The American Academy of Periodontology (AAP) has established a protocol toward standardizing a comprehensive approach in the assessment, diagnosis and treatment of periodontitis associated with systemic conditions. The imperative implication of this parameter is to ensure that patients are informed about the significance of their systemic condition(s) and the probable impact it can have to the periodontal disease process. A conscientious effort should be made in presenting therapeutic choices and alternatives, potential complications, and expected outcomes. An informed patient has a thorough understanding of their rights and responsibilities as an active participant in the treatment decision, applications and successful outcomes within their periodontal therapy or in declining to proceed with the prescribed treatment.38,39
It is important to consider periodontal risk factors because they can affect periodontal disease onset, progression and severity. Risk factors include genetics, ethnicity, advancing age, smoking, diabetes, specific medications, impaired nutrition, poor oral hygiene, poor dental restorations, hormonal variations, immunocompromised status, connective tissue diseases and previous history of periodontal disease.26-28
A comprehensive periodontal evaluation should include a review of systemic disorders, oral signs and symptoms, medication history, addictive habits, familial factors, psychological issues and disease states. Signs and symptoms of undiagnosed or poorly controlled diabetes need to be identified. Consultation with the patient’s physician should be included and deemed necessary. The patient should receive instructions on medications and diet during periodontal therapy as well as education regarding the possible impact of periodontal infection on their glycemic control. The office needs to be prepared to manage diabetic and other medical emergencies.26-28,38-44
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