22. Management Of Plaque Induced Gingivitis

Question 1

LOs

Answer 1

Question 2

What is gingivitis?

Answer 2

• Plaque-induced gingival inflammation confined to the gingival tissues
• highly prevalent
  -common condition

Question 3

Is gingivitis painful?

Is gingivitis reversible?

Answer 3

• Largely painless

• Completely reversible

Question 4

Signs and symptoms of gingivitis?

Answer 4

• Inflammation of the gingiva, in response to plaque o Erythema (redness)
o Odema (swelling)
o Absence of stippling on attached gingiva
o Bleeding on probing
o Bleeding on brushing

Question 5

What is periodontitis? (Difference with gingivitis)

Answer 5

Periodontitis is:
• “Irreversible destruction to the supporting tissues of the teeth
• Apical migration of the junctional epithelium
• Alveolar bone loss

Question 6

Key signs of gingivitis

Answer 6

Key signs
• Pocket formation
• Gingival recession (receding gums)
• Tooth mobility/ Tooth drifting

Question 7

Gingivitis & periodontitis relationship

Answer 7

Question 8

How do we manage plaque induced gingivitis?

Answer 8

Question 9

What happens if we don’t treat gingivitis?

Answer 9

• May develop into periodontitis

Question 10

AiMs of management in plaque inducedgingiritis?

Answer 10

• Reduce gingival inflammation
• restore gingival health

Question 11

How do we remove plaque?

Answer 11

1. PMPR - professional mechanical plaque removal
   ↳ Supra-gingival scaling: professional cleaning to remove plaque and calculus
   ↳ this instrumentation is required to disrupt plaque biofilm and remove local factors to give smooth root surface
2. Eliminate/ modify local plaque retentive factors (these would increase the accumulation of plaque? (e.g. malpositioned teeth, overhanging restorations, crown and bridgework, partial dentures, fixed and removable orthodontic appliances)

Question 12

What do we do to reduce plaque accumulation?

Answer 12

1. Eliminate/ modify local plaque retentive factors (these would increase the accumulation of plaque? (e.g. malpositioned teeth, overhanging restorations, crown and bridgework, partial dentures, fixed and removable orthodontic appliances)
2. Deliver oral hygiene instructions (more info in diff lecture)
3. Smoking cessation advice

• 2+3 require action by the patient

Question 13

What instruments are used in PMPR?

Answer 13

Professional removal of supragingival calculus
• Manual instruments:
- scalers
- curettes
• Powered instruments:
- Sonic/ Ultrasonic instruments
- Piezoelectric

Calculus removal is Important as it can then enable patient to practice effective plaque control/ oralhygeine

Question 14

What does management of plaque induced gingivitis depend on?

Answer 14

Combination of:
- good professional scaling & cleaning by the clinician
- good plaque control by the patient

Question 15

How to remove plaque retentive factors?

Answer 15

1. Explain and point to where the local plaque retentive factors
2. Provide instruction on how to clean adequately
3. Eliminate or modify local factors e.g. removal overhangs from restorations

Question 16

Why is it important to remove plaque retentive factors?

Answer 16

• without correction, would risk preventing successful treatment of gingivitis
• increase risk of progression into periodontitis
• facilitates patients plaque control

Question 17

How to encourage plaque control by the patient?

Answer 17

Question 18

Why is smoking cessation advice important?
How to give?

(Covered later in course)

Answer 18

• Main risk factor for periodontitis, oral cancer and many other health conditions

• Inform the patients the risk of smoking and benefits of smoking cessation

• Offer smoking cessation advice [ref to smoking cessation lectures]

Question 19

Summary of how to manage plaque induced gingivitis?

Answer 19

Management of plaque-induced gingivitis

1. Explain the risk of untreated gingivitis
   (Risk of periodontitis and then tooth loss) (risk can be reduced with good oral hygiene)
2. Reinforce plaque control
   (Show patients on how to plaque control)
3. Smoking cessation
4. Remove supragingival plaque and calculus
5. Remove local retentive factors
   (Eg overhanging restorations, denture design)
6. Review
   (To ensure gingivitis remains resolved)