Expected+Outcomes+of+Phase+I+Therapy



Non-surgical periodontal therapy has demonstrated the reduction C-reactive protein (CRP), fibrinogen, and white blood cell (WBC) counts. These three serum levels are markers of inflammation and are associated with coronary heart disease risk. A result from the reduction of these serum inflammatory marker levels may reduce the risk of CHD.
 * 1. Phase I periodontal therapy can potentially reduce the risk of CHD. AP12 **

**2. Surgical therapy has demonstrated to be more effective than scaling and root planning in elimination of pocket depths.**Phase I therapy involves the elimination of the microbial etiology, plaque control, and treatment of carious lesions. Referral to the specialist is indicated when the there is no improvements after phase I therapy or depending on the extent of the disease. One study evaluated the outcome of a surgical group and a nonsurgical group in patients with advance periodontal disease.The surgical therapy group had a greater reduction in the pocket depths when compared to the nonsurgical therapy group 1-3 years after the intervention. The treatment for each group started at a different phase, leaving doubts if the surgical group received the most appropriate treatment.MC#3

3-4 weeks inflammation is normally reduced and long junctional epithelium is formed. The idea of re-evaluation is using assessments to determine if the initial therapy was effective or if other treatment, such as periodontal surgery, is needed.
 * 3. Re-evaluation should be completed at 4 weeks after the completion of scaling and root planning. KT4 **

**4. Phase I therapy can help reduce complications in pregnant women. GE #6** Studies have shown to help reduce the incidence of low birth weight, and pre-matures babies. Phase I therapy is recommended in women that have moderate and advance periodontitis to receive phase I therapy during there pregnancy. There have been reviews on studies to show the effectiveness of Phase I therapy and has shown to be effective and reliable. The purpose of Phase I therapy is to reduce or eliminate any factors that may progress that patient periodontal status. By eliminating local irritate factors allows the surrounding tissue to heal and inflammation to reduce. Studies have also shown that greater outcomes of Phase I therapy can be achieve with the use of a subgingival placement treatment in deeper pockets. However, advanced or complicated cases require specialized treatment. Therefore each patient should be individualized when determining the proper treatment plan for them, no two patient's are alike.

**5. Clinical and environmental considerations play a role in the outcomes of phase I therapy. MW 19** Although scaling and root planing can be an effective means for healing, including reduced bleeding and increased attachment, much of the success can depend on patient clinical and environmental factors as well. This can include furcations, existing restorations with faulty margins, smoking, diet, and home care. For example furcations may have less success with healing compared to a tooth that does not have a furcation, and the conditions of existing restorations can make home care very difficult for the patient. Also, what the patient is eating, how often they are brushing and flossing, and whether or not they smoke all must be considered when making a prognosis for teeth, and predicting possible outcomes of treatment.

**6. Salivary Interleukin-1beta levels show a correlation to periodontal disease LM # 11**Salivary levels were taken before and after Phase I therapy in order to measure the amount of interleukin-1beta levels. Patients with moderate to severe periodontal disease showed higher levels of interleukin-1beta even a month after scaling and root planing. Interleukin-1beta's are cytokine proteins that are activated by macrophages. This cytokine plans an important role in the inflammatory process as well as cell proliferation, differentiation and apoptosis. Therefore, concluding that with more research it can be proven that these interleukin-1beta are a marker for periodontal disease.

**7. Recall interval should be based on the individual patient. MT #18**When placing a patient on a recall interval it must be appropriate for their needs. Factors to consider are: periodontal status, patient compliance, systemic conditions, restorations, and patients dexterity.

**8. The goal of Phase I therapy is to stop the progression of gingival and periodontal diseases and return the dentitiion to a state of health. TL #8**This is done by by eliminating or minimizing the microbial etiology and contributing factors. These include plaque control, calculus removal, correction of defective restorations and the removal of carious lesions.

9. **Phase I Therapy determines the success of treatment. ** Phase I therapy is needed to remove etiological and contributing factors. An assessment of the patient attitude is also evaluated in phase I therapy. This analysis can determine the treatment outcome of the patient. By first removing the local irritants the tissues is given a chance to heal properly. Along with removal of the irritants the patient is given OHI to maintain the patient oral health. If the tissue is not healing properly there may be a need for a specialist referral. SR 14

Phase I Therapy AKA: Initial therapy, nonsurgical periodontal therapy, or cause-related therapy.
 * 10. Phase I therapy can reduce the cell count present in crevicular fluid. RK 7 **

Phase I Therapy Objective Is to alter or eliminate the microbial etiology and contributing factors for gingival and periodontal diseases, in order to reduce the progression of disease and return the dentition to a state of health and comfort. The specific aim of Phase I therapy for every patient is effective plaque removal. By assessing and eliminating contributing local factors patient’s will be able to readily access and remove the plaque with oral hygiene aids.

