Parameters of Care Summary - Refractory Periodontitis
- This is not a single disease entity.
- Refers to the destructive periodontal diseases in patients who, when longitudinally monitored, demonstrate additional attachment loss at one or more sites, despite well-executed therapeutic and patient efforts to stop the progression of disease.
- The "refractory" designation can be applied to all forms of destructive periodontal disease that appear to be non-responsive to treatment; e.g., refractory chronic periodontitis and refractory aggressive periodontitis.
Conventional therapy that has usually been performed:
- Patient education and customized oral hygiene instructions.
- Scaling and root planing
- Local and/or systemic antimicrobial agents
- Eliminate or control local contributing factors.
- Surgical therapy
- Extraction of severely involved teeth
- Occlusal therapy
- Periodontal maintenance and re-evaluation
- Occurrence of additional clinical attachment loss after repeated attempts to control the infection with conventional periodontal therapy.
- Diagnosis should only be made in patients who satisfactorily comply with recommended oral hygiene procedures and follow a rigorous program of periodontal maintenance.
Diagnosis is not appropriate for patients who:
- Have received incomplete or inadequate conventional therapy.
- Have systemic conditions that may increase susceptibility to periodontal infections.
- Have localized areas of rapid attachment loss which are related to other factors.
- Root fracture, retrograde pulpal diseases, foreign body impaction, root anomaly.
- Have recurrence of progressive periodontitis after many years of successful periodontal maintenance.
- Arrest or slow the progression of the disease.
- Subgingival microbial samples, and possibly antibiotic sensitivity testing.
- Antibiotic regimen.
- Conventional periodontal therapies.
- Reevaluation with microbial testing.
- Identify and control risk factors.
- Intensified periodontal maintenance program.
- May include shorter intervals between appointments.
- May include microbiologic testing.
- Arresting or controlling the disease.
- Control may not be possible in all instances. In such cases, a reasonable objective is to slow the disease progression.
Source: Journal of Periodontology, Volume 71 Number 5, May 2000 (Supplement)
Parameters are available for download from the AAP web site.