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Clinical practice - IODC > Clinical management of periodontal disease > Flashcards

Clinical management of periodontal disease Flashcards

1
Q

Goals of periodontal therapy

A
  1. Restore health/ eliminate disease
  2. Improve px’s quality of life
  3. Clinical goals
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2
Q

What is health?

A

“A complete state of physical, mental and social well being, not merely the absence of disease” - WHO 1948

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3
Q

What is disease?

A

“medically defined abnormalities in anatomical structures and/ or physiological/ biochemical processes”

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4
Q

What is illness?

A

“individuals experience or subjective perception of changes in physical, mental and social well-being”

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5
Q

What is oral health?

A

“such a state of health of the teeth,
supporting tissues, and of efficiency, as is
reasonable to safeguard general health”

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6
Q

Dental components of quality of life

A

• Functional: Chewing/Talking
• Social: Smiling without embarrassment.
• Measured by Indices such as Oral Health
Impact Profile (OHIP) Slade 1997.

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7
Q

Clinical goals criteria (Lang et al)

A 
no progression.
< in probing depths.
no probing depth > 5mm.
no bleeding on probing.
no progression.
no smoking
plaque score < 20% surfaces
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8
Q

Treatment strategy

A

Initial treatment
Cause-related therapy
Non-surgical treatment
Surgical treatment

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9
Q

Principles of periodontal therapy

A

Structured approach
Chronic gingivitis and periodontitis: anti-infectious approach
-reduce total bacteria load

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10
Q

Initial treatment

A

Relief of pain
Diagnosis and treatment plan
Extraction of hopeless teeth
• Emergency treatment (where necessary)
• Extraction of teeth which are irrational to treat
• Px info
• Plaque control including correction of plaque retention factors
• Root surface debridement
• Initial occlusal adjustment (where necessary)
• Reassessment and monitoring

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11
Q

What is adequate oral hygiene?

A

“such a level of plaque control as is compatible

with periodontal health for an individual.”

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12
Q

Non-surgical treatment

A

• Removal of plaque retention factors (includes
scaling & correction of restoration margins)
• Root surface debridement/ disinfection where required. (>4mm pd)
• Review
• Further treatment of non-responding sites
(further RSD, antimicrobials)

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13
Q

Surgical treatment

A 
• Improved access to non-healing sites
• Tissue recontouring to allow better plaque control
*oral hygiene must be adequate*
-flap surgery: open flap debridement
-gingivectomy
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14
Q

Reasons for maintenance and monitoring

A
  • Re-motivation.
  • Patients cannot clean subgingivally
  • Re-infection issues.
  • Episodic nature of disease
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15
Q

Monitor

A
  • Attachment loss
  • Plaque control
  • Inflammation
  • Mobility
  • Recession
  • Drifting/migration
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16
Q

Limitations of probing

A 
• Inter/intra operator variance
• Probe design
• Patient factors
• Tissue factors
• BPE 
*Computer controlled probes: The Florida Probe (0.3-0.8mm accuracy)*
17
Q

Limitations of bleeding

A
  • Low sensitivity/specificity
  • Smoking
  • Medication
  • Flow between sites
18
Q

Limitations of absence of bleeding

A

Higher sensitivity/ specificity

19
Q

Limitations of radiographs

A
  • Show hard/calcified tissue only
  • Inter/intra operator variance, angulation
  • Processing consistency
  • Px factors, tolerance/dosage
20
Q

FGDP radiography guidelines

A

< 5mm uniform pocketing & little or no recession –
horizontal bitewings
5mm pocketing – vertical bitewings + PAs as
necessary
Irregular pocketing – bitewing (H or V) + PAs
Alternatively panoramic of optimal quality + PAs as
necessary

21
Q

Risk factors

A
  • Genetics
  • Age
  • Previous periodontal disease
  • Smoking
  • Stress
  • Alcohol
  • Diabetes
  • Diet
22
Q

Success rates, measured by percentage of teeth lost during fixed maintenance period

A
  • Average: 13%.
  • Canines: 0.2%
  • Molars: 29%
  • Figures for untreated teeth are not known!
23
Q

Average tooth loss per year as a measure

A 
Treated patients (good
compliance): 0.1
Treated patients (poor
compliance): 0.2
Untreated patients: 0.6
24
Q

Toothbrushing

A

Lack of evidence that one specific toothbrush design is superior to another
Brushing twice daily probably optimal
Most people not effective brushers
Manual brushes on average reduce plaque scores by half
-rotation/ oscillation powered toothbrushes < plaque and gingivitis compared to manual

25
Q

Single oral hygiene instruction + toothbrush demonstration + sclaing

A

Significant albeit small positive effect on reduction of gingival inflammation in adults with gingivitis

26
Q

Toothpaste

A

Triclosan /zinc citrate & triclosan/copolymer toothpastes have significant albeit small +ve effects on plaque reduction & gingivitis
Toothpastes to < calculus formation also available -usually contain a pyrophosphate or zinc system

27
Q

Interdental cleaning

A

Routine recommendation to use floss not supported by scientific evidence
-many studies show no benefit of flossing on plaque or gingivitis.
Interdental brushes < time consuming and > efficacious than floss for interdental plaque removal
Decision on which to use based on local anatomy and dexterity of individual px
-has to be sufficient space to use interdental brush

28
Q

Quadrant vs full-mouth approach

A

Similar outcomes
Single visit full-mouth mechanical debridement (ultrasonic) may have limited additional benefit over a quadrant approach – but completed in a shorter time
No difference in incidence of recurrence of diseased periodontal pockets between full-mouth ultrasonic debridement vs traditional quadrant approach – 1 year follow up

29
Q

Review at 1 month

A

Symptoms, risk factors and plaque scores

30
Q

Review at 3 months

A

Plaque scores, probing depths, bleeding indices, mobility scores

31
Q

RSD outcomes

A 
Positive
-< probing depths
-< bleeding
-no supparation
-> tissue countour
Negative
-recession
-> sensitivity
-other complications
32
Q

When is periodontal treatment complete?

A

Residual probing depths ≥ 6mm represent incomplete perio treatment, require further therapy
Residual probing depths ≥6mm & BoP ≥30% represent risk for further tooth loss

33
Q

Role of systemic antibiotics

A 
Aggressive forms of disease
“Refractory” disease
Necrotising forms of periodontal diseases
Severe disease
Abscesses
34
Q

Aggressive periodontitis antibiotics

A

Metronidazole (400mg) and amoxicillin (500mg) both TDS, 7 days
Azithromycin 500mg daily for 3 days
caution with statins and other drugs

35
Q

Locally applied antimicrobials

A

Metronidazole (Elyzol)
Chlorhexidine (PerioChip, Chlosite gel)
Minocycline (Dentomycin)

Clinical practice - IODC (18 decks)

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