Treatment+Options

After the diagnosis and prognosis have been established, the treatment is planned. The treatment plan is an outline for the management of each individual patient. It includes all procedures needed to improve or maintain the patients oral health. The following treatment options will need to be explained to the patient prior to implementing them: Unforeseen developments during treatment may necessitate modification of the initial treatment plan. However, //except for emergencies, no treatment should be started until the treatment plan has been established. FerminA. Carranza and Henry H. Takei//
 * Treatment Options**
 * Teeth to be retained or extracted.
 * Pocket therapy techniques, surgical or nonsurgical, that will be used.
 * The need for occlusal correction, before, during, or after pocket therapy.
 * The use of implant therapy.
 * The need for temporary restorations.
 * Final restorations that will be needed after therapy, and which teeth will be abutments if a fixed prosthesis is used.
 * The need for orthodontic consultation.
 * Endodontic therapy.
 * Decisions regarding esthetic considerations in periodontal therapy.
 * Sequence of therapy.

**Patient care can always be modified due to unforseen circumstances, but a treatment plan has to be established before any treatment is done. The listed items on the have to be explained so that the patient understands what is going to be provided. The reason why the treatment if going to be done and the anticipated outcome. A patient needs to understand for example how long a crown is going to last or will their disease process stop.**

The goal for the treatment plan is total treatment that is the coordination of all the treatment procedures for the purpose of creating a well-functioning dentition in a healthy periodontal environment. The treatment plan is based is on the diagnosis and disease severity as well as other factors that may effect what treatment should be done first. The primary goal is elimination of gingival inflammation and correction of the conditions that cause and perpetuate it (Carranza 626) Changes may occur during the treatment making it necessary to modify the initial treatment plan. Nevertheless a treatment plan should always be established prior to beginning treatment, with the exception of emergencies (Carranza 626).

If a patient refuses treatment or refuses to remove hopeless diseased teeth the clinician needs to explain the consequences of no treatment which include: 1. Periodontal disease is a microbial infection, and research has clearly shown it to be important risk factor severe life-threatening disease such as stroke, cardiovascular disease, pulmonary disease, diabetes, and low-birth weight babies. Correcting the periodontal condition eliminates a serious potential risk of systemic disease. 2. It is not feasible to place restorations and bridges on teeth with untreated periodontal disease, because the usefulness of the restoration would be limiting by the uncertain condition of the supporting structures. 3. Failure to eliminate periodontal disease not only results in the loss of teeth already severely involved, but also shortens the life span of other teeth that, with proper treatment, could serve as the foundation for a healthy, functioning dentition.

__PHASES OF TREATMENT PLAN:__

1. Preliminary/Emergency Phase 2. Phase I Therapy: Etiotrophic Phase 3. Phase II Therapy: Surgical Phase 4. Phase III Therapy: Restorative Phase 5. Phase IV Therapy: Maintenance Phase

1. Preliminary/Emergency Phase: In the preliminary phase the patient is receiving emergency treatment. This is the phase where all the emergency and other critical situations under control such as extractions of hopeless teeth and provisional restorations such temporary acrylic bridges complete. Dental abscesses and periodontal abscesses are treated during the preliminary/emergency phase. Emergency endodontic therapy can be performed during this phase in order to give relief to the patient and out of pain.

2. Phase I Therapy (Etiotrophic Phase): Phase I Therapy is also known as initial or active therapy, non-surgical therapy, cause related therapy, or hygiene phase of treatment. This is the phase that a dental hygienist completes. In Phase I therapy, procedures to control and eliminate the etiologic factors of the disease process such as plaque are performed. The specific aim of phase I therapy is effective plaque control. In the beginning of Phase I therapy, patient education and oral hygiene instructions are given and reinforced. Risk management is performed if the patient is at risk due to caries, systemic factors such as diabetes mellitus, and/or smoking. If the patient has numerous caries due to eating habits and food choices, nutritional counseling is started. Tobacco cessation is also started to assist and advice patient to stop smoking. In Phase I therapy, scaling and root planing are performed and antimicrobial agents such as chlorhexidine gluconate or Arestin are used and placed subgingivally. Chlorhexidine gluconate can be recommended for home care in a specific duration of time. In this phase the patient receives education of plaque control as well as removal, gingival pocket measurements, prognosis, and calculus removal. Reevaluation of the periodontal case should occur about 4 weeks after completion of the scaling and root planning treatment.

3. Phase II Therapy (Surgical Phase): Phase II Therapy is the surgical phase of the treatment plan. Surgical procedures such as wisdom teeth extractions, periodontal surgeries such as osseous surgeries, gingivectomies, frenectomies, gingival tissue regeneration, or crown lengthenings, implant placements, and endodontic therapies are performed in this phase. This procedures are done to reduce the effects of the disease and restore and regenerate gingival tissues that was previously lost due to recession. In this phase the patient undergoes endodontic treatment or placement of an implant.

4. Phase III Therapy (Restorative Phase): Phase III Therapy is the restorative phase of the treatment plan. The restorative phase involves the final restorations such as placement of amalgam or composite fillings on teeth that have been diagnosed with caries by the dentist. It also involves restorations and replacement of missing teeth, involving the initial preparation for fsingle crowns or fixed bridges, the deliveries and cementations of single crowns or fixed bridges, and initial fabrications and deliveries of partial and full dentures. In this phase the patient has a perdiodontal exam to evaluate the response to the restorative phase, restorations placed on teeth with decay, fixed or removable appliances

5. Phase IV Therapy (Maintenance Phase): Phase IV Therapy is also known as the recall or re-care phase. The patient is placed and remains in Phase IV for a lifetime after all the phases that was treatment planned has been completed. Phase IV can also be called periodontal maintenance; thus the patient's periodontal health is continuously monitored and evaluated from hereon. Peirodontal maintenance can be performed simultaneously with Phase III. Periodontal maintenance can be done every 90 days or every three months; however, the interval actually depends on the condition and the plaque control of the patient. Assessments are gathered, plaque and calculus are removed, if necessary local anesthetics are administered, and chemotherapeutics are applied. This is the patient's recare appointment when the clinician checks all the assessments and for inflammation.

When considering treatment for patients suffering from NUG Nutritional Supplements may be recommended for patients suffering from NUG. The rationale for nutritional supplements in the treatment of NUG is based on the following:
 * Lesions resembling those of NUG have been produced experimentally in animals with certain nutritional deficiencies.
 * Difficulty in chewing raw fruits and vegetables in a painful condition such as NUG could lead to the patient selecting a diet inadequate in vitamins B and C.
 * Isolated clinical studies report fewer recurrences when local treatment of NUG is supplemented with vitamin B or vitamin C.
 * Early during therapy, when eating may be painful, the patient may benefit from the use of liquid medical nutritional supplements. The patient should then be placed on a natural diet with the required nutritional content as soon as the oral condition permits. Nutritional supplements may be discontinued after 2 months.
 * When the intake of water-soluble vitamins B and C has been severely curtailed because of pain in NUG, nutritional supplements may be indicated along with local treatment to ward off deficiencies of these vitamins. Under such circumstances the patient may be given a standard multivitamin preparation combined with a therapeutic dose of vitamins B and C. (Carranza, Klokkevold, Takei, & Newman 2006)

Isabel De Los Rios is a certified nutritionist and exercise specialist, who has put her time and energy into helping people learn about weight loss and disease prevention. **[|diet solution info]**