BSP guidelines for treatment

Question 1

Explain the 3 diagnoses of oral health

Answer 1

• periodontal health
• gingivitis
• periodontitis

Question 2

when do you know to extract teeth affected by periodontitis

Answer 2

those with hopeless prognosis or unsavable teeth
e.g. grade 3 mobile teeth

Question 3

what is step 1 of the guidelines

Answer 3

building foundation for optimal tx outcomes
1. explain disease, risk factors, tx alternatives, risk and benefits including no tx
2. explain importance of OH, encourage and support behaviour chnage for OH improvement
3. reduce risk factors including removal of PRF, smoking cessation and diabetes control interventions
4. provide individually tailored OH advice inclduing interdental cleaning, +/- adjunctive effacious toothpaste and mouthwash, PMPR inclduing supra and sub scaling of the clinical crown
5. select recall period following published guidance and considering risk factors such as smoking and diabetes

Question 4

what is step 2 of the guidelines

Answer 4

subgingival instrumentation (RSD)
- reinforce OH, RF control, behaviour chnage
- subginigval instrumentation (hand or powered, sonic or ultrasonic)
- use of adjunctive systemic antimicrobials determined by practitioner

Question 5

how long do you wait before step 2 and step 3/4

Answer 5

reevaulate after 3 months

Question 6

if after step 2, unstable what step do you go to

what do you do in this step

Answer 6

step 3 - Managing non-responding sites

1. reinforce OH, risk factor control, behaviour change
2. reperform sub instrumentation on moderate (4-5mm) residual pockets
3. deep residual pocketing (more than or euqal to 6mm) consider alternative causes
4. consider referral for pocket management or regenerative surgery
5. if referral not possible, reperform sub, if all sites stable after step 3 do step 4

Question 7

if after step 2, stable what step do you go to

what do you do in this step

Answer 7

step 4 - Maintenance

1. supportive periodontal care strongly encouraged
2. reinforce OH risk factor control, behaviour change
3. regular targeted PMPR as required to limit tooth loss
4. consider evaluate based adjunctive efficacious toothpaste and/or mouthwash to control gingival inflammation

Question 8

what do you do after step 4

Answer 8

maintenance recall - individually tailored intervals from 3-12 months

Question 9

what 3 things define a disengaging pt

Answer 9

1. insufficient improvement in OH - indicated by less than 50% improvement in plaque and margibnal bleedings scores
   OR
2. plaque levels less than 20% and bleeding levels more than 30%
   OR
3. pt states preference to a palliative approach to perio care

Question 10

what 3 things define an engaging pt

Answer 10

1. favourable improvement in OH - indicatdd by more than or equal to 50% improvement in plaque and marginal bleeding score
   OR
2. plaque levels less than or equal to 20% and bleeding levels more than or equal to 30%
   OR
3. pt has met targets outlined in plan determined by practioner

Question 11

what should you supplement toothbrushing with

Answer 11

use of IDB (where anatomically possible)

Question 12

what should you inform the pt

Answer 12

regular effective self performed plaque removal offers the largest tx benefit
- enagage them in verbal agreement to peform daily plaque control

Question 13

what 4 things do you need to consider when selective a toothbrush and IDB for pt

Answer 13

1. pt abilities
2. pt need
3. pt preferences
4. manual dexterity