16. treatment planning Flashcards
what is the definition of periodontal diseases?
group of diseases affecting the periodontal tissues, representing an immune reaction to adjacent microbial plaque
what is the definition of periodontal health?
the outcome of the balance between bacteria of the dental plaque and the host immune system
what are 3 treatment strategies of periodontal diseases?
I. mechanical disruption
II. systemic antibiotics or local antimicrobials
III. host modulation therapy
what is the main goal of treatment of periodontal disease?
plaque control
removal of plaque retention factors
what does a BPE score of 0 mean?
no calculus or overhangs
no bleeding on probing
black band entirely visible
what does a BPE score of 1 mean?
no calculus or overhangs
bleeding on probing
blackboard entirely visible
what does a BPE score of 2 mean?
supra or sub gingival calculus or overhangs
black band entirely visible
what does a BPE score of 3 mean?
black band partially visible indicating a probing depth of 4-5mm
what does a BPE score of 4 mean?
black band disappears indicating pocket of 6mm or more
what does a BPE score of * mean?
furcation involvement
what does PMPR stand for?
professional mechanical plaque removal
what is supra gingival PMPR?
targeting the biofilm formed above the gingival line
first step of PMPR treatment
what is sub gingival PMPR?
biofilm that causes problems, indicates inflammation, hidden pockets below gingiva
if we remove the thin cementum during PMPR what does it cause?
exposed dentine
what is calculus?
calcified plaque
what is step 1 of the treatment plan?
control of local and systemic risk factors
what are local risk factors to the oral environment?
calculus
overhangs
what are systemic risk factors to the oral environment?
diabetes
smoking
what would be additional steps only done if required in the first step if the treatment plan?
extracting teeth with bag prognosis
endodontic treatment
initial occlusal corrections
what oral hygiene instructions should you give to a patient?
tooth brushing techniques
flossing
interdental brushes
how powerful are sonic scalers? what are their vibrations like?
2000 to 8000 Hz
- vibrations caused by flow of compressed air
- circular vibrations with large amplitude of 60-100 um
how powerful are ultrasonic scalers? what extra effect do they have?
20000 to 45000 Hz
additional cavitation effect
what are piezoelectric ultrasonic scalers vibrations like?
vibrations caused by changes in size of quartz crystals subjected to alternating current
Linear vibration with small amplitude 20-72 um
what are magnetostrictive ultrasonic scalar vibrations like?
vibrations caused by movement between iron/steel nickel allow plates in alternating magnetic field
Ellipsoidal vibrations with large amplitude 100um
how much of an ultrasonic solar tip should be used on the tooth?
2-3 mm of tip
what should the angle be between the working edge of an ultrasonic scalar and the tooth surface?
0-15 degree angle
how much pressure should be applied when using an ultrasonic scalar on the tooth?
slight pressure
what motions should you move the ultrasonic scaling tip in?
overlapping zig zag motions starting from occlusal part of crown and moving apically towards gum line
what can we do to counter act the fact when using an ultrasonic tip it gets very hot due to the lots of energy?
use constant water spray and keep it moving
what are some contradictions for ultrasonic scalers?
oral infectious diseases
dysphagia
acute leukemias and lymphomas
pregnancy
heart pacemaker
what is step 2 in the treatment plan?
sub gingival instrumentation
what instruments are used in sub gingival PMPR?
both hand instruments and sonic/ultrasonic scalers
give an example of local antimicrobials?
chlorhexidine
what happens if there is no improvement in the oral health 8 weeks after step 2?
repeat the treatment from the beginning
what happens if there is some improvement but still some residual pockets in the oral health 8 weeks after step 2?
targeted PMPR
then go to step 3 = surgery
what happens if there is complete improvement in the oral health after 8 weeks of step 2 treatment?
step 4 = maintenance
give an example of a host modulation therapy?
anticytokine and biological therapies
- biological disease modifying anti-rheumatic drug like infliximab-anti-TNF-alfa
