PERIODONTAL

THERAPY
Consists of:
PHASE I
PHASE II
PHASE III
PHASE IV

E&D

TREATMENT
PLANNING

INITIAL PHASE

TREATMENT

REASSESSMENT

BEHAVIORAL
CHANGE

OHE

PROPHYLAXIS

DEBRIDEMENT

CORRECTIVE
PHASE
SURGICAL
PROCEDURES

RECONSTRUCTIVE
PROCEDURES

OTHER DENTAL
TREATMENT
SUPPORTIVE PERIODONTAL CARE

Phase I therapy is referred to by many names;

Initial / first line therapy
Nonsurgical periodontal therapy
Cause-related therapy
Etiotropic phase of therapy

PHASE 1

PHASE 1
AIM of Therapy;
Elimination & prevention of recurrence of
supra / subgingivally located bacterial
deposits.

PHASE 1
Rationale
Reduction & elimination of etiologic & contributing
factors in periodontal treatment are achieved by;
- complete removal of calculus
- Correction of defective restoration
- Treatment of carious lesion
- Comprehensive
daily
plaque
control
regimen
Provided to all patients with periodontal pockets who
later will be evaluated for surgical intervention (gingivitis
/ mild chronic periodontitis).

PHASE 1
Components:

Relief pain
Patient education &
motivation
Behavioral change
Plaque control & oral
hygiene care
Prophylaxis
Scaling & root
debridement
Chemical control of
plaque deposition

Correction/ replacement
of poorly fitting
restorations & prosthetic
devices
Restorations of carious
lesions
Orthodontic tooth
movements
Treatment of occlusal
trauma
Endodontic treatment
Extraction of hopeless
teeth

PHASE 1
OHE Patient Information
Indications:
- Low oral health knowledge, awareness,
motivation & compliance.
- Poor self performed plaque control,
smoking & other psychosocial behaviors.
- High risk individuals to plaque induced
diseases.

PHASE 1
OHE Patient Information
- To provide information about dental health
demonstration to the patient of the disease
present in the mouth.
- To provide information & guidance about
the techniques of plaque control.

PHASE 1

OHE Patient Motivation

Change in knowledge
Change in understanding
Change in attitude
Change in habit
Use simple everyday language & avoid
jargons

PHASE 1
Behavioral Change
- Diet counseling encourage balanced diet
and frequency.
- Smoking cessation (smoking risk factor
for periodontitis), it will increase in
progression of disease, alter the fibroblast
function & impair wound healing.

PHASE 1
OHI
- Tooth brushing method:
Roll roll method or Modified Stillman technique
Vibratory Bass Technique
Circular Fones Technique
Vertical Leonard Technique
Horizontal Scrub Technique

PHASE 1
OHI
Recommendation of toothbrush design:
- Soft
- Nylon bristle
- Toothbrushes need to be replaced about
every 3 months (or replace when it start to
show sign of matting).

PHASE 1
OHI
- Powered toothbrush also can remove
plaque effectively (properly used).
- Patients need to be instructed in the proper
use of powered devices.
- Patients who are poor brushers, children &
caregivers may particularly benefit from
using powered toothbrushes.

PHASE 1
OHI Interdental Cleaning Aids
- Cleans the interdental region (most common
site for plaque retention).
- Most inaccessible site to tooth brushing.
- Dental floss
- Interdental space brush

PHASE 1
OHI Interdental Cleaning Aids (Dental Floss)
Technique;
- 12 18 inches of floss wrapped around the fingers /
the ends may be tied together in a loop.
- Stretch the floss tightly between the thumb &
forefinger/ between both forefingers & pass it gently
through each contact area with a firm back-and-forth
motion.
- Move the floss across the interdental gingiva &
repeat the procedure on the proximal surface of the
adjacent tooth.

PHASE 1
Prophylaxis
- Removal of supragingival plaque & calculus
(scaling & polishing).
- Removal of plaque retentive factors;
Smooth roughness of restoration
Removal of overhangs
Ill-fitting / rough prosthesis
Removal of staining

PHASE 1
Non surgical Instrumentation
Scaling procedure of removal of plaque &
calculus from the tooth surface.
Root debridement hard/ powered driven
subgingivally instrumentation aimed at removal
of toxic substances without
overinstrumentation / intentional removal of
cementum to produce a root that is biologically
acceptable for a healthy attachment.

