guidelines

Question 1

define clinical gingival health, localised gingivitis and generalised gingivitis

Answer 1

health <10% BOP
localised - 10-30-% BOP
generalised - >30% BOP

Question 2

if a BPE of 2 is recorded what should also be included in diagnosis

Answer 2

a comment on plaque retentive factors
Also extent of gingivitis i.e localised or generalised

Question 3

what BPE code pathway should be followed for a patient with obvious interdental recession irrespective of their BPE score

Answer 3

code 4

Question 4

what should be done for a patient with a BPE of 3 and no obvious interdental recession

Answer 4

1. appropriate radiographic assessment
2. initial periodontal therapy
3. review in 3 months, do a localised 6PPC for areas which scored 3
4. if no pockets >4mm revert to code 0/1/2 pathway, if pockets >4mm and/or radiographic evidence of bone loss due to perio progress to code 4 pathway

Question 5

what should be done for a patient with a code 4 BPE

Answer 5

1. radiographic assessment
2. full mouth 6PPC
3. Assess extent - localised, generalised, MI
4. Make periodontal diagnosis

Question 6

Staging periodontitis

Answer 6

uses worst site of interproximal bone loss
stage I - early - <15%
stage II - moderate - coronal 1/3 of root
stage III - severe - mid 1/3 of root
stage IV - very severe - apical 1/3 of root

Question 7

Grading periodontitis

Answer 7

% bone loss / patient age
(use worst site of bone loss)
Grade A - <0.5 - slow progression
Grade B - 0.5-1 - moderate progression
Grade C - >1 - rapid progression

Question 8

define a currently stable periodontitis patient

Answer 8

BOP <10% sites
PPD <_4mm
no BOP at 4mm sites

Question 9

define a periodontitis patient in remission

Answer 9

BOP >_10% sites
PPD <_4mm
no BOP at 4mm sites

Question 10

define a currently unstable periodontitis patient

Answer 10

PPD >_5mm OR PPD>_4mm with BOP

Question 11

step 1 of treating periodontal disease
(BSP guidelines)

Answer 11

building foundations for optimum outcomes
- explain disease, risk factors and pros and cons to treatment
- explain importance of OH
- reduce risk factors - smoking cessation, diabetes control, removal of plaque retention factors
- Provide individually tailored OHI
- supragingival PMPR

Question 12

what should be done after step 1 of treating periodontal disease according to BSP guidelines

Answer 12

re evaluate the patient
are they engaging ?

Question 13

define and engaging vs a non engaging patient

Answer 13

engaging:
>_50% improvement in plaque and bleeding scores OR
plaque levels <_20%, bleeding levels <_30% OR
patient has met personal targets

Question 14

step 2 of periodontal treatment according to BSP guidelines

Answer 14

Subgingival instrumentation
- reinforce OH, risk factor control
- combination of hand and ultrasonic
- possible introduction of antimicrobials

Question 15

when should a patient be re evaluated after step 2 of periodontal treatment
(BSP guidelines)

Answer 15

3 months

Question 16

what should be done if a patients periodontitis is stable at their 3 month re evaluation appointment

Answer 16

progress to step 4 of treatment - maintenance
- supportive periodontal care
- regular PMPR as required
- reinforcing OH and reducing risk factors

Question 17

what should be done if a patients periodontitis is unstable at their 3 month evaluation

Answer 17

manage non responding sites
- reinforce OH, risk factor control
- re perform subgingival scaling on residual moderate pockets (4-5mm)
- if remaining deep pockets >_6mm consider alternative causes and possible referral

Question 18

how often should supportive periodontal therapy be done

Answer 18

intervals of 3-12 months, specific to each patient

Question 19

what are the 3 types of necrotising periodontal diseases

Answer 19

necrotising gingivitis
necrotising periodontitis
necrotising stomatitis

Question 20

what makes patients more prone to necrotising periodontal diseases

Answer 20

smokers
immunodeficient e.g HIV
stressed
poor OH

Question 21

describe the appearance of necrotising periodontal diseases

Answer 21

grey pseudomembranous slough covering a painful ulcerative gingival margin
papilla have a punched out appearance and there may be loss of crestal bone
patients experience bad breath and a metallic taste

Question 22

local measures of treating necrotising gingivitis

Answer 22

advise use of soft toothbrush, toothpaste and interdental cleaning
advise use of chlorhexidine mouthwash
Using benzydamine spray prior to cleaning may help reduce pain
removal of supra and subgingival deposits under LA

Question 23

antibiotic of choice for necrotising gingivitis
(same as pericoronitis)

Answer 23

metronizadole 400mg 3x daily for 3 days

Question 24

how might you tell the difference between a periapical and a periodontal abscess

Answer 24

periapical abscess tooth is usually non vital
periodontal tooth is usually vital

Question 25

describe the common clinical findings of a periodontal abscess

Answer 25

patient has periodontitis an loss of alveolar crest may be seen radiographically
Tooth is usually mobile and TTP in lateral directions
Abscess often adjacent to a periodontal pocket
May be pus draining from pocket or through a sinus tract
May be fever if systemic involvement

Question 26

antibiotic regime of choice for dental abscesses

Answer 26

PenV 500mg 4x day for 5 days

(metronizadole if penicillin allergy, clindamycin if no response to 1st line drugs)