Disease Prevention and Non-Surgical Instrumentation

Question 1

Formally define “dental plaque”

Answer 1

Dental Plaque is a host-associated biofilm

Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity (removable and fixed restorations)

Question 2

What are the three take-home points of Experimental Gingivitis Studies of LOE?

Answer 2

• Undisturbed plaque accumulation leads to gingivitis
• Time to develop gingivitis: 10-21 days
• reinstitution of oral hygiene results in healthy gingival conditions

Question 3

3 forms of mechanical plaque control

Answer 3

manual tooth brush, electric tooth brush, interdental cleaning devices

Question 4

How large in diameter should the end-rounded nylon or polyester filaments be in a manual tooth brush?

Answer 4

no larger than 0.23 mm (0.009 inches)

Question 5

What is the most recommended brushing method?

Describe method

Answer 5

Bass Technique (vibratory)

the head of brush is positioned in an oblique direction towards apex. Tips directed into sulcus at 45 degree to long axis of tooth. Brush moved back and forth using short strokes. On lingual surfaces in anterior regions, brush head is kept in vertical direction.

Question 6

Why is it recommended to brush twice a day?

Answer 6

1. plaque control (2 min for plaque removal)
2. fluoride application

Question 7

What are the 3 interdental cleaning aids?

Answer 7

dental floss/tape, interdental brushes, single tufted brushes

Question 8

What represents the ideal interdental cleaning tool for the periodontitis patient?

Answer 8

Interdental brushes

• its also the aid of choice when root surfaces with concavities or grooves have been exposed.
• it is also the most suitable cleaning device in “through and through” furcation defects

Question 9

studies on oral irrigation

Answer 9

as monotherapy, it’s unable to resolve gingivitis. Should not be used instead of toothbrushing. Combined with toothbrushing, it is good therapy, especially for patients who perform inadequate inter proximal cleansing.

Question 10

What are 3 alterations in exposed cementum in root surfaces in periodontitis?

Answer 10

hypermineralized surface zone

changes in organic matrix

endotoxins cytotoxic in tissue culture

Question 11

what is the definition of scaling?

what is the definition of root planing?

Answer 11

Scaling: removing supra and subgingival tooth surface plaque and calculus

Root planing: removing residual embedded calculus and portion of cementum from the root to produce a smooth, hard surface

Question 12

Does smoothness after SPR matter?

Answer 12

Rosenberg and Ash: compared SRP (smoother surfaces) to ultrasonics (rougher surfaces) - rougher surfaces were not significantly more likely to accumulate plaque or promote inflammation

Smoothness of root surface is less important than getting rid of bacteria. But we like smooth surfaces because its the only way to evaluate calculus removal.

Question 13

explain the terminology regarding ultrasonic scalers:

• cavitation effect
• magnetostrictive
• piezoelectric

Answer 13

Cavitation effect: ultrasonic used with water due to heat, water plus heat leads to bursting

Magnetostrictive: vibration of the tip is elliptical (cavitron) - bigger contact

Piezoelectric: vibration of the tip is linear - smaller contact of tip to tooth

Question 14

What are the two principal mechanisms for pocket depth reduction after SRP?

Answer 14

1. Recession of the gingival margin due to resolution of the inflammation
2. Reattachemnt to the root surface: long junctional epithelium

Question 15

% surfaces with residual calculus at different probing depths: comparison of open procedure and closed (nonsurgical)

Answer 15

close procedure had fewer % surfaces with residual calculus

Question 16

SRP efficacy in calculus removal conclusions (4)

Answer 16

• residual calculus correlates with initial pocket depth
• open approach is better than closed in depper pockets and posterior teeth
• removal less complete on posterior teeth and furcation areas, regardless of approach
• training and experience improve performance

Question 17

Changes in attachment level with SRP (4)

Answer 17

• SRP causes shallow sites to lose attachment
• SRP causes deep sites to gain attachment
• greater reduction in probing depths with initial deep pockets
• adverse outcomes: dentin hypersensitivity and gingival recession

Question 18

GIngival recession occurs proportional to initial ______

the greatest changes in probing depth reduction can be recorded after ____ weeks but gradual repair and maturation may take up to _____ months

Answer 18

intial probing depth

4-6 weeks, 12 months

Question 19

What are 3 limitations to non-surgical approach?

Answer 19

• complete calculus removal is not possible when pockets are > 4 mm
• similar healing response was accomplished by a single initial instrumentation as by 3 instrumentations separated by 3 months. repeated instrumentation is of little value
• multipe residual probing depths greater than or equal to 6 mm at re-evaluation run a greater risk of losing further attachments

Question 20

What are some factors that contribute to unsuccessful results of SRP?

Answer 20

• poor plaque control by patient
• insufficient plaque and calculus removal
• systemic disease
• smoking
• initial probing depth
• furcation involvement grade II and III