PHASE 1
Non surgical Instrumentation
- Chemotherapeutic approaches
Topical application of antiseptics to prevent
plaque accumulation & to disinfect the root
surfaces.
Mouthrinses
Chlorhexidine
Chip-perio chip
Solution injection elyzol/periocline

PHASE 1
Non surgical Instrumentation
- Chemotherapeutic approaches
Systemic approach selective use of antibiotic
or host modulation of tissue destructive
enzymes (Doxycycline).
Rationale;
Pathogenic organisms that were not accessible
to mechanical removal by hand/power driven
instruments can be reduced/eliminated.

PHASE 1
Treatment Sessions
- The following conditions must considered to
plan Phase 1 treatment sessions needed;
General health & tolerance of
treatment
Number of teeth present
amount of subgingival calculus
Probing pocket depths &
attachment loss
Furcation involvement

Alignment of teeth
Margins of restorations
Developmental anomalies
Physical barriers to access (limited
opening / tendency to gag)
Patient cooperation & sensitivity
(requiring anesthesia / analgesia)

PHASE 1
Step 1 (Limited Plaque Control Instruction)
- Should start in 1st appointment & should
include only the correct use of toothbrush
on all surfaces of the teeth.
- Use of dental floss should await the removal
of calculus & overhanging restorations.

PHASE 1
Step 2 (Supragingival Removal of Calculus)
- Can be done by scalers, curettes or
ultrasonic instrumentation.

PHASE 1
Step 3 (Recountouring Defective
Restorations & Crowns)
- May require replacing the entire restoration
or crown or correcting it with finishing burs
or diamond-coated files mounted on the
special handpiece.

PHASE 1
Step 4 (Obturation of Carious Lesion)
- Involves complete removal of the carious
tissue & placement of final or a temporary
restoration.

PHASE 1
Step 5 (Comprehensive Plaque Control
Instrumentation)
- Patient should learn to remove plaque
completely from all supragingival areas,
using toothbrush, floss & other necessary
complementary method.

PHASE 1
Step 6 (Subgingival Root Treatment)
- Complete calculus removal & root planning
can be effectively performed.

PHASE 1
Step 7 (Tissue Reevaluation)
- The periodontal tissue reexamined to
determine the need for further therapy.
- Pocket are reprobed & all related anatomical
conditions are carefully evaluated to decide
whether surgical treatment is indicated.

PHASE 1
LIMITATIONS of NON-SURGICAL TREATMENT
Requires skill, practice & patience blind
tactile sensibility has to be developed to
achieve smooth root surface.
Root proximity & rotation, concavities &
ridges, groove, furcation & pits all causing
cleaning problems.

Roles of chemical agents (antiseptic &

antibiotic) in periodontics
The different of chemical plaque agent
Content, indication, limitation & effects of use
of these agents

CHEMICAL
PERIODONTAL THERAPY

CHEMICAL PERIODONTAL
THERAPY
GOAL
Removal of supragingival & subgingival
bacteria.

CHEMICAL PERIODONTAL
THERAPY
Supragingival plaque accessible to patient
(can effectively disrupted / removed using
toothbrush/ interproximal cleaning devices).
Mechanical plaque control can be effective
in preventing / reversing gingivitis.
If patient unable to perform mechanical
plaque removal use of chemotherapeutic
agents as an adjunct may be warranted.

CHEMICAL PERIODONTAL
THERAPY
TERMINOLOGY:
- Plaque inhibitory effect: reducing plaque to a level
insufficient to prevent the development of
gingivitis.
- Anti-plaque effect: produces a prolonged &
profound reduction in plaque sufficient to prevent
the development of gingivitis.
- Anti-gingivitis: anti-inflammatory effect on the
gingival health not necessarily mediated through
an effect on plaque.

CHEMICAL PERIODONTAL
THERAPY
Antimicrobial agents;
Can be used:
- Antiseptics
topically, locally
applied &
- Antibiotics
systemically
Miscellaneous agents;
- Matrix protein
- Growth factor
- Hydrogen peroxide

CHEMICAL PERIODONTAL
THERAPY
ANTISEPTIC AGENTS
- Directed against supra-gingival plaque
development
- Directed against sub-gingival bacteria

CHEMICAL PERIODONTAL
THERAPY
ANTISEPTICS
Topically (mouthwashes)
- Oradex chlorhexidine 0.12%
- Listerine antiseptic mouthwash (phenolic
compound/ essential oil)
- Plax (triclosan)
Typically act supra-gingivally.

