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BDS4 Perio > BSP guidlines > Flashcards

BSP guidlines Flashcards

1
Q

What are the BPE scores and what do they mean

A

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

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2
Q

What would be classified as gingival health

A

<10% BOP

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3
Q

What would be clasified as localised gingivitis

A

10-30% BOP

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4
Q

What would be classified as generalised gingivitis

A

> 30% BOP

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5
Q

If there is a sextant with a code 3 and no obvious interdental recession what would you do

A

Radiographic assessment and initial perio therapy

Review after 3months including a 6PPC

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6
Q

After a 3month review of a sextant score of 3 when could you move to the 0/1/2 score pathway

A

If in review no pockets >/=4mm and no radiographic bone loss

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7
Q

After a 3month review of a sextant score of 3 when would you move to the code 4 pathway

A

If in review pockets >/=4mm and/or radiographic bone loss

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8
Q

Wgat would you do to a sextantt with a BPE score of 4

A

Radiographic assessment and full periodontal assessment including 6PPC

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9
Q

When staging and grading perio what are the STAGING scores

A

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

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10
Q

With the staging scores of perio what do the scores actually mean

A

stage 1=early/mild

stage 2=moderate

stage 3=severe

stage 4=very severe

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11
Q

When staging and grading perio what are the GRADING scores

A

% bone loss dividedd by pt age

<0.5= Grade A

0.5-1.0= Grade B

> 1.0= Grade C

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12
Q

What do the GRADING scores of perio mean

A

A= slow progression

B= Moderate progression

C= Rapid progression

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13
Q

When would periodontitis be classified as currently stable

A

BOP<10%
PPD</= 4mm
No BOP at 4mm sites

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14
Q

When would periodontitis be classified as currently in remission

A

BOP>/= 10%
PPD</= 4mm
No BOP at 4mm sites

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15
Q

When would periodontitis be classified as currently unstable

A

PPD>/= 5mm

or

PPD >/= 4mm with BOP

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16
Q

What is required to be diagnose with periodontitis

A

Presence of interdental attachement loss at 2 or more non-adjacent teeth

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17
Q

How many steps is therew in the BSP guidlines and what are they

A

4

Step 1- Building foundations for optimal Tx outcomes
Step 2- Subgingival instrumentation
Step 3- Managing non-responsive sites
Step 4- Maintenance

18
Q

What does step 1 centre around and what does it involve

A

Proffesional mechanical plaque removal and involves OHI advice, pt education, removal of stains/plaque/plaque retentive factors

19
Q

What are the steps in stage1of BSP perio Tx guidlines

A

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

20
Q

How could you explain disease to Pt

A

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

21
Q

What do you do after step 1

A

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

22
Q

What would be classified as an engaged and non-engaged pt

A

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%

23
Q

What is step 2 and what does it involve

A

Sub G instrumentation

Involves root surface instrumentation or debridement

24
Q

Whats the difference betweeen Sub G scaling and debridement

A

Sub G scaling= involves identifying the calculus and removing it

Debridement= involves taking a systemic approach and washing/cleaning away endotoxins in cementum

25
Q

What are some different approaches to step 2

A

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

26
Q

What approach is recommended for step 2

A

split over multiple visits as alloiws you to see pt more during Tx to reinforce OH and behaviour changes

27
Q

What is a risk factor is doing step 2 all in one go

A

Doing all te scaling in 1 go would create a chance of bacteremia so pt with CVS problems would be at risk

28
Q

What are the steps involved in stage 2 “

A

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

29
Q

What do you do after step 2

A

Re-evaluate after 3 months to see in stable or un-stable

If stable move to step 4 if UNSTABLE move to step 3

30
Q

What would be classed as a un-stable perio

A

> /=4mm +/- BOP

31
Q

What is step 3 and what does it involve

A

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

32
Q

What are the steps in stage 3

A

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

33
Q

If using systemic antimicrobials in Tx what must it be with

A

MUST be with instrumentation to disrupt the biofilm

34
Q

When would asntibiotic regime start and what could you use

A

Start morning of 1st RSD visit

400mg metronidazole TID for 7 days

35
Q

What local antiseptic measures are there if needed to assist with Tx

A

Perio chip

Chlo Site

36
Q

What are the indications for the use of local antiseptic measures

A

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

37
Q

What local antimicrobials can be used in helping Tx

A

1) Arestin, 1mg minocycline HCL microspheres

2) Atriclox, doxycycline hyclate 10%

3) Elyzol, 25% metrondiazole

38
Q

What is done after step 3

A

Re-evaluate and if all sites stable move to step 4

39
Q

What is step 4 and what does it involve

A

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

40
Q

After step 4 what are the recall periods

A

Individually taolred between 3-12 months

41
Q

What is the aims of step

A

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

BDS4 Perio (5 decks)

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