Clinical session 1

Question 1

What does TIPPS stand for

Answer 1

TALK with the patient about the causes of periodontal disease and discuss any barriers to effective plaque removal

INSTRUCT the patient on the best ways to perform effective plaque removal

Ask the patient to PRACTISE cleaning his/her teeth and to use the interdental cleaning aids whilst in the dental surgery

Put in place a PLAN which specifies how the patient will incorporate oral hygiene into daily life

Provide SUPPORT to the patient by following up at subsequent visits

Question 2

BPE score 0

Answer 2

Black band completely visible

No probing depths >3.5mm, no calculus/overhangs, no bleeding after probing

Question 3

BPE score 1

Answer 3

Black band completely visible

No probing depths >3.5mm, no calculus/overhangs, but bleeding after probing

Question 4

BPE score 2

Answer 4

Black band completely visible

No probing depths >3.5mm, but supra or sub gingival calculus/overhangs present

Question 5

BPE score 3

Answer 5

Black band partially visible
Probing depths(s) of 3.5-5.5mm present

Question 6

BPE score 4

Answer 6

Black band entirely within the pocket
Probing depth(s) of 6mm or more present

Question 7

BPE score *

Answer 7

furcation involvement

Question 8

BPE score 0 treatment plan

Answer 8

no need for periodontal treatment

Question 9

BPE score 1 treatment plan

Answer 9

Oral hygiene instruction (OHI)

Question 10

BPE score 2 treatment plan

Answer 10

OHI, removal of plaque retentive factors, including all supra- and subgingival calculus

Question 11

BPE score 3 treatment plan

Answer 11

OHI, root surface debridement (RSD)

Question 12

BPE score 4 treatment plan

Answer 12

OHI, root surface debridement (RSD), assess the need for more complex treatment; referral to a specialist may be indicated

Question 13

BPE score * treatment plan

Answer 13

OHI, root surface debridement (RSD), assess the need for more complex treatment; referral to a specialist may be indicated

Question 14

What BPE scores should radiographs be taken for and why

Answer 14

• to assess alveolar bone levels

- where BPE codes 3 or 4

Question 15

What is the BPE for this patient:

• interproximal plaque
• spaced teeth
• bleeding on probing
• probing depths are 3.5-5.5mm in the upper and lower anterior sextants, >5.5 in all posterior sextants

Answer 15

4 3 4

4 3 4

Question 16

Describe the mini-sickle

Answer 16

A double-ended point scaler with two cutting edges on each blade for buccal and lingual embrasure surfaces supra-gingivally and within the pocket orifice

Question 17

Describe the Columbia curette 4R-4L

Answer 17

A double-ended universal curette with 2 cutting edges on each blade for subgingival scaling and root planing anywhere in the mouth but with limited access to deep pockets

Question 18

Describe your seating position when scaling

Answer 18

• forearms parallel to floor
• weight evenly balanced
• thighs parallel to floor
• hip angle 90 degrees
• seat height positioned so that you are able to rest the heels of your feet on the floor
• 11o’clock, 9 o’clock or 7o’clock

Question 19

What teeth surfaces should you scale in the 11 o’clock position

Answer 19

upper anterior buccal
all upper palatal
upper left buccal
lower right posterior lingual
lower left posterior buccal

Question 20

What teeth surfaces should you scale in the 9 o’clock position

Answer 20

upper right posterior buccal
lower right posterior buccal
lower left posterior lingual

Question 21

What teeth surfaces should you scale in the 7 o’clock position

Answer 21

lower anterior palatal

lower anterior buccal

Question 22

How do you grip the curette

Answer 22

‘modified pen grasp’

• index and thumb on the instrument
• middle finger rests lightly on the shank
• ring finger on oral structures, often a tooth surface
• little finger near ring finger, held in a natural, relaxed manner

Question 23

what is the function of the index and thumb finger when holding a curette

Answer 23

holds the instrument

Question 24

what is the function of the middle finger when holding a curette

Answer 24

• helps to guide the working-end

- feels vibrations transmitted from the working-end to the shank

Question 25

what is the function of the ring finger when holding a curette

Answer 25

stabilizes the hand for control and strength

Question 26

what is the shape of the cross-section of the minisickle

Answer 26

triangle

Question 27

what is the shape of the cross-section of the columbia/universal curette

Answer 27

rounded

Question 28

how should the lower terminal shank be positioned when scaling with either a columbia or minisickle curette

Answer 28

parallel to the long axis of the tooth

Question 29

What is a BPE used for

Answer 29

• screening tool for periodontal disease
• provide guidance as to further investigations needed, and may
  inform treatment planning.

Question 30

Can BPE be used for diagnosis

Answer 30

no

Question 31

How do we manage patients with a BPE score of 3 at glasgow dental school

Answer 31

The SDCEP guidelines suggest full periodontal
pocket chart for sextants with BPE=3 before treatment, AND at re-evaluation.
The British Society for Periodontology Guidelines suggest full periodontal
pocket chart for sextants scoring a BPE of 3 after initial treatment. At Glasgow
Dental School, we carry out full periodontal chart for sextants initially scoring 3
after initial treatment*. Either approach is correct.
*initial treatment includes dental health education, oral hygiene instruction, and
removal of all accessible (both supra and subgingival) plaque and calculus.
This should take no more than 2 appointments.

Question 32

What are the limitations of BPE

Answer 32

• it relies on pocket depth and this can be misleading

- it fails to indicate the extent of disease

Question 33

What probe is used to do a BPE

Answer 33

CPITN/WHO/BPE probe