牙周病的預(yù)后和計(jì)劃專(zhuān)家講座

QUESTION？Ismydiseasefatal?

WillIlosemyteeth?

Willyourtreatmenthelpme?

Whatcanyoudotohelpme?牙周病的預(yù)后和計(jì)劃第1頁(yè)第11章

PROGNOSTICJUDGMENTTREATMENTPLANNING牙周病預(yù)后和計(jì)劃牙周病的預(yù)后和計(jì)劃第2頁(yè)P(yáng)ROGNOSISPrognosisForecast

預(yù)后預(yù)測(cè)牙周病的預(yù)后和計(jì)劃第3頁(yè)預(yù)后類(lèi)型骨吸收病因依從性全身病變極佳無(wú)可消除良好無(wú)良好輕較差中難消除差顯著/未控制極差重牙周病的預(yù)后和計(jì)劃第4頁(yè)整體預(yù)后依據(jù)病史、年紀(jì)疾病類(lèi)型發(fā)展速度全身原因環(huán)境原因患者意愿、依從性菌斑牙石量解剖牙周破壞程度牙周病的預(yù)后和計(jì)劃第5頁(yè)有全身原因牙齦炎

全身原因控制后能夠痊愈齦炎預(yù)后

單純性齦炎：良好牙周病的預(yù)后和計(jì)劃第6頁(yè)牙周炎預(yù)后總預(yù)后個(gè)別牙預(yù)后牙周病的預(yù)后和計(jì)劃第7頁(yè)牙周炎總預(yù)后

對(duì)整個(gè)牙列預(yù)后評(píng)定，內(nèi)容包含牙周炎類(lèi)型單原因輕中度CP，療效易鞏固有全身原因牙周炎，改變多樣牙周病的預(yù)后和計(jì)劃第8頁(yè)骨破壞速度、程度、類(lèi)型局部原因消除情況:菌斑、根分叉問(wèn)題、咬合牙松動(dòng)余留牙數(shù)目、分布；患者依從性環(huán)境與行為原因全身、遺傳、年紀(jì)原因牙周病的預(yù)后和計(jì)劃第9頁(yè)牙周炎個(gè)別牙預(yù)后探診深度、附著水平：部位？程度？袋深淺不是決定原因。牙槽骨：破壞部位、程度、根分叉病變；牙松動(dòng)度：自限性？進(jìn)行性牙松動(dòng)？牙解剖：牙周病的預(yù)后和計(jì)劃第10頁(yè)牙周病治療計(jì)劃牙周病的預(yù)后和計(jì)劃第11頁(yè)總體目標(biāo)控制菌斑、炎癥合理牙周組織形態(tài)糾正：牙周袋齦退縮骨缺損牙松動(dòng)牙齒及鄰接關(guān)系牙周病的預(yù)后和計(jì)劃第12頁(yè)恢復(fù)牙周組織功效

合理咬合關(guān)系

修復(fù)失牙

戒除不良習(xí)慣維持長(zhǎng)久療效防復(fù)發(fā)口腔衛(wèi)生指導(dǎo)與菌斑控制定時(shí)檢驗(yàn)牙周病的預(yù)后和計(jì)劃第13頁(yè)治療程序主要分為四個(gè)階段牙周病的預(yù)后和計(jì)劃第14頁(yè)第一階段

病因治療基礎(chǔ)治療INITIALTHERAPY消除、控制：致病原因臨床炎癥牙周病的預(yù)后和計(jì)劃第15頁(yè)包含以下方法：自我控制菌斑方法：刷牙方法和習(xí)慣；牙線(xiàn)和牙簽；菌斑顯示劑檢驗(yàn)漱口劑牙周病的預(yù)后和計(jì)劃第16頁(yè)拔除病牙潔治、刮治、根面平整術(shù)藥品控制感染咬合調(diào)整牙周病的預(yù)后和計(jì)劃第17頁(yè)治療齲齒，矯正不良修復(fù)體和食物嵌塞處理牙周-牙髓病變1st階段結(jié)束后4~6周再評(píng)定，確認(rèn)療效、依從性、治療方案牙周病的預(yù)后和計(jì)劃第18頁(yè)第二個(gè)階段牙周手術(shù)治療并非每個(gè)患者都要進(jìn)行牙周病的預(yù)后和計(jì)劃第19頁(yè)牙周手術(shù)目標(biāo)去除袋內(nèi)感染物

