Advanced Hygiene Therapy - Developing a Comprehensive Approach

(Half or Full Day, Dentists, Hygienists)

Periodontal diseases are multi-factorial, chronic infections that cause destruction of periodontal structures and influence many non-oral disease processes in the body.  Treating periodontal diseases successfully involves understanding how and why the disease progresses and developing customized strategies that are aimed at disease control.  This course examines the latest evidence-based information related to patient care protocol, including (but not limited to) pathogenicity, disease progression considerations, patient classification, pain control modalities, traditional and novel treatment sequence and protocol, and documentation of periodontal care.  Also covered are periodontal maintenance strategies and liability risk/informed refusal.

Course Objectives – Attendees should be able to:

  • Understand the role of the host and microbes in disease etiology.
  • Implement evidence-based treatment strategies.
  • Implement effective sequencing protocol for the periodontal patient.
  • Understand the role of inflammation.
  • Use proper pain control techniques.
  • Implement proper aerosol control procedures.
  • Understand proper documentation.
  • Discuss the usage of intrapocket therapies.
  • Implement enhanced verbal skills with patients.
  • Ascertain when referral to a specialist is needed.
  • Understand liability risks associated with refusal of definitive care.

Course Outline


1) Understanding periodontal disease

a) Etiology and microbes associated with disease progression

b) Bacterial complexes and role of viruses


2) Pathogenesis of periodontal disease

a) Role of biofilm

b) Biofilm structure

c) Efficacy of various antimicrobials

d) High velocity lavage

e) Other risk factors


3) Inflammation

a) Classic signs

b) Aim of the inflammatory cascade

c) Therapeutic modulation

d) Tissue destruction

e) Role of the host



4) Factors in disease progression

a) Home care

b) Susceptibility

c) Systemic disease, condition, and drugs

d) Fear

e) Lifestyle factors

f) Local oral factors


5) Risk assessment of periodontal disease

a) Risk assessment tools

b) Limitations of BOP

c) Limitations of mechanical therapy


6) Microbiological testing and systemic antibiotics

a) Testing services

b) Protocol

c) Common antibiotic therapies

d) Antibiotic considerations

e) Indications for testing

f)  Host modulation therapy


7) Homecare considerations

a) Floss

b) Power brushes

c)  Dentifrice

d) De-sensitizing options


8) Treatment Protocol

a) The gingivitis patient

b) Early periodontitis patient

c) Moderate and advanced cases

d) Insurance coding considerations


9) Step-by-step debridement protocol

a) Blood pressure guidelines

b) Power and hand scaling

c) Adjuncts for sensitivity control

d) Scaling considerations

e) Ultrasonics and infection control

f) Treatment interval

g) Pain control modalities

h) Re-evaluation of periodontal therapy


10) Intrapocket therapies

a) Site specific therapies

b) Laser as an adjunct to treatment

c) Photo-dynamic therapy


11) Documentation of periodontal care

a) The “amnesia” test

b) Informed consent/informed refusal


12) Dealing with resistant patients


13) Wrap-up and questions



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