PEMBRA is an acronym for Periodontal Management by risk assessment. This works by first collecting information about important risk factors that affect periodontal health and disease progression.
PEMBRA risk factors are numerous and are divided into local and systemic. It is very important to work with patients to identify their risk factors, to eliminate the risk where possible. This approach allows adopting a tailored plan for each patient to optimising their treatment outcome and devising a plan for maintenance of their periodontal tissues once the active phase of treatment is complete.
Local Risk Factors
These include anatomical factors such as root groves that retain plaque and are difficult to clean. Furcation lesions occur where bone has been lost between roots of teeth and are also very difficult to clean. Tooth position may render effective home care difficult. Previous restorations with roughness or marginal discrepancies contribute to plaque retention and difficulty with home care.
Removable partial dentures can enhance plaque accumulation and increase risk. Proximal surfaces are most at risk. Orthodontic appliances both fixed and removable can also pose a risk as they are often worn over a long period of time and can present challenges to patients with effective home care. Calculus both subgingival and supragingival act as local plaque retention factors. The surface of the calculus offers a large and irregular area for harboring plaque. These areas are also relatively sheltered from host maintenance. One of the main foci of periodontal therapy is removal of calculus.
Mouth breathing and lack of lip seal at rest can lead to dehydration of the oral tissue and cause high levels of dental plaque.
All these need to be addressed by your Dentist to ensure best outcome.
Systemic Risk Factors
These are numerous and only the most common are outlined. Detailed individual medical histories will be taken from every patient to help assess their individual risk.
Diabetes Types 1 and 2 lead to impaired immune function and impaired wound healing.
Smoking has a direct toxic effect on cells, thermal effects, increased stain and calculus and effects on the flora. There are adverse effects of smoking on bone tissue resulting in reduced bone mineral density.
Dietary Calcium; Low dietary calcium is associated with increased periodontal disease in both men and women according to cross-sectional studies.
Other systemic factors include genetic factors, obesity, stress, Osteopenia and Osteoporosis in post menopausal women.
We work with our patients to establish their systemic risk factors and help to formulate an effective treatment plan to treat active disease and set up a maintenance plan going forward.