根面平整

治療牙槽骨缺損糾正齦及膜齦畸形基礎(chǔ)治療后1~3月全方面評(píng)定牙周病的預(yù)后和計(jì)劃第20頁(yè)手術(shù)種類(lèi)牙齦切除術(shù)切除肥大增生牙齦病理性牙周袋牙周病的預(yù)后和計(jì)劃第21頁(yè)翻瓣術(shù)牙周骨手術(shù)骨修整術(shù)、植骨GTR膜齦手術(shù)牙種植術(shù)牙周病的預(yù)后和計(jì)劃第22頁(yè)第三階段

修復(fù)治療階段

并非每個(gè)患者都要進(jìn)行2st階段后2~3月進(jìn)行松牙固定義齒修復(fù)、正畸牙周病的預(yù)后和計(jì)劃第23頁(yè)第四階段

療效維護(hù)期1st階段后不論是否需要進(jìn)行2、3階段治療即應(yīng)該開(kāi)始，內(nèi)容包含：牙周病的預(yù)后和計(jì)劃第24頁(yè)定時(shí)復(fù)查時(shí)間：普通3~6個(gè)月1次。內(nèi)容：PLI、CI、DI、GI、BOP、PD、附著水平、牙松動(dòng)度、咬合情況、骨高度、密度、危險(xiǎn)原因：吸煙、全身疾病牙周病的預(yù)后和計(jì)劃第25頁(yè)復(fù)治依據(jù)發(fā)覺(jué)問(wèn)題進(jìn)行新一輪治療與療效維護(hù)牙周病的預(yù)后和計(jì)劃第26頁(yè)牙周治療與院內(nèi)感染

P163-164自學(xué)牙周病的預(yù)后和計(jì)劃第27頁(yè)OVER

THANKS牙周病的預(yù)后和計(jì)劃第28頁(yè)牙周治療與院內(nèi)感染

交叉感染是醫(yī)院內(nèi)感染(NOSOCOMIALINFECTION)中主要內(nèi)容之一。牙周病的預(yù)后和計(jì)劃第29頁(yè)醫(yī)院感染傳輸路徑有：直接接觸病損、血液、體液、齦溝液、菌斑等；吸人含致病菌氣霧或飛濺物(如血液、唾液等)；間接接觸(污染器械、手、治療臺(tái)等傳染媒體)；手機(jī)供水管道中存水返流人口中。牙周病的預(yù)后和計(jì)劃第30頁(yè)我國(guó)人群中HBV攜帶者約占10%，

艾滋病、梅毒等也有增多趨勢(shì)。牙周病的預(yù)后和計(jì)劃第31頁(yè)牙周診室控制感染

特點(diǎn)及標(biāo)準(zhǔn)牙周病的預(yù)后和計(jì)劃第32頁(yè)病史采集及必要檢驗(yàn)

重視問(wèn)詢(xún)?nèi)砑膊?、傳染性疾病?/p>

“一致對(duì)待”標(biāo)準(zhǔn)

universalprecaution

即假定每位患者都有血源性傳輸感染性疾病，診治中一律嚴(yán)格防交叉感染，必要時(shí)作相關(guān)化驗(yàn)檢驗(yàn)。牙周病的預(yù)后和計(jì)劃第33頁(yè)治療器械消毒