CHEMICAL PERIODONTAL
THERAPY
ANTISEPTICS
Locally applied
- Slow release devices (biodegradable polymer, gel, fibers,
collagen)
- Applied into periodontal pockets:
Perio Chip (2.5 mg chloroxedine in gelatin
matrix)
Atrigel (5% sanguinarine)
Typically act sub-gingivally.

CHEMICAL PERIODONTAL
THERAPY
TOPICALLY ACTING CHEMICAL AGENTS
Requirement:
- Effective in reducing plaque & gingivitis
- Effective & remains for a sufficient amount of time to accomplish the
desired results (substantivity)
- Without development of resistant bacterial strains or damage to the
oral tissues.
- Cost-effective
- Pleasant to use
- Low toxicity without adverse effects
- High potency
- Good permeability & intrinsic efficacy

CHEMICAL PERIODONTAL
THERAPY
ANTISEPTICS Mouthwashes
Quaternary ammonium compound (cetylpyridium chloride)
Hexidine Bactidol
Oxygenating agents hydrogen peroxide
Amine alcohols Delminol
Povidone iodine natural products sanguinarines
All these available either as mouthwashes, irrigation,
toothpaste, gel/ spray.

CHEMICAL PERIODONTAL
THERAPY
TOPICALLY ACTING CHEMICAL AGENTS
CHEMICAL SUPRAGINGIVAL PLAQUE CONTROL
Bisguanides

Chlorhexidine, Alexidine

Phenolic compounds

Listerine, Thymol & other essential oils

Quartenary ammonium compound

Amyloglucosidase, Glucose oxidase

Enzymes

Cetylpyridium chloride, Benzalconium

chloride

Oxygenating agents

Hydrogen peroxide, Peroxyborate

Fluorides

Sodium fluoride, Stannus fluoride, Sodium

MFP

Other antiseptics

Triclosan, Povidone Iodine, Hexetine

CHEMICAL PERIODONTAL
THERAPY
CHLORHEXIDINE
Bisguanide compound
Dicationic and strong base
Prolonged action
Concentration 0.2% or equivalent
The only product to kill bacteria
Not act as anti-adhesive
Only can penetrate into thin plaque not thick /mature
(calculus) plaque.
Can inhibit the plaque formation but cannot eliminate the
plaque in untreated mouth.

CHEMICAL PERIODONTAL
THERAPY
CHLORHEXIDINE
Broad spectrum antiseptic which possess anti-plaque
activity.
Mostly available in digluconate salts formulations.
Strong base & dicationic at pH levels above 3.5 with 2
positive charges on either side of hexamethylene bridge.
At low concentration cause increase in cell membrane
permeability & leakage of intracellular components.
At high concentration precipitation of bacterial cytoplasm
& cell death.

CHEMICAL PERIODONTAL
THERAPY
PHENOLIC COMPOUNDS
Eg: Listerine
Have moderate plaque-inhibitory effects &
some anti-gingivitis effect.
Less effective than chlorhexidine but more
powerful than triclosan.

CHEMICAL PERIODONTAL
THERAPY
CHX
- As a broad spectrum antimicrobial agent,
have no bacterial resistance reported & no
evidence of superinfection by fungi / viruses.

CHEMICAL PERIODONTAL
THERAPY
INDICATION:
CHX m/w indicated to post perio-surgical patient to reduce
the bacterial load / to prevent plaque formation at time
when mechanical cleaning may be difficult due discomfort.
Patient with mental & physically disabilities lack of manual
dexterity in;
- Parkinson disease
- Adjunct to immunocompromised such as HIV/AIDS
- Cerebral palsy
In this situation, advisable agent would be CHX m/w.

CHEMICAL PERIODONTAL
THERAPY
INDICATION:
CHX m/w can be prescribed to patient
wearing orthodontic appliance & also for
patient with intermaxillary fixation following
trauma / orthognathic surgery.
As an adjunct to mechanical instrumentation
in case such as refractory periodontitis &
locally applied antimicrobial agents can be
used.

CHEMICAL PERIODONTAL
THERAPY
LIMITATION:
CHX particular inhibit plaque formation in a
clean mouth but not significantly reduce
bacterial load in untreated mouth.
CHX m/w cannot penetrate into gingival
crevice, therefore have no place in control of
chronic periodontitis presence of deep
pocket of >5 mm.

