2 - Step 3 treatment plan

Question 1

What is step 1 of the periodontal treatment plan?

Answer 1

• education and explanation
• OHI
• risk factor control
• PMPR
• arrange review

Question 2

How should you approach PMPR?

Answer 2

• if you can see it, remove it
• aids patient to keep mouth clean

Question 3

What OHI should you give to patients?

Answer 3

• small head, medium textured bristles
• oscillating and rotating
• interdental cleaning brushes should fit snuggly without wire touching teeth
• use floss if the papilla is intact

Question 4

How often should you review periodontal patients?

Answer 4

• flexible, 6-8 weeks
• review OH after 3 weeks
• response is quick but the healing is slow

Question 5

What is the difference between marginal bleeding and BPE?

Answer 5

• marginal bleeding indicates how well the patient brushes
• BPE indicates inflammation at the base of the pocket (active disease)

Question 6

What do you evaluate at the step 1 review?

Answer 6

• good OHI? (relative improvement, ideally plaque <20%)
• no BOP (<10%)
• no pockets > 4mm
• no increasing tooth mobility
• functional and comfortable dentition

Question 7

What is step 2 of the periodontal treatment plan?

Answer 7

• step 1, in addition:
• instrumentation of pockets > 4mm

Question 8

What are the steps you can take if you have a non-engaging patient?

Answer 8

• find out why and support if possible
• repeat cause-related therapy
• place on palliative care (supportive plan) if uninterested or unable

Question 9

What do you evaluate at the step 2 review?

Answer 9

Good OH and inflammation resolved = supportive care
Good OH and persistent disease = repeat RSD or consider surgical access

Question 10

What are the different types of periodontal surgery?

Answer 10

• access flap
• resective
• regenerative

Question 11

What are the guidelines for considering periodontal surgery?

Answer 11

PPD 4-5mm = repeated RSD
PPD >6 mm = surgical

Question 12

What decisions influence the decision for surgery?

Answer 12

• smoking
• compliance
• OH (lower threshold for plaque)
• systemic disease
• site and prognosis

Question 13

What is the ideal endpoint of periodontal treatment?

Answer 13

• no pockets > 4mm
• no BOP on pockets of 4mm
• BOP <10%
• functional and comfortable dentition
• plaque scores < 20%

Question 14

What is supportive periodontal therapy?

Answer 14

• risk adapted intervals 3-12 months
• continuous monitoring
• PMPR