16. treatment planning

Question 1

what is the definition of periodontal diseases?

Answer 1

group of diseases affecting the periodontal tissues, representing an immune reaction to adjacent microbial plaque

Question 2

what is the definition of periodontal health?

Answer 2

the outcome of the balance between bacteria of the dental plaque and the host immune system

Question 3

what are 3 treatment strategies of periodontal diseases?

Answer 3

I. mechanical disruption
II. systemic antibiotics or local antimicrobials
III. host modulation therapy

Question 4

what is the main goal of treatment of periodontal disease?

Answer 4

plaque control
removal of plaque retention factors

Question 5

what does a BPE score of 0 mean?

Answer 5

no calculus or overhangs
no bleeding on probing
black band entirely visible

Question 6

what does a BPE score of 1 mean?

Answer 6

no calculus or overhangs
bleeding on probing
blackboard entirely visible

Question 7

what does a BPE score of 2 mean?

Answer 7

supra or sub gingival calculus or overhangs
black band entirely visible

Question 8

what does a BPE score of 3 mean?

Answer 8

black band partially visible indicating a probing depth of 4-5mm

Question 9

what does a BPE score of 4 mean?

Answer 9

black band disappears indicating pocket of 6mm or more

Question 10

what does a BPE score of * mean?

Answer 10

furcation involvement

Question 11

what does PMPR stand for?

Answer 11

professional mechanical plaque removal

Question 12

what is supra gingival PMPR?

Answer 12

targeting the biofilm formed above the gingival line
first step of PMPR treatment

Question 13

what is sub gingival PMPR?

Answer 13

biofilm that causes problems, indicates inflammation, hidden pockets below gingiva

Question 14

if we remove the thin cementum during PMPR what does it cause?

Answer 14

exposed dentine

Question 15

what is calculus?

Answer 15

calcified plaque

Question 16

what is step 1 of the treatment plan?

Answer 16

control of local and systemic risk factors

Question 17

what are local risk factors to the oral environment?

Answer 17

calculus
overhangs

Question 18

what are systemic risk factors to the oral environment?

Answer 18

diabetes
smoking

Question 19

what would be additional steps only done if required in the first step if the treatment plan?

Answer 19

extracting teeth with bag prognosis
endodontic treatment
initial occlusal corrections

Question 20

what oral hygiene instructions should you give to a patient?

Answer 20

tooth brushing techniques
flossing
interdental brushes

Question 21

how powerful are sonic scalers? what are their vibrations like?

Answer 21

2000 to 8000 Hz
- vibrations caused by flow of compressed air
- circular vibrations with large amplitude of 60-100 um

Question 22

how powerful are ultrasonic scalers? what extra effect do they have?

Answer 22

20000 to 45000 Hz
additional cavitation effect

Question 23

what are piezoelectric ultrasonic scalers vibrations like?

Answer 23

vibrations caused by changes in size of quartz crystals subjected to alternating current
Linear vibration with small amplitude 20-72 um

Question 24

what are magnetostrictive ultrasonic scalar vibrations like?

Answer 24

vibrations caused by movement between iron/steel nickel allow plates in alternating magnetic field
Ellipsoidal vibrations with large amplitude 100um

Question 25

how much of an ultrasonic solar tip should be used on the tooth?

Answer 25

2-3 mm of tip

Question 26

what should the angle be between the working edge of an ultrasonic scalar and the tooth surface?

Answer 26

0-15 degree angle

Question 27

how much pressure should be applied when using an ultrasonic scalar on the tooth?

Answer 27

slight pressure

Question 28

what motions should you move the ultrasonic scaling tip in?

Answer 28

overlapping zig zag motions starting from occlusal part of crown and moving apically towards gum line

Question 29

what can we do to counter act the fact when using an ultrasonic tip it gets very hot due to the lots of energy?

Answer 29

use constant water spray and keep it moving

Question 30

what are some contradictions for ultrasonic scalers?

Answer 30

oral infectious diseases dysphagia acute leukemias and lymphomas pregnancy heart pacemaker

Question 31

what is step 2 in the treatment plan?

Answer 31

sub gingival instrumentation

Question 32

what instruments are used in sub gingival PMPR?

Answer 32

both hand instruments and sonic/ultrasonic scalers

Question 33

give an example of local antimicrobials?

Answer 33

chlorhexidine

Question 34

what happens if there is no improvement in the oral health 8 weeks after step 2?

Answer 34

repeat the treatment from the beginning

Question 35

what happens if there is some improvement but still some residual pockets in the oral health 8 weeks after step 2?

Answer 35

targeted PMPR then go to step 3 = surgery

Question 36

what happens if there is complete improvement in the oral health after 8 weeks of step 2 treatment?

Answer 36

step 4 = maintenance

Question 37

give an example of a host modulation therapy?

Answer 37

anticytokine and biological therapies - biological disease modifying anti-rheumatic drug like infliximab-anti-TNF-alfa