CHEMICAL PERIODONTAL
THERAPY
LIMITATION:
CHX have local side effects such as;
- Tooth & tongue staining
- Staining tooth-colored restorations (composite &
porcelain)
Reversible parotid swelling
Numbness of tongue taste disturbance
Bitter taste
Mucosal erosion are also reported

CHEMICAL PERIODONTAL
THERAPY

Periodontitis can be classified by:

Disease activity (chronic/aggressive)
Cause (specific bacterial, fungal / viral infection)
Site (localized or generalized)
Extent (size & morphology defects)
Type of associated gingivitis (chronic/necrotizing)
Type of patient (child, adolescent, adult/ compromised)

Non-specific plaque theory (reduction of bacterial load)

Specific plaque theory (specific plaque therapy)

CHEMICAL PERIODONTAL
THERAPY

ANTIBIOTICS
1. Use of antibiotics (systemically / local application) mainly
directed against specific bacteria & sub-gingival plaque to
target identified periodontal pathogens. Eg. In ANUG &
localized aggressive periodontitis.
2. Antibiotics is directed against specific microorganisms, eg.
AA in specific plaque hypothesis in ANUG/P & aggressive
periodontitis.
3. While mechanical removal of plaque aimed at reduction of
bacterial load for non-specific plaque theory.

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTICS
4. If unresponsive pockets (after reassessment therapy done
& no response to therapy), chlorhexidine in slow release
of polymer can be used locally, advantage of that, agents
can be sustained release within the pocket. Locally applied
antibiotics also can be used in this situation.
5. Used of antibiotics in periodontal abscess usually not
necessary if the abscess only localized unless there are
signs of spread of infection to systemic area / sign of
cellulitis/ lymphadenopathy.

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTICS
6. Post surgical rinsing with chlorhexidine mouthwash
mainly due to inability to mechanically removed
plaque because discomfort.
7. Post surgical systemic antibiotic prescription may
not indicated, unless complex surgical procedures
been carried out (post-implant surgery) / patient is
medically compromised.

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTICS
8. Indication of use of antimicrobial agents to
patient with lack of manual dexterity or
with patients with mental disability is clear.
9. Patient wearing orthodontics appliances
cannot used chlorhexidine mouthwash for
a long term due to tooth & tongue staining
side effects.

CHEMICAL PERIODONTAL
THERAPY
Antibiotics agents:
Local application
Systemic use

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC Local Application
Antibiotics can be in form of:
Gel for topical application onto surface or
sub-gingival application.
May present in polymer.
Also present in the form of biodegradable
slow, release gel, hollow or solid fibers.

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC Local Application
Examples:
a. Elyzol gel - 25% of Metronidazole
b. Dentomycin gel - 2% of minocycline
c. Actisite tetracycline fibers (hollow/solid)
d. Periocline - 2% minocycline
e. Atridox - 42.5 mg Doxycycline
f. Arestin - 1 mg minocycline

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC Systemic Uses
In the form of liquid, tablets or capsules
suitable if patients diagnosed with
aggressive periodontitis ONLY.
Must finish antibiotic simultaneously with
the therapy/ root debridement.

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC Systemic Uses
(Aggressive Periodontitis )
Amoxicillin in combination with Metronidazole (if allergic to penicillin
give clindamycin);
- 250 mg amoxicillin & 200 mg Metronidazole tds for 4 to 7 days.
Tetracycline
- 250 mg tetracycline for 14 days
- Doxycycline 100 mg once a day for 14 days (double dose for first day
because half of it will bind to plasma & another half will be in blood).

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC Systemic Uses
(ANUG/P)
In case of ANUG/P, Metronidazole may be needed
for 3 4 days only.
- 200 mg Metronidazole tds for 3 4 days.
- Analgesic may be prescribed to patient diagnosed
with ANUG/P due to pain.
- Since the ANUG/P lesions being very painful to
mechanical plaque control, chlorhexidine may be
given.

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC Systemic Uses
For post-surgical systemic antibiotic,
Metronidazole may be needed for 1 7 days.
- 400 mg Metronidazole tds for 1 day.
- Analgesic may also prescribed.
- Chlorhexidine mouthwashes must be given
since the wound may be painful to
mechanical plaque removal.

