Page 9 - IDX-DecisionTree-Booklet-Digital

Step 2a

Baseline Assessment & Preventive or Routine Management
Risk-Factor Management • Emphasize preventive care and microbial stabilization rather
than aggressive therapy.
• Perform routine prophylaxis or localized scaling if inflamed
sites are present.
• Reinforce home care (powered brushing, interdental cleaning,
tongue hygiene).

• Short-term adjunctive rinse (e.g., 0.12% chlorhexidine or
essential oil rinse) for 1–2 weeks may be recommended if
localized inflammation exists.
• Recall every 6 months for monitoring, with optional re-testing
annually or if clinical signs worsen.

Step 2b
Initial Non-Surgical Therapy

In cases of medium or high detected pathogen levels, the following
treatments may be appropriate.
• Comprehensive scaling and root-planing (SRP) or ultrasonic
debridement, including all pockets 4-6mm in quadrants; aim to
complete within a short timeframe (ideally full-mouth or staged
within week).

• Adjunctive antiseptic or subgingival irrigation such as 0.12%
chlorhexidine, povidone-iodine, sodium hypochlorite, chlorine
dioxide, or antimicrobial powders (glycine or erythritol), especially
in deep pockets or peri-implant areas.
• Consider local adjuncts: e.g., subgingival administration of
minocycline microspheres, doxycycline gel, locally delivered
antimicrobials in ≥6 mm pockets (supported in literature).
Refer to periodontal specialists if needed.
The Open Dentistry Journal
• Allow approximately 4–6 weeks of healing following initial
debridement before re-evaluation.