clinical management of PDD Flashcards
goals of periodontal therapy
1) restore health/eliminate disease
2) improve patients quality of life
3) clinical goals
what is health
- complete state of physical, mental and social wellbeing, not merely the absence of disease
oral health
- such a state of health of the teeth and supporting tissues and of efficiency, as is reasonable to safeguard general health (general dental services regulations)
disease
- medically defined abnormalities in anatomical structures and/or physiological/biochemical processes
clincicla goals for PD therapry
- no progression
- reduction in probing depths
- no probing depths greater than 5mm
- no bleeding on probing
- no smoking
- plaque score on less than 20% of surfaces
factors which may affect outcome of treatment
- susceptibility to disease genetic factors
- plaque control
- previous periodontal disease
- smoking
- stress
- some systemic diseases eg diabetes
- diet
treatment strategy
1) initial treatment
2) cause related therapy
3) non surgical treatment
4) surgical treatment occasionally
inital treatment should be based on
- emergency treatment/relief of pain (where necessary)
- extraction of teeth having a hopeless prognosis
- oral health education/OH advice
- plaque control including correlation of plaque retention factors
- root surface debridement
- initial occlusal adjustment (where necessary)
- reassessment and monitoring
positive ledges
plaque retentive features
- replace all or part of the restoration or place an indirect restoration
when do you perform RSD
- pockets equal or more than 4mm
- removal of subgingival plaque and calculus
- removal of surface toxins (endotoxin)
- under LA usually
- predominantly ultrasonic
non surgical treatment strategey
Deliver treatment as a quadrant or full mouth RSD
• Removal of plaque retention factors (includes scaling and correction of restoration margins)
• Root surface debridement of periodontal pockets ≥4mm) under LA
• 1 month oral health check
• Review 3 months following the completion of treatment (review oral hygiene at 1 month)
• Further treatment of non-responding sites
when do you review
1 month
3 months
1 month review
symtoms
risk factors
plaque score
3 month
- plaque score
- probing depth
- mobility
- bleeding
- recession
- furcation
root surface debridement
- reduced probing depth
- less bleeding
- no suppuration
- improved tissue contour
will also see - more recession
- increased sensitivity (due to the recession)
- other complications
when is PD therapy complete
- residual probing depths above or equal to 6mm show incomplete periodontal treatment and further therapy is required
- residual probing depths greater than 6mm and BOP on over 3-% represent risk of further tooth loss
- need to keep checking to ensure progress
what should you monitor for further treatment
Monitor
- probing depths
- recession
- plaque control
- inflammation (BOP)
- mobility
- drifting/migration
- dentine sensitivity
Implant care
- Must combine efforts to have build-up of biofilm under control during maintenance and to reduce the influence that risk factors may play in plaque accumulation as well as in the tissue inflammatory response.
limitations of clinical measurement
errors in probing depth measurements Bleeding on probing - smoking - low sensitivity - medication - flow between sights
limitations of radiographs
- show hard/calcified tissue only
- inter/intra operator variance, angulation
- patient factors/tolerance
role of systemic antimicobials when to used them
1) severe rapidly progressive forms of disease
2) refractory disease
3) necrotising forms of periodontal diseases
4) abscesses
what has use in PDD antimicrobials wise
amoxicillin
metronsazole
side effect of azithromycin
can prolong QT inerval
risk of abnormal hear rhytm
peripdontl surgert types
flap surgeyr
gingivectomy
flap surgery
rasie a flap
can clean direcrly into root
gingivectomy
cut back the gignival tissues