CHEMICAL PERIODONTAL
THERAPY
ANTIBIOTIC Systemic Uses
Periostat is available as a
- 20 mg doxycycline taken twice daily about an
hour before or 2 hours after meals.
- Adjunct to scaling & root planning.
- Act as collagenase inhibitor (degrade collagen
at periodontal ligament/gingiva but not to
controlled the bacteria) at low concentration.
- Danger to develop bacterial resistance.
- Take about a month.

CHEMICAL PERIODONTAL
THERAPY
INDICATION:
Antibiotic prophylactic agents in which the risks of
bacterimia & infective endocarditis is high.
Systemic antibiotics prescribed are directed against specific
microorganisms as an adjunct to mechanical
instrumentation in aggressive periodontitis & ANUG/P.
The used of systemic antibiotic without cautions can lead to
development of bacterial resistance.
Certain individual may suffered from immediate
hypersensitivity which can be fatal.

General terms for a chemical substances

provides a clinical therapeutic benefit.

CHEMOTHERAPEUTIC
AGENTS

COMMON ANTIBIOTIC REGIMENS TO TREAT PERIODONTAL

DISEASES
Regimen

Dosage/Duration

Single Agent
Amoxicillin

500 mg

tds for 8 days

Azithromycin

500 mg

Once daily for 4 7 days

Ciprofloxacin

500 mg

Twice daily for 8 days

Clindamycin

300 mg

tds daily for 10 days

Doxycycline or Minocycline
Metronidazole

100- 200 mg

Once daily for 21 days

500 mg

tds for 8 days

Metronidazole + amoxicillin

250 mg of each

tds for 8 days

Metrinidazole + ciprofloxacin

500 mg of each

Twice daily for 8 days

Combination Therapy

Data from Jorgensen MG, Slots J: Compend Contin Educ Dent 21:111, 2000

CHEMOTHERAPEUTIC AGENTS
Monocycline
Effective against broad
spectrum of
microorganisms.
Suppresses spirochetes &
motile rods as effectively
scaling & root
debridement.
Less phototoxicity & renal
toxicity than tetracycline
but may cause reversed
vertigo.

Doxycycline
Same spectrum of activity
as minocycline & may be
equally effective.

CHEMOTHERAPEUTIC AGENTS
Metronidazole
Bactericidal to anaerobic
organisms & is believed to
disrupt bacterial DNA synthesis
in conditions with a low
reduction potential.
Effective against Porphyromonas
gingivalis & provetella
intermedia.
Used in ANUG, chronic
periodontitis & aggressive
periodontitis

Clindamycin
Effective against anaerobic
bacteria.
Effective in situations in
patient is allergic to
penicillin.
Shown efficacy in patient
with refractory
periodontitis.

CHEMOTHERAPEUTIC AGENTS
Ciprofloxacin
Quinolone active against
gram-negative rods,
including all facultative &
some anaerobic putative
periodontal pathogens.
Minimal effect on
Streptococcus species.
To fight AA.

Amoxicillin
Semisynthetic penicillin
with extended
antiinfective spectrum that
includes gram-positive &
gram-negative bacteria.
Used in management of
aggressive periodontitis in
both localized &
generalized forms.
Susceptible to
penicillinase.

CHEMOTHERAPEUTIC AGENTS
Amoxicillin Clavulanate
potassium
= Augmentin
Useful in managing patient
with localized aggressive
periodontitis or refractory
periodontitis.
This antiinfective agent is
resistant to penicillinase
enzymes produced by
some bacteria.

Guidelines for use of antimicrobial therapy

Clinical diagnosis
Health

Chronic periodontitis

Aggressive, refractory or medically

related periodontitis

Periodontal therapy including:

-Oral hygiene
-Root debridement
-Supportive periodontal treatment
-Surgical excess for root debridement or
-Regenerative therapy

Microbial analysis

-Antibiotic as indicated by microbial analysis

Effective

Ineffective

Supportive periodontal treatment

Sequencing of antimicrobial agents (modified from Jorgensen MG, Slots J: Compend

Contin Educ Dent 21:111, 2000)
Medically
related,
aggressive, or
refractory
periodontitis
(diagnosis)
-Periodontal
evaluation
-Review
medical
history
-Plaque
sampling

Periodontal
therapy
-Scaling & root
planning
-Place
subgingival
antimicrobials
-Betadine
irrigation
-OHI
-Periodontal
surgery

Periodontal
therapy

- 8 days regimen
antibiotics at
completion of root
debridement if
recommended by
reference lab
-Intraoral irrigation
at home
-Chlorhexidine
rinse for 2 weeks

