2. Periodontology Non-Surgical Management

Question 1

Alternative names of non-surgical management (2)

Answer 1

Cause related therapy (CRT)

Hygiene phase therapy (HPT)

Question 2

Aim of periodontal therapy (3)

Answer 2

Arrest the disease process
Regenerate lost tissue
Maintain periodontal health long-term

Question 3

Disease control process involves (5)

Answer 3

Extraction of hopeless teeth
HPT
Caries management
Endodontic therapy
Provisional prostheses

Question 4

Features of periodontitis (3)

Answer 4

Loss of attachment
True pocket formation
Colonisation of root surface

Question 5

HPT involves (5)

Answer 5

DHE
OHI
Scaling and RSD
Removal of other plaque-retention factors (defective restoration margins)
Re-evaluation

Question 6

DHE involves (6)

Answer 6

Evaluate patient reasons for attendance, attitudes to healthcare, motivation
Explain the nature of disease using diagrams, photographs, models
Discuss findings of examination
Demonstrate health and disease in the patient’s mouth
Explain the nature and consequences of treatment
Use language the patient will understand

Question 7

OHI involves (3)

Answer 7

Tooth-brushing – modified-bass technique
Interdental cleaning (floss and tape, interdental sticks/brushes)
Disclosing agents

Question 8

Definition of scaling

Answer 8

Removal of plaque and calculus from tooth surfaces

Question 9

Definition of debridement

Answer 9

Act of removing dead, contaminated or adherent tissue or foreign material

Question 10

RSD encompasses (2)

Answer 10

Scaling

Root planing

Question 11

Definition of root planing

Answer 11

Removal of contaminated cementum, leaving the root surface smooth and hard

Question 12

Periodontal therapy success is measured by (3)

Answer 12

Inflammation (BPI - BoP indices)
Reduction in probing death
Gain in probing attachment level

Question 13

Probing depth indicates (2)

Answer 13

Difficulty of treatment

Likelihood of recurrence

Question 14

Attachment levels are (2)

Answer 14

A measure of tissue destruction (pre-treatment)

Extent of repair (post-treatment)

Question 15

Manual proving measurements may be influenced by (6)

Answer 15

The resistance of the tissues
Size, shape and tip diameter of the probe
Site and angle of probe insertion
Pressure applied
Presence of obstructions such as calculus
Patient discomfort

Question 16

Requirements of successful periodontal therapy (2)

Answer 16

Supragingival plaque control

Subgingival plaque control

Question 17

Effect of supragingival plaque control alone (4)

Answer 17

Decreased gingival inflammation
Limited effect on probing depth
No change in attachment levels
No alteration in subgingival microflora in deep pockets (>6mm)

Question 18

Effects of RSD without supragingival plaque control (3)

Answer 18

Initial reduction in inflammation and pocket depth
Pockets are re-colonised by bacteria from supragingival plaque
Disease recurs

Question 19

Effects of supragingival plaque control and RSD (4)

Answer 19

Decreased gingival inflammation
Reduction in probing depth
Gain in probing attachment
Marked changes in the subgingival microbial flora

Question 20

Decreased probing depth calculation

Answer 20

Gingival recession + gain in attachment level

Question 21

Gain in attachment is due to (2)

Answer 21

Long junctional epithelium formation

Improved tissue tone (inflammatory infiltrate is replaced by collagen)

Question 22

Effects of debridement (2)

Answer 22

Reduces microbial challenge (decreased inflammation)

Inoculation with plaque organisms (boosts immune response)

Question 23

Re-evaluation looks at the response to initial therapy (4)

Answer 23

Patient plaque control
BoP
Residual probing depths and attachment levels
Tooth mobility

Question 24

Measurements of periodontal treatment success (6)

Answer 24

Good OH with no BoP
No pockets >4mm
Reduced probing depth
Gain in attachment
No change in furcation or tooth mobility
A functional and comfortable dentition

Question 25

Re-evaluation decision making (3)

Answer 25

Poor OH, persistent inflammation (supportive care or repeat CRT) Good OH, inflammation resolved (supportive care and proceed with treatment plan) Good OH, persistent deep pockets with BoP (surgical access or repeat RSD then re-evaluate)

Question 26

Reasons for treatment failure (3)

Answer 26

Poor compliance Inadequate debridement Host factors (smoking)

Question 27

Limitations of non-surgical therapy (5)

Answer 27

``` Root morphology Furcation involvement Deep pockets Skill level Time ```

Question 28

Supportive periodontal care - management (4)

Answer 28

Maintain periodontal health Detect and treat recurrence Maintain an acceptable level of disease Manage tooth loss