BPE Flashcards
what is the aetiological agent of gingivitis and periodontitis
plaque
what is gingivitis
Plaque induced gingivitis is an inflammatory response of the gingival tissues resulting from bacterial plaque accumulation located at and below the gingival margin
what are the clinical signs of gingivitis
○ Bleeding on probing
○ High plaque score
○ High bleeding scores
○ Gingival swelling and redness
what will the patient notice in gingivitis
○ Blood in saliva
○ Bleeding with toothbrushing and interdental cleaning
○ Bad breath (halitosis)
what are key points to gingivitis
○ Reversible inflammation of the gingival tissues
○ Swelling and bleeding at the gingival margins
○ Risk factor for periodontitis
○ Probing depths < 3mm
○ No attachment loss
○ No radiographic bone loss
define periodontitis
Periodontitis is an inflammatory disease initiated by bacteria which, in susceptible people, can cause severe inflammation and loss of bone around the teeth
what are the clinical signs of periodontitis
○ Bleeding on probing
○ Radiographic bone loss
○ Gingival recession
○ Probing depths >4mm (clinical attachment loss)
what does the patient notice in periodontitis
○ Blood in saliva ○ Bleeding with tooth brushing and interdental cleaning ○ Bad breath (halitosis) ○ Black triangles (spaces between teeth) ○ Tooth movement
what are the key points of periodontitis
○ Inflammation of the supporting structures of the teeth ○ Bleeding on probing in active disease ○ Probing depths > 4mm ○ Radiographic bone loss ○ Susceptible patients most at risk for bone loss § Some are more susceptible than others ○ Can be modified by systemic disease ○ More aggressive in younger patients
what questions should you ask to identify the oral hygiene regime that the patient uses
- How often do you brush your teeth?
- Do you use a manual or powered toothbrush?
- What toothpaste do you use?
- Do you clean in between your teeth with floss or interdental brushes?
- Do you use any mouth rinse?
- Do you attend the dentist regularly?
- Do you have your teeth cleaned by the dentist / hygienist?
what does BPE stand for
basic periodontal examination
what is the BPE
- Screening tool for periodontal disease to quickly assess someone to see if they have gum disease or not
- mouth is divided into sextants
- WHO CPITN probe walked around the gingival margin of the teeth
- indicates what further assessment and periodontal treatment the patient requires
how is the mouth divided into sextants
- upper right (17 to 14)
- upper anterior (13 to 23)
- upper left (24 to 27)
- lower right (47 to 44)
- lower anterior (43 to 33)
- lower left (34 to 37)
what does a BPE score of 0 mean
black band completely visible
No probing depth > 3.5mm
No calculus / overhangs
No bleeding after probing
what does a BPE score of 1 mean
black band completely visible
No probing depth > 3.5mm
No calculus / overhangs
Bleeding after probing
what does a BPE score of 2 mean
black band completely visible
No probing depth > 3.5mm
Supra- and sub- gingival calculus / overhangs present
what does a BPE score of 3 mean
black band partially visible
Probing depths of 3.5-5.5mm present
what does a BPE score of 4 mean
black band entirely within the pocket
Probing depths of 6mm or more present
what does * represent on a BPE score
furcation involvement
= disease between the roots of the teeth
can only happen in posterior sextants where there is more than one root present
what would the treatment be for a patient with a BPE score of 2
remove calculus / overhang
give oral hygiene instruction
what is included in a personalised hygiene regime
- Toothpaste
- Toothbrush
- Method
- Duration
- Frequency
- Interdental cleaning
- Mouth rinse
- Denture hygiene
what can chlorhexidine mouth rinse do
reduce gingivitis and plaque build up
what ppm of fluoride should adults with permanent dentition use
1000/1100 ppm
what does sensitive toothpaste for dentine hypersensitivity include
§ potassium- § stannous fluoride- § potassium and stannous fluoride- § calcium sodium phosphosillicate- § arginine- containing desensitizing toothpastes
what type of desensitising toothpaste shows no evidence for working
strontium containing desensitising toothpaste
what technique should be used for manual brushing
modified bass technique
what does powered toothbrush show that it is better than a manual toothbrush
reduction in plaque and gingivitis after use
how long should you brush your teeth
2 mins
longer if you have periodontitis (especially when considering need for interdental cleaning devices)
how does frequency of brushing impact periodontal disease
• Relatively few studies evaluating the association between tooth brushing frequency and periodontitis
A clear effect was observed, indicating that infrequent tooth burhsing was associated with severe forms of periodontal disease
how does interdental cleaning affect periodontal disease
• Using floss or interdental brushes in addition to toothbrushing may reduce gingivitis or plaque or both, more than toothbrushing alone
Interdental brushes may be more effective than floss
what does corsodyl do as a mouth rinse
○ Reduce gingivitis and plaque build up
○ Masks how well patient cleans teeth
§ Like weed killer for teeth as it kills all bacteria
○ Rinsing with chlorhexidine mouth rinse for 4 weeks or longer causes extrinsic tooth staining
○ Other adverse effects such as calculus building up, transient taste disturbance and effects on the oral mucosa were reported in the included studies
○ Not recommended for routine every day use
what does Fluoride mouth rinse do
○ Large reduction in tooth decay in children’s permanent teeth
○ Little information on potential adverse effects and acceptability
○ Recommended for routine daily use if high caries risk
○ Use when not brushing
○ Gives an extra dose of fluoride on exposed dentine surfaces
what should plaque scores be for treatment to work well
less than 20%
what can be said about patient behaviour change
- Learning a skill can take minutes or hours but changing a habit takes weeks or months
- Instruction is meaningless and easily forgotten without understanding the context in which it fits
- A few appropriately selected and delivered words are more effective than a full lecture delivered with the hole that the patient will grasp the relevant details
- Repeating instructions multiple times will not increase motivation, in fact, it may offend and decrease motivation
- Offering assistance, and seeking permission to give knowledge or teach skills facilitates patient ownership of the task
○ Remember the natural response to force is resistance - Motivation is not static but can vary as an individual is affected by other life related factors and stresses
what helps to guide what is important in oral hygiene instruction
TIPPS
What is TIPPS
• Talk
○ About the causes of dental disease and discuss any barriers to effective plaque removal
• Instruct
○ The patient on the best ways to perform effective plaque removal
• Practise
○ Ask the patient to clean his / her teeth and to use the interdental cleaning aids whilst in the dental surgery
• Plan
○ Put in place a plan which specifies how the patient will incorporate oral hygiene into daily life
• Support
○ Provide support to the patient by following up at subsequent visits
