AAP Parameters of Care
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Complete Text of 13 Parameters of Care (2000)
In response to increasing concerns on the part of health care providers,
third-party payers and consumers about the quality, cost and access to dental
care, The American Academy of Periodontology has developed practice parameters
on the diagnosis and treatment of periodontal diseases. These parameters are
strategies developed to assist dentists in making clinical decisions from a
range of reasonable treatment options to achieve a desired outcome. Practice
parameters are designed to help the profession provide appropriate dental
services while containing costs, without sacrificing quality.
The following parameters are included in the complete set and may also be accessed individually:
Parameter on Comprehensive Periodontal Examination (2000)
Appropriate screening procedures may be performed to determine the need for a comprehensive
periodontal evaluation. Periodontal Screening and RecordingTM (PSR), a screening procedure
endorsed by the American Dental Association and The American Academy of
Periodontology, may be utilized.
Parameter on Periodontal Maintenance (2000)
Periodontal maintenance is started after completion
of active periodontal therapy and continues at
varying intervals for the life of the dentition or its
implant replacements. Periodontal maintenance is an
extension of active periodontal therapy that is supervised by the dentist.
Parameter on Plaque-Induced Gingivitis (2000)
Plaque-induced gingivitis is defined as inflammation
of the gingiva in the absence of clinical attachment
loss. Gingivitis may be characterized by the presence of
any of the following clinical signs: redness and edema
of the gingival tissue, bleeding upon provocation,
changes in contour and consistency, presence of calculus
and/or plaque, and no radiographic evidence
of crestal bone loss.
Parameter on Chronic Periodontitis with Slight to Moderate Loss of Periodontal Support (2000)
Chronic periodontitis is defined as inflammation of the
gingiva extending into the adjacent attachment apparatus.
The disease is characterized by loss of clinical
attachment due to destruction of the periodontal ligament
and loss of the adjacent supporting bone.
Parameter on Chronic Periodontitis with Advanced Loss of Periodontal Support (2000)
Chronic periodontitis is defined as inflammation of
the gingiva and the adjacent attachment apparatus.
The disease is characterized by loss of clinical attachment
due to destruction of the periodontal ligament
and loss of the adjacent supporting bone.
Parameter on "Refractory" Periodontitis (2000)
“Refractory periodontitis” is not a single disease entity.
The term refers to 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.
Parameter on Mucogingival Conditions (2000)
Mucogingival conditions are deviations from the normal
anatomic relationship between the gingival margin
and the mucogingival junction (MGJ). Common mucogingival conditions are recession,
absence or reduction of keratinized tissue, and probing
depths extending beyond the MGJ.
Parameter on Acute Periodontal Diseases (2000)
Acute periodontal diseases are clinical conditions of
rapid onset that involve the periodontium or associated
structures and may be characterized by pain or
discomfort and infection. They may or may not be
related to gingivitis or periodontitis. They may be
localized or generalized, with possible systemic manifestations.
of the acute signs and symptoms as soon as
possible.
Parameter on Aggressive Periodontitis (2000)
Aggressive periodontitis encompasses distinct types
of periodontitis that affect people who, in most cases,
otherwise appear healthy. It tends to have a familial
aggregation and there is a rapid rate of disease progression.
Aggressive periodontitis occurs in localized
and generalized forms.
Parameter on Placement and Management of the Dental Implant (2000)
A dental implant is a biomedical device usually composed
of an inert metal or metallic alloy that is placed
on or within the osseous tissues. The implant restoration
consists of components that attach the prosthesis
to the implant. Dental implants are used to replace single or multiple
teeth or to serve as an abutment(s) for fixed or
removable prostheses with the goal of restoring masticatory
function and/or esthetics.
Parameter on Occlusal Traumatism in Patients with Chronic Periodontitis (2000)
Occlusal traumatism affects the supporting structures
of the tooth or teeth. The lesion of trauma from
occlusion may occur in conjunction with, or independent
of, inflammatory periodontal diseases.
Although trauma from occlusion and inflammatory
periodontal disease may occur concurrently, each
condition may be treated separately. The treatment
goals and endpoints for each condition may be independent
of each other. Occlusal therapy is generally
addressed following, or in conjunction with, procedures
to resolve the inflammatory lesions.
Parameter on Periodontitis Associated with Systemic Conditions (2000)
A number of systemic factors have been documented
as being capable of affecting the periodontium and/or
treatment of periodontal disease. Systemic etiologic
components may be suspected in patients who exhibit
periodontal inflammation or destruction which
appears disproportionate to the local irritants. The
clinician should be aware of systemic conditions
and/or drugs that may be contributing factors to periodontal
diseases, and of steps necessary to evaluate
them. Periodontal therapy may be modified based on
the current medical status of the patients. Periodontal
organisms may be the source of infections elsewhere
in the body. Therefore, those infections may
also affect systemic health.
Parameter on Systemic Conditions Affected by Periodontal
Diseases (2000)
The role of local infections in generalized disease is well
established (for example, in oral-derived bacteremia
and infective endocarditis). While much information
is available concerning the potential effects of systemic
conditions and diseases on the periodontium,
less is known about the consequences of a diseased
periodontium on systemic health. The periodontium
may serve as a reservoir of bacteria, bacterial products,
and inflammatory and immune mediators which
can interact with other organ systems remote from
the oral cavity. Periodontal infections may increase
the risk for certain conditions by contributing to disease
pathogenesis or by serving as a source of infective
organisms.
Reproducing the Papers
The Academy will grant AAP members permission to reproduce up to 150 copies of a paper for not-for-profit, educational purposes only. To obtain this permission or information on reproducing position papers for any other use, please contact Managing Editor Julie Daw in the Publications Department:
- E-mail: julie@perio.org
Phone: 312/573-3224
Fax: 312/573-3225
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