Clinical Responses to non surgical therapy

Question 1

Why is it important to review after a treatment?

Answer 1

• Evaluate the response to a treatment (pocket depths, bleeding, furcations, mobility)
• Access how well you gave treatment and OHI
• Improve patient involvement by giving them a plaque score at each appointment and a goal
• Enquire about any patient reported emotions or pain
• Increase patient awareness through discussions about their risk factors

Question 2

What do we assess for tissue healing?

Answer 2

• Bleeding on probing
• Pocket depths
• Recession
• Mobility
• Furcation
• Plaque control

Question 3

What is an ideal response to treatment?

Answer 3

• Lack or reduction in bleeding
• Pocket reduction
• Recession
• Sensitivity
• Clinical attachment gain

Question 4

When a pocket reduces in depth, what are the two reasons for this?

Answer 4

Attachment gain & recession (less swelling, less collagen)

Question 5

What will be the visible changes in gingiva after treatment?

Answer 5

• Gingival tissue texture (from spongey to firm)
• Contour (swollen papillae to flattening of soft tissue)
• Colour (from red gingiva with BOP to healthy pink)

Question 6

What considering a site-specific response, what are the 3 classifications that the sites can be?

Answer 6

1) Treated
- Pocket depths <5mm
- No BOP or plaque seen

2) Responding
- Reduction in pocketing
- Absence of gingival bleeding
- Absence of plaque

3) Non-Responding
- Persistant pockets
- Persistant inflammation
- Persistent or increasing symptoms

Question 7

What are some of the reasons for sub-optimal change?

Answer 7

Patient:
poor compliance, poorly controlled diabetes, inadequate plaque control, smoking

Site: is the tooth restored, any active caries, osseous defect

Operator: level of skill, time provided for treatment, a pulpal issue

Question 8

What are some of the remedies for suboptimal outcomes?

Answer 8

1. Reviewing modifiable risk factors
   - Smoking, poorly controlled diabetes
2. Evaluate oral hygiene - disclose teeth, show patient to improve motivation
3. Evaluate restorative status - examine for cracks, fractures, overhangs, any fremitus
4. Consider antimicrobials
5. Consider periodontal surgery particularly in furcation areas