按器械分類(lèi)、分別用不一樣方法消毒。

“雙消毒”：對(duì)使用過(guò)器械應(yīng)實(shí)施消毒液浸泡、超聲波或手工清洗、清水沖凈干燥、高壓滅菌或其它消毒方法。

大型設(shè)備如綜合治療臺(tái)表面等，

可用可靠消毒劑進(jìn)行表面擦拭等。牙周病的預(yù)后和計(jì)劃第34頁(yè)應(yīng)盡可能使用已消毒一次性用具

(如檢驗(yàn)器、吸唾器、注射器等)。

一人一機(jī)。

也可2%碘酊擦拭手機(jī)各部位，酒精脫碘2次，

也可用1%碘附消毒。牙周病的預(yù)后和計(jì)劃第35頁(yè)保護(hù)性屏障

口罩、帽子、防護(hù)眼鏡、面罩、手套、工作服等

治療過(guò)程中，

污染手套不得任意觸摸周?chē)锲罚?/p>

治療結(jié)束后

應(yīng)清洗手套上血污后再摘除手套，書(shū)寫(xiě)病歷等。牙周病的預(yù)后和計(jì)劃第36頁(yè)盡可能使用腳控開(kāi)關(guān)來(lái)調(diào)整治療椅

照明燈扶手、開(kāi)關(guān)等可用一次性覆蓋物覆蓋。一次性器械及覆蓋物在用畢后應(yīng)妥善、單獨(dú)回收，作必要銷(xiāo)毀。牙周病的預(yù)后和計(jì)劃第37頁(yè)降低治療椅周?chē)諝庵屑?xì)菌量

治療前1%過(guò)氧化氫或0.12%氯己定液鼓漱一分鐘，降低患者口中細(xì)菌數(shù)量、治療時(shí)氣霧污染。

診室內(nèi)應(yīng)有良好通風(fēng)。

不在診室內(nèi)飲水和進(jìn)食。牙周病的預(yù)后和計(jì)劃第38頁(yè)治療臺(tái)水管系統(tǒng)消毒、

阻止水回流裝置；

在每位患者治療結(jié)束后，再空放水30秒；

天天開(kāi)始工作前再?zèng)_水一至數(shù)分鐘。

國(guó)外提議超聲波潔牙機(jī)使用單獨(dú)凈水儲(chǔ)水器，并每七天用1:10次氯酸鈉液沖儲(chǔ)水系統(tǒng)，隨即馬上用蒸餾水沖洗。牙周病的預(yù)后和計(jì)劃第39頁(yè)嚴(yán)格恪守控制醫(yī)院感染標(biāo)準(zhǔn)，

使病原微生物擴(kuò)散和環(huán)境污染降低到最小程度。

保護(hù)患者和醫(yī)務(wù)人員利益安全。牙周病的預(yù)后和計(jì)劃第40頁(yè)Treatmentcanalterprognosis.Prognosishasdifferentconnotationsandnuances.Thepatienthaseveryrighttoknowtheanswerstothesequestions.牙周病的預(yù)后和計(jì)劃第41頁(yè)Question？Ismydiseasefatal?

WillIlosemyteeth?

Willyourtreatmenthelpme?

Whatcanyoudotohelpme?牙周病的預(yù)后和計(jì)劃第42頁(yè)Whatarethetherapeutic"odds"?

Whatarethefinancialrisks?

