all methods of care or designed to help the profession provide appropriate exclusive of treatment appropriately directed to obtain dental services while containing costs, without sacri- the same results. It should also be noted that these ficing quality. These parameters are constantly updated parameters summarize patient evaluation and treat- and are partially based on methodology utilized by ment procedures which have been presented in more participants in the American Academy of Periodon- detail in the medical and dental literature. tology 1996 World Workshop in Periodontics (Annals It is important to emphasize that the final judgment of Periodontology, Volume 1, 1996) to assess the evi- regarding the care for any given patient must be deter- dentiary status of periodontal and implant treatment. mined by the dentist. The fact that dental treatment The major goal is to improve treatment decisions by varies from a practice parameter does not of itself increasing the strength of the inference that practi- establish that a dentist has not met the required stan- tioners can derive from the base of knowledge con- dard of care. Ultimately, it is the dentist who must tained within the literature. determine the appropriate course of treatment to pro- There are several types of periodontal diseases, with vide a reasonable outcome for the patient. It is the den- many treatment options. The Academy has developed tist, together with the patient, who has the final respon- a series of parameters to address a full range of clin- sibility for making decisions about therapeutic options. ii 01_IPC_AAP_553430 6/1/00 9:00 AM Page 847 Parameters of Care Supplement Parameter on Comprehensive Periodontal Examination* The American Academy of Periodontology has developed the following parameter on comprehensive peri- odontal examination for periodontal diseases. Appropriate screening procedures may be performed to deter- mine the need for a comprehensive periodontal evaluation. Periodontal Screening and Recording (PSR), a screening procedure endorsed by the American Dental Association and the American Academy of Periodon- tology, may be utilized. J Periodontol 2000;71:847-848. KEY WORDS Periodontal diseases/diagnosis; dental history; medical history; patient care planning. PATIENT EVALUATION/EXAMINATION restorations, caries, tooth mobility, tooth position, Evaluation of the patient’s periodontal status requires occlusal and interdental relationships, signs of para- obtaining a relevant medical and dental history and functional habits, and, when applicable, pulpal status. conducting a thorough clinical and radiographic 6. Radiographs that are current, based on the diag- examination with evaluation of extraoral and intrao- nostic needs of the patient, should be utilized for ral structures. All relevant findings should be docu- proper evaluation and interpretation of the status of mented. When an examination is performed for lim- the periodontium and dental implants. Radiographs ited purposes, such as for a specifically focused of diagnostic quality are necessary for these pur- problem or an emergency, records appropriate for poses. Radiographic abnormalities should be noted. the condition should be made and retained. 7. The presence and distribution of plaque and 1. A medical history should be taken and evalu- calculus should be determined. ated to identify predisposing conditions that may 8. Periodontal soft tissues, including peri-implant affect treatment, patient management, and outcomes. tissues, should be examined. The presence and types Such conditions include, but are not limited to, dia- of exudates should be determined. betes, hypertension, pregnancy, smoking, substance 9. Probing depths, location of the gingival margin abuse and medications, or other existing conditions (clinical attachment levels), and the presence of that impact traditional dental therapy. When there is bleeding on probing should be evaluated. a condition that in the judgment of the dentist requires 10. Mucogingival relationships should be evalu- further evaluation, consultation with an appropriate ated to identify deficiencies of keratinized tissue, health care provider should be obtained. abnormal frenulum insertions, and other tissue abnor- 2. A dental history, including the chief complaint malities such as clinically significant gingival reces- or reason for the visit, should be taken and evalu- sion. ated. Information about past dental and periodontal 11. The presence, location, and extent of furca- care and records, including radiographs of previous tion invasions should be determined. treatment, may be useful. 12. In addition to conventional methods of evalu- 3. Extraoral structures should be examined and ation; i.e., visual inspection, probing, and radiographic evaluated. The temporomandibular apparatus and examinations, the patient’s periodontal condition may associated structures may also be evaluated. warrant the use of additional diagnostic aids. These 4. Intraoral tissues and structures, including the include, but are not limited to, diagnostic casts, oral mucosa, muscles of mastication, lips, floor of microbial and other biologic assessments, radi- mouth, tongue, salivary glands, palate, and the ographic imaging, or other appropriate medical lab- oropharynx, should be examined and evaluated. oratory tests. 5. The teeth and their replacements should be 13. All relevant clinical findings should be docu- examined and evaluated. The examination should mented in the patient’s record. include observation of missing teeth, condition of 14. Referral to other health care providers should be made and documented when warranted. * Approved by the Board of Trustees, American Academy of 15. Based on the results of the examination, a Periodontology, May 1998. diagnosis and proposed treatment