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Questions To Ask In Periodontal Treatment Planning

Up to this point I have posted several blogs concerning the periodontal assessment. We’ve talked about periodontal charting, the evaluation of radiographs, the assessment of local factors, etc. I like to refer to the accumulation of this information as the science of the periodontal assessment. It is black or white. A 5 millimeter pocket is a 5 millimeter pocket. A class 2 furcation exposure is a class 2 furcation exposure. The exam findings are what they are. The diagnosis is what it is.

However, now we must move into the art of the assessment. When we undertake periodontal treatment planning, we realize that there is a patient attached to these teeth. This is when a 5 millimeter pocket in an 18 year old is not the same thing as a 5 millimeter pocket is an 80 year old. This is when we develop a treatment plan. This is when our basic philosophy of care comes into play.

It’s my goal to help my patients keep their teeth in a state of health for the rest of their lives. I want their teeth to function well without discomfort. I want them to feel their teeth are aesthetically pleasing.

Now, let’s go back to our two patients with 5 millimeter pockets. Would we use the same treatment approach for both? Would our criteria for success be the same for both? I don’t think so and here’s why.

Our 80 year old patient has had 70 or so years to develop this pocket. Our 18 year has had only 10 or so years. You can conclude from this that the level of resistance is better in the 80 year old. Further, if our 80 year old is lucky, he or she will have about 20 years to use this tooth. Our 18 year old may have 80 or more. No, I can’t predict the future but we can make reasonable assumptions.

I believe one can make an argument that the approach for treating the 80 year old should be a much more conservative one than the approach for treating the 18 year old. Also, I believe a less than ideal result is acceptable for the older patient. For example, a residual 5 millimeter pocket in the presence of little or no bleeding upon probing even with a residual vertical bone defect is just fine for our elderly patient. For our teenager, surgery along with an augmentation procedure should be considered.

periodontal treatment

The above example is very simplistic. My point is the age, health, desire, etc. of our patients need be considered when planning treatment.

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