BSP guidlines Flashcards
What are the BPE scores and what do they mean
0= <3.5mm pockets
1= <3.5mm pockets, BOP
2= <3.5mm pockets, plaque retentive factor
3= 3.5-5.5mm pockets
4= >5.5mm pockets
What would be classified as gingival health
<10% BOP
What would be clasified as localised gingivitis
10-30% BOP
What would be classified as generalised gingivitis
> 30% BOP
If there is a sextant with a code 3 and no obvious interdental recession what would you do
Radiographic assessment and initial perio therapy
Review after 3months including a 6PPC
After a 3month review of a sextant score of 3 when could you move to the 0/1/2 score pathway
If in review no pockets >/=4mm and no radiographic bone loss
After a 3month review of a sextant score of 3 when would you move to the code 4 pathway
If in review pockets >/=4mm and/or radiographic bone loss
Wgat would you do to a sextantt with a BPE score of 4
Radiographic assessment and full periodontal assessment including 6PPC
When staging and grading perio what are the STAGING scores
Look at worst site of radiographic bone loss
<15%= Stage 1
Coronal third= stage 2
Mid third of root= stage 3
Apical third= stage 4
With the staging scores of perio what do the scores actually mean
stage 1=early/mild
stage 2=moderate
stage 3=severe
stage 4=very severe
When staging and grading perio what are the GRADING scores
% bone loss dividedd by pt age
<0.5= Grade A
0.5-1.0= Grade B
> 1.0= Grade C
What do the GRADING scores of perio mean
A= slow progression
B= Moderate progression
C= Rapid progression
When would periodontitis be classified as currently stable
BOP<10%
PPD</= 4mm
No BOP at 4mm sites
When would periodontitis be classified as currently in remission
BOP>/= 10%
PPD</= 4mm
No BOP at 4mm sites
When would periodontitis be classified as currently unstable
PPD>/= 5mm
or
PPD >/= 4mm with BOP
What is required to be diagnose with periodontitis
Presence of interdental attachement loss at 2 or more non-adjacent teeth
How many steps is therew in the BSP guidlines and what are they
4
Step 1- Building foundations for optimal Tx outcomes
Step 2- Subgingival instrumentation
Step 3- Managing non-responsive sites
Step 4- Maintenance
What does step 1 centre around and what does it involve
Proffesional mechanical plaque removal and involves OHI advice, pt education, removal of stains/plaque/plaque retentive factors
What are the steps in stage1of BSP perio Tx guidlines
I: Explain disease, risk factors and TX alternatives, risks and benifits including no Tx
II: Explain importance of OH, encourage and support behaviour change for OH improvement
III: Reduce risk factors
IV: Provide individually tailored OH advice including interdental cleaning, PMPR including sub/supra G scaling of clinical crown
V: Select recall period as per guidlines considering risk factors
How could you explain disease to Pt
The gum disease present in your mouth is caused by bacteria in dental plaque which collect around the gum margin (where the crown of the tooth joins the root). The dental plaque irritates the gums causing them to swell and sometimes bleed during tooth brushing. The dental plaque spreads below the gum margin onto the root. The gum irritation also spreads and this irritation/inflammation can eventually damage the
bone that surrounds the teeth. In the long run this may lead to the teeth becoming loose and, eventually, falling out. We want to try to stop this bone destruction continuing and so prevent you losing teeth
What do you do after step 1
At re-call period re-evaluate to see if pt is engaged or not
If pt is engaged move to step2 if not back to step1
What would be classified as an engaged and non-engaged pt
engaged:
> /= 50% improvement in plaque and bleeding scores OR
plaque levels </= 20% and bleeding levels </= 30% OR
Pt has met targets outlined in ther personal self care plan as determined by healthcare practitioner
non-engaged:
< 50% improvement in P&B scores OR
plaque levels >20% and bleeding scores >30%
What is step 2 and what does it involve
Sub G instrumentation
Involves root surface instrumentation or debridement
Whats the difference betweeen Sub G scaling and debridement
Sub G scaling= involves identifying the calculus and removing it
Debridement= involves taking a systemic approach and washing/cleaning away endotoxins in cementum
What are some different approaches to step 2
Can do it all in one step as in do all scaling in 1 go
or
Do it over multiple visits as in 2 or 3
What approach is recommended for step 2
split over multiple visits as alloiws you to see pt more during Tx to reinforce OH and behaviour changes
What is a risk factor is doing step 2 all in one go
Doing all te scaling in 1 go would create a chance of bacteremia so pt with CVS problems would be at risk
What are the steps involved in stage 2 “
I: reinforce OH, risk factor control, behaviour change
II: SubG instrumentation, hand or powered either alone or in cmbo
III: Use of sustained local antimicrobials if needed
What do you do after step 2
Re-evaluate after 3 months to see in stable or un-stable
If stable move to step 4 if UNSTABLE move to step 3
What would be classed as a un-stable perio
> /=4mm +/- BOP
What is step 3 and what does it involve
Managing non-responsive sites
Very important as its a review and involves taking detailed perio chart to get site specific data to see how sites have responded to Tx
What are the steps in stage 3
I: Reinforce OH, risk factor control, behaviour change
II: Moderate (4.5mm) residual pockets re-perform subG instrumentation
III: Deep (>6mm) residual pockets consider alteranative
IV: Consider referral for pocket management or regen. surgery
V: If referral not available re-perform subG instrumentation
If using systemic antimicrobials in Tx what must it be with
MUST be with instrumentation to disrupt the biofilm
When would asntibiotic regime start and what could you use
Start morning of 1st RSD visit
400mg metronidazole TID for 7 days
What local antiseptic measures are there if needed to assist with Tx
Perio chip
Chlo Site
What are the indications for the use of local antiseptic measures
1) Only presisting pockets >5mm
2) Always with RSD
3) Only in isolated pockets
4) In case of perio abscesses, after evacuation of pus and RSD
What local antimicrobials can be used in helping Tx
1) Arestin, 1mg minocycline HCL microspheres
2) Atriclox, doxycycline hyclate 10%
3) Elyzol, 25% metrondiazole
What is done after step 3
Re-evaluate and if all sites stable move to step 4
What is step 4 and what does it involve
Maintenance
I: Supportive perio care strongly encoraged
II: Reinforce OHG, risk factor control, behaviour change
III: regular targeted PMPR
IV: Consider evidence based adjunctive afficacious toothpaste and/or MW to control gingival inflammation
After step 4 what are the recall periods
Individually taolred between 3-12 months
What is the aims of step
Treat areas of dentition not responding adequately to step 2 with purpose of gaining further access to SubG instrumentation or aiming at regen or resecting thoselesions that add complexity in the management of perio
may include:
-Repeated SubG instrumentation with or without adjunctive therapies
-Access flap surgery
-Resective flap surgery
-Regen flap surgery