Whatarethechancesthatthetreatmentwillbeofbenefit?牙周病的預(yù)后和計(jì)劃第43頁(yè)P(yáng)rognosishas

threemeanings

indentistry.牙周病的預(yù)后和計(jì)劃第44頁(yè)Diagnosticprognosis.Whatareevaluationsofthecourseofthediseasewithouttreatment?WhatisthestatusoftheteethnowWhatistheanticipatedfutureoftheseteeth?牙周病的預(yù)后和計(jì)劃第45頁(yè)Therapeuticprognosis.Giventhestateoftheartandscienceofperiodonticsandtheknowledgeandskillofthepractitioner,whateffectwillperiodontaltreatmenthaveonthecourseofthedisease?牙周病的預(yù)后和計(jì)劃第46頁(yè)P(yáng)rostheticprognosis.Whatistheforecastforthesuccessoftheprostheticrestoration?Willtheprosthesisbetherapeuticordetrimental?Whatspecificneedsdictatethatitbeprescribed?牙周病的預(yù)后和計(jì)劃第47頁(yè)Judgementoftheseveritydependson：1.pocketdepth,2.degreeofboneloss,3.toothmobility,4.crown-rootratio.牙周病的預(yù)后和計(jì)劃第48頁(yè)generalizedorlocalizedThedistributionofdisease：Inflammatoryfactors：Traumaticfactors：牙周病的預(yù)后和計(jì)劃第49頁(yè)Individualtooththerapeuticprognosisincludessuchfactorsas：Percentageofboneloss;Probingdepth;牙周病的預(yù)后和計(jì)劃第50頁(yè)Distributionandtype

ofboneloss

Presenceandseverityof

furcationinvolvements

Mobility牙周病的預(yù)后和計(jì)劃第51頁(yè)Crown-rootratio

Pulpalinvolvement

Toothpositionandocclusal

Strategicvalue牙周病的預(yù)后和計(jì)劃第52頁(yè)Followingarefactorsincludedinoverallprognosis:AgeMedicalstatus牙周病的預(yù)后和計(jì)劃第53頁(yè)Individualtoothprognoses

(distributionandseverity)

Degreeofinvolvement,duration,andhistory

ofthedisease(rateofprogression)牙周病的預(yù)后和計(jì)劃第54頁(yè)P(yáng)atientcooperation

Economicconsiderations

Knowledgeandabilityofthedentist

Etiologicfactors牙周病的預(yù)后和計(jì)劃第55頁(yè)Accuracyandcompletenessoftheinformationgatheredattheexamination

Dentist'sabilitytorecognizeandeliminateorcontrolthefactorscausingthedisease牙周病的預(yù)后和計(jì)劃第56頁(yè)thepatient'sabilityanddeterminationinmaintainingthehealthoftheperiodontiumandteeth.牙周病的預(yù)后和計(jì)劃第57頁(yè)Theoverallprognosisdependsontheprognosesoftheindividualteeth.牙周病的預(yù)后和計(jì)劃第58頁(yè)P(yáng)ASTHISTORY

(RATEOFDESTRUCTION)牙周病的預(yù)后和計(jì)劃第59頁(yè)P(yáng)robablythemostimportantfactorinforecastingthefuturehealthstatusofadentitionisknowledgeofitspasthealthstatus.

牙周病的預(yù)后和計(jì)劃第60頁(yè)Speedofbreakdownundercontrolsoruncontrols

Thelocation,shapeanddepthsofthepockets牙周病的預(yù)后和計(jì)劃第61頁(yè)Toothmobilitycanbecontrolledoreliminated,theprognosisisbetter.

Thegreatertheboneloss,thepoorertheprognosis.牙周病的預(yù)后和計(jì)劃第62頁(yè)Asbonelossexceeds50%,theprognosisworsensrapidly.

Themoreirregulartheboneloss,thepoorertheprognosis.牙周病的預(yù)后和計(jì)劃第63頁(yè)thepatternofboneloss:horizontal,verticalorinfrabonydefects.

theageofthepatientandtheetiologicfactorsinvolvedinthepatient'sdisease.牙周病的預(yù)后和計(jì)劃第64頁(yè)poorerprognosis:

tilted,drifted,orrotated,hygienedifficult,eliminationofpocketsimpaired牙周病的預(yù)后和計(jì)劃第65頁(yè)periodontaldiseaseiscomplicatedbyactivesystemicfactors

andtraumatism牙周病的預(yù)后和計(jì)劃第66頁(yè)morphologicinnatureandincludethenumberanddistributionofteeth,toothmorphology,furcationinvolvement.牙周病的預(yù)后和計(jì)劃第67頁(yè)Extentofinvolvement.