Examples of Local Contributing Factors: Calculus, poorly fitting restorations, caries lesions, crowded teeth, areas where food may become impacted, hopeless teeth, and pregnancy. In addition to the amount of calculus, the following conditions should be considered when planning phase I therapy: General health, number of teeth present, pocket depths, furcation involvement, alignment of teeth, margins of restorations, physical barriers, and patient co-operation.

Overview: Phase I therapy involves complex and individualized treatment which requires detailed analysis of each patient’s disease and contributing factors, along with customized therapy. Phase I therapy treatment includes plaque control by scaling and root planning to remove supra-gingival and sub-gingival calculus. Its outcome can be affected by patient’s oral home care. The healing is evaluated 4 weeks after treatment in order to permit time for both the epithelial and connective tissue to heal.

Knowing when to refer: Many patients are treatable in the general dentist’s office and likely to heal well after phase I therapy that no further treatment is required beyond routine maintenance. Patients who present with a 5mm or greater loss of attachment at their re-evaluation appointment should be referred to a specialist. At this stage a specialist can help preserve the tooth by eliminating deep pockets and regenerating support for the tooth. Other factors that are taken into consideration when deciding whether or not to refer a patient are: The extent of the disease, the length of the roots, mobility, difficulty of scaling, and restorative work.

A study was conducted to evaluate the effectiveness of phase I therapy in reducing the cell count present in crevicular fluid. It consisted of nineteen participants who had advanced periodontitis. Each patients dentition was divided into two, one side was treated with an ultrasonic and the other with manual instrumentation. The following assessments were taken nine months prior to treatment, immediately prior to treatment, and one month after treatment: gingival index, plaque index, bleeding index, bleeding on probing, probing depths, and probing attachment levels. The cell count was obtained through crevicular fluid that was collected in 3 to 4 sites, per patient, at the same time. The crevicular fluid was then stained with ethydium bromide-fluorescein-diacetate in order to evaluate the presences of leukocytes. The previous assessment was taken pre and post treatment. The results found not difference in the probing attachment level in the two pre treatment readings; however, one month after the treatment there was a significant gain in the probing attachment level and reductions in gingival index, plaque index, bleeding on probing, and pocket depths. When comparing the measurements in the presences of leukocytes both pretreatment readings were similar, but one month after the treatment there was a reduction in cells. In conclusion the study found a reduction in the amount of crevicular cells upon completion of phase I therapy.

Conclusion: Phase I therapy includes many different procedures with the overall aim of controlling periodontal breakdown and inflammation. Plaque control is central to the success of the treatment, and in some patients with moderate periodontal disease, thorough Phase I therapy will adequately treat their periodontal condition in addition to reducing the cell count present in their crevicular fluid.

References Boretti, G, Zappa, U, & Graf, H. (1995). Short-term effects of phase I therapy on crevicular cell populations. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7776170

The success in treating periodontal disease has a great deal to do with patients being able to maintain the results that was achieved during Phase I therapy. During Phase I therapy, the dental professional would be given the opportunity to evaluate the integity of the gingival tissue and at the same time the patient's attitude toward the care that was given. The dental professional could also evaluate the patient's motivation toward behavioral changes and patient's perception of benefits and barriers. These are important factors that need to be considered to the success of the patient's treatment. The position regarding treatment of plaque induced gingivitis and chronic periodontitis stated that professional guidance and assistance in addition to scaling and root planing in necessary to the overall success of the treatment.
 * 11. Phase I therapy is a significant aspect of the treatment plan. LL#9.**

Treatments that are common to all phase I therapies are plaque control, caries control, scaling and root planing to remove supragingival calculus, subgingival calculus and plaque deposits. Plaque control by the patient at home is crucial for optimum phase I therapy results.
 * 12. Phase I therapy involves complex and individualized treatment. It requires detailed analysis of each patient's disease and contributing factors and customized therapy. CE5**