Day 0

Reevaluation
-Evaluation of
response to
therapy
-Reinforce oral
hygiene
-Plaque
sampling as
clinically
indicated

6 8 weeks

Supportive
Periodontal
Therapy
-Periodontal
evaluation
-Review
medical
history
-OHI
-Scaling &
root planning
-Plaque
sampling as
indicated
clinically

Every 3 4
months

Assessment of Periodontal Treatment Outcome

Periodontal Risk Assessment

PHASE 2

PERIODONTAL RISK ASSESSMENT

DEFINITION:
Risk
probability that an event will occur in the future/ probability that an individual
develops a given disease.
Can divide into:
- Risk factor
- Risk indicator (determinant)
- Risk predictor
Risk Assessment
it is a process which qualitative / quantitative assessment are made of likelihood
for adverse effect to occur as a result of exposure to specified health hazards, so
it can be reduced, avoided / managed.

PERIODONTAL RISK ASSESSMENT

IMPORTANCE OF PRA
Periodontal disease is an imbalance of bacterial plaque & host susceptibility.
Role of the bacteria as initiator to periodontal disease & 1o etiology of
periodontal disease.
Host related factors (influence the presentation & progression of periodontal
disease).
All people are not equally susceptible to periodontal disease. (in longitudinal
study of Sri Lankan tea plantation)
All people are not equally response to periodontal therapy.(in longitudinal study
of well maintained 600 patients were followed for 22 years)
Successful of periodontal therapy.
- Early & corrective diagnosis
- Risk management
- Effective treatment

PERIODONTAL RISK ASSESSMENT

PURPOSE OF PRA
Identify disease severity
Identify the patient likelihood of developing
the disease
Understand future disease progression
For comprehensive treatment planning.
When To Perform:
1. To all new periodontal patient.
2. After active treatment before Supportive
Periodontal Therapy

PERIODONTAL RISK ASSESSMENT

RISK TO LOOK FOR:
RISK FACTOR

RISK INDICATOR

Biological plausible as a
causative agent for disease.

Biological plausible as a
causative agent for disease.

RISK PREDICTOR
No current biological
plausible as a causative
agent.

Shown to precede the

Where the associated only
development of the disease show by cross-sectional
in prospective clinical
studies.
studies & longitudinal
studies.

Shown to be associated
with disease on a crosssectional/ longitudinal
studies.

Eg: smoking & diabetes

Eg: markers/ historical

measure of disease/
number of missing teeth.

Eg: patient with HIV/ age/

gender/ race/
osteoporosis/ genetic
factors/ bacterial/ stress

PERIODONTAL RISK ASSESSMENT

CLINICAL PREDICTIVE FACTOR
TOOTH FACTOR
Tooth position
Caries
Defective
restoration margin
Bacterial
Furcation
Type of bony
defects

BLEEDING ON
PROBING
Low BOP <25%:
lower risk of disease
progression

POCKETS DEPTH
Increased number
of remaining deep
pocket 6mm
following Initial Phase
Therapy : greater risk
for disease
progression

PERIODONTAL RISK ASSESSMENT

METHOD TO IDENTIFY INDIVIDUAL AT RISK
Diagnostic test Clinical parameters, PD, BOP &
r/g.
GCF analysis & saliva-oral microorganism,
neutrophil defects, genetic markers & antibody.
Subjective risk assessment asking environmental
risk.

PERIODONTAL RISK ASSESSMENT

PRA MODEL
RISK

BOP
(%)

PPD
>5mm

TOOTH
LOSS

BL/AGE

SMOKING/
day

GENETIC/
SYSTEMATIC

LOW

0-9

0-4

0-4

0.05

MOD

10-25

5-8

5-8

>0.05
1.0

10 - 19

HIGH

>25

>8

>8

>1.0

>19

Coding System For PRA (Lang & Tonetti 2003)

Coding System For PRA:

LOW all low risk + 1 MOD risk
MOD 2 MOD + 1 HIGH risk
HIGH 2 HIGH risk

BOP bleeding on probing

PPD periodontal pocket depth
BL bone loss
MOD moderate

PERIODONTAL RISK ASSESSMENT

BL/Age
% of bone loss in the worst site of posterior tooth
measured from PA / BW.
Then devide it by patients age.
Eg. If a 40 year old man suffered 20% of bone loss
at mesial of 46:
20/40 = 0.5 = LOW RISK