Isthefurcationpartiallyortotallyinvolved?

Statusofbonesupport.

Ifthebonelevelsarerelativelysound,theefforttosavemaybejustifiable.牙周病的預(yù)后和計(jì)劃第68頁(yè)Rootlengthandcrown-rootratiomustbeconsidered牙周病的預(yù)后和計(jì)劃第69頁(yè)Angulationofrootspread.

Healthofneighboringteeth.牙周病的預(yù)后和計(jì)劃第70頁(yè)Thenumberanddistributionofteethpresent

crown-rootratio,

shapeandnumberoftheroot牙周病的預(yù)后和計(jì)劃第71頁(yè)theheightofthealveolarcrest

personalpsychologicandsociologic,

financialconsiderations.牙周病的預(yù)后和計(jì)劃第72頁(yè)OTHERCONSIDERATIONSINESTABLISHINGPROGNOSIS牙周病的預(yù)后和計(jì)劃第73頁(yè)Theperformanceofhomecareisacceptableandthecariesincidenceislow,

theprognosisisbetter

牙周病的預(yù)后和計(jì)劃第74頁(yè)Theprimeconsiderationisthepreservationofthedentitionasafunctioningunit.牙周病的預(yù)后和計(jì)劃第75頁(yè)Insomeinstances

theextractionofasingletoothwillmakethewholesituationuntenable.

Inothersituationsisolatedextractionswillsimplifytheproblem.牙周病的預(yù)后和計(jì)劃第76頁(yè)whatisconsideredtobeahopelesstooth.

Thiswillmaketreatmentplanningsimpler.

牙周病的預(yù)后和計(jì)劃第77頁(yè)thecharacteristicsofhopelessperiodontallyinvolvedteeth:牙周病的預(yù)后和計(jì)劃第78頁(yè)Associatedwithintractablepainrelieved,massiveinfectionreducedbyextraction

Mobilitybeyond3degrees牙周病的預(yù)后和計(jì)劃第79頁(yè)Furcationinvolvementwithlittleornointerradicularbone

Bonelossbeyondtheapex

Bonelosstotheapexononesideofthetooth牙周病的預(yù)后和計(jì)劃第80頁(yè)Generalizedcircumferential

bonelosstowithin3mmoftheapex

Pocketdepthtotheapexwithoutpulpalinvolvement

Verticalcracksorfractures牙周病的預(yù)后和計(jì)劃第81頁(yè)Inaccessibleperforationsoraccessory

canals

Numberandpositionofremainingteethprecludingprosthetic

Extremecariessusceptibility牙周病的預(yù)后和計(jì)劃第82頁(yè)Objectives

oftreatment牙周病的預(yù)后和計(jì)劃第83頁(yè)Treatmentgoalsshouldbe

evaluatedineverycase.牙周病的預(yù)后和計(jì)劃第84頁(yè)Cantreatmentobjectivesofafirmnon-retractablegingivathatdoesnotbleedbereached?

Canthepocketbeeliminated?

Willtheboneregenerate?

Canthetoothbestabilized?

牙周病的預(yù)后和計(jì)劃第85頁(yè)Cantoothberestored?

Canthepatienttoleratethetreatment?

牙周病的預(yù)后和計(jì)劃第86頁(yè)Ifyoubelievetheanswerstothesequestionstobe"yes,"thenplanandproceedwiththetreatment.

If“no,”alternativetreatment,compromise,orextractionisadvisable.牙周病的預(yù)后和計(jì)劃第87頁(yè)Asdefinitivelaboratorytestsaredevelopedtomakediagnosismoreaccurate,andasfurtherknowledgeconcerningtheetiologyandpathogenesisofperiodontaldiseasesisdeveloped,prognosiswillchangefromaqualitativetoaquantitativejudgment.

牙周病的預(yù)后和計(jì)劃第88頁(yè)TREATMENTPLAN牙周病的預(yù)后和計(jì)劃第89頁(yè)P(yáng)resentation

Patientconsent

Orderoftreatment

PhaseI

PhasesIlandIII

MaintenancetherapyProstheticprescription牙周病的預(yù)后和計(jì)劃第90頁(yè)Alternativetreatmentplans

Treatmentcriteria

Qualityofcare

Philosophyoftreatment

Recordkeeping

Referral牙周病的預(yù)后和計(jì)劃第91頁(yè)P(yáng)resentation

Patientconsent

Afterhearingthepresentation,thepatientmustdecidewhethertoundergotreatment.牙周病的預(yù)后和計(jì)劃第92頁(yè)P(yáng)HASEI牙周病的預(yù)后和計(jì)劃第93頁(yè)Firststeps(Theinitialeffort)shouldbedirectedtowardtheeliminationofinflammationandtheinstitutionofaprogramofplaquecontrol.

牙周病的預(yù)后和計(jì)劃第94頁(yè)Toreducepocketdepth

Tominimizeperiodontaltraumatism

Orthodontics

(mayprecedeorfollowanysurgicalinterventions)牙周病的預(yù)后和計(jì)劃第95頁(yè)Extractions

(Teethwithhopelessprognoses)

Restorations

Usuallyperiodontaltherapyshouldprecederestorativeinterventions.

therestorationsshouldbetemporary牙周病的預(yù)后和計(jì)劃第96頁(yè)Theprovisionalsplinting

duringthetreatmentperiodshouldbeevaluated.牙周病的預(yù)后和計(jì)劃第97頁(yè)Schedulingofrestorativetreatment

shouldbedoneaccordingtothefollowinggeneralrules:牙周病的預(yù)后和計(jì)劃第98頁(yè)Normalpatients.

(Restorativetreatmentstartsimmediately.)

ClassI

(ADAperiodontaldiseaseclassification)牙周病的預(yù)后和計(jì)劃第99頁(yè)Withoutocclusaltreatmentneed

Cariescontrolandscalingandrootplanning.includingplaquecontrol,maybesimultaneous.Definitiverestorativetreatmentshouldfollowcompletionofscalingandplaquecontrol.牙周病的預(yù)后和計(jì)劃第100頁(yè)WithocclusaltreatmentneedDefinitiverestorativetreatmentmayimmediatelyfollowcompletionofscaling,plaquecontrol,andocclusaladjustment.牙周病的預(yù)后和計(jì)劃第101頁(yè)WithsurgicaltreatmentneedDefinitiverestorativetreatmentshouldnotbeinstitutedforatleast4to6weeksafterthepatienthashealed.牙周病的預(yù)后和計(jì)劃第102頁(yè)Splinting

(Wireligationandcompositeacid-etchsplinting)

Emergency

(pain,swelling,infection,anddiscomfort)

Theemergenciesalltakepriorityoverothertreatmentscheduling.牙周病的預(yù)后和計(jì)劃第103頁(yè)Medicalstatus

asystemicconditionthatwouldcomplicatetreatment,amedicalconsultationisnecessary.牙周病的預(yù)后和計(jì)劃第104頁(yè)P(yáng)HASESIIANDIII牙周病的預(yù)后和計(jì)劃第105頁(yè)P(yáng)haseIIsurgery

permitspocketelimination/reduction

Therestorationofnormalosseousform

ostectomy-osteoplasty

osseoussurgerycombinedwithgraftingprocedures牙周病的預(yù)后和計(jì)劃第106頁(yè)rootresections

mucogingivalandgingivectomy

periodontal-endodonticrestorativetreatment

provisionalsplinting.牙周病的預(yù)后和計(jì)劃第107頁(yè)Maintenancetherapy

Thespecialistmayseethepatientonceayearoreveryotheryearforthelessinvolvedcases,

whereasthegeneralistmaintainsthepatientintherecallsystem.

Advancedcasesmaybeseenalternatelyat2-to4-monthintervals.牙周病的預(yù)后和計(jì)劃第108頁(yè)P(yáng)ROSTHETICPRESCRIPTION

Waitingforaperiodofatleast2monthsafterperiodontalsurgery.

Partialdenturesorafixedprosthesis牙周病的預(yù)后和計(jì)劃第109頁(yè)ALTERNATIVETREATMENTPLANS牙周病的預(yù)后和計(jì)劃第110頁(yè)Alternativetreatmentplans

shouldbepreparedforthepatientwhoelectstoforegosplintingandsurgerywhentheseareindicated.牙周病的預(yù)后和計(jì)劃第111頁(yè)InthiscasethepatientmaybetreatedthroughphaseItherapyandbeplacedonamaintenanceschedule.

Theestablishmentofanalternativeplangenerallycallsforarigorousmaintenanceschedulewithscalingandplaningperformedmorefrequentlythanisotherwiseusual.牙周病的預(yù)后和計(jì)劃第112頁(yè)Treatmentcriteria牙周病的預(yù)后和計(jì)劃第113頁(yè)Qualityofcare

Ingeneral,periodontalcareseeksthefollowing:

Removalofknownetiologicfactors

Reductionofallpockets

toaminimaldepthtofacilitatemaintenancebythepatientandthedentalhygienist

Creationofamaintainablegingivalandosseousarchitecture牙周病的預(yù)后和計(jì)劃第114頁(yè)Restorationofafunctionalandestheticdentition

Maintenanceoftheresultinghealthbythepatient,doctor,andhygienist牙周病的預(yù)后和計(jì)劃第115頁(yè)P(yáng)HILOSOPHYOFTREATMENT牙周病的預(yù)后和計(jì)劃第116頁(yè)periodontaldiseasescanbetreatedsuccessfully

thehealthofthediseasedperiodontiumcanberestoredandtheteethmaintained.牙周病的預(yù)后和計(jì)劃第117頁(yè)Thetherapeuticconceptoftodayincludesallformsoftherapy,conservativeandcomplexselectedandblendedforthesuccessfulmanagementoftheindividualpatient.牙周病的預(yù)后和計(jì)劃第118頁(yè)Therapymustbetailoredtotheneeds,bothphysicalandpsychologic,ofthepatient.牙周病的預(yù)后和計(jì)劃第119頁(yè)RECORDKEEPING

Thetreatmentperformedshouldberecordedcarefullyateachvisit.牙周病的預(yù)后和計(jì)劃第120頁(yè)Referral

Therearethreebasicreasonsforreferral:

(1)professional,

(2)moralanethical,and

(3)legal.牙周病的預(yù)后和計(jì)劃第121頁(yè)P(yáng)rofessional:

Professionalreferralsareclassifiedasfollows:

1.

Medical:

Referral/consultation

isindicatedwhenapatient'smedicalhistorydisclosessignificantinformationthatmaycontributetoorinfluencethecourseandoutcomeofthetreatmentorwhenthedentistsuspectsillness.牙周病的預(yù)后和計(jì)劃第122頁(yè)2.Dental:

Referral/consultationisindicated

whenthedentistcannotprovidetheentiredentaltherapythepatientneeds.

Whentheexaminationrevealsperiodontaldiseasethatthegeneralistcannotordoesnotwishtotreat,referraltoaperiodontistisinorder.

Equallytheperiodontistisobligatedtoreferpatientsfortreatmenttothegeneralpractitionerorotherspecialists.牙周病的預(yù)后和計(jì)劃第123頁(yè)3.Moralandethical:Thespecialists