Initial Periodontal Therapy Flashcards
what are the 3 stages of periodontal therapy
initial - NON-SURGICAL
corrective -surgical/ restorative/ re-constructive phase
supportive
they follow history exam and diagnosis.
a treatment plan is dependant on
correct diagnosis which is dependant on screening/ classification of disease
what is the aims of initial therapy
- to eliminate ALL the infections and inflammatory processes that cause periodontitis and other oral health problems which may hinder the patients GENERAL health
- bring back the oral cavity to a state of health: this can occur via periodontal procedures, other dental therapy, liase with GP
as part of initial therapy you have to…
set up baseline indices of periodontal health (perio indices)
instruct on OH techniques
smoking cessation counselling
scaling and root debridement/ eliminating any PRFs
ARRANGE extractions/ endo/ restorations/ dentures
Monitor the response to treatment
you may give anti-microbial therapy (local like perio chip or systemic)
occlusal therapy
provisional splinting and prosthesis
when you first see the patient, you will have to create a baseline by doing some investigations.
describes the steps you would take if the patient had a BPE score of 1/2 (gingivitis) with patient who has BPE score of 3/4/* (periodontitis)
1/2/= do the gingival indices such as marginal bleeding free scores, then record plaque free score THEN initial therapy where you would repeat these indices
3/4/*= INITITAL THERAPY FIRST, then you would record the indices such as plaque free score AND marginal bleeding, followed by PERIO indices: probing pocket dept, BOP, suppuration etc
—> at this BPE score, you may need to consider taking a radiograph
CAL is measured from
CEJ to base of pocket
recession is measured from
gingival margin to base of pocket
initial therapy includes instruction in OH techniques
what interdental brushes would you recommend for gingivitis and perio patients respectively
Gingivitis= TePe brushes
Periodontitis= TePe brushes, vision brushes (curvature depresses inflammed papilla)
to which patient would you recommend super-floss
bridge with pontics
what is a dentrifice
e.g. toothpaste
something to clean teeth with
toothpaste can be focused on preventing specific OH problems. give examples
fluroride- prevent caries
gum health toothpaste- prevents gingivitis
total care- prevents caries and gingivitis
tartar control - prevents calculus therefore gingivtiis
sensitive teeth
which toothpaste would you recommend for gum health
cordodyl daily gum toothpaste:
Na bicarbonate, 6 plant extracts, NaF 1400 ppm
which toothpaste would you recommend for total care
colgate total:
triclosan 0.3%, co-polymer PVM/MA (gantrez) 2%, 0.24% NaF
like toothpaste, mouthrinses can be directed to patients needs such as being cosmetic, anti-caries, anti-plaque.
what can a mouthrine contain for it to be anti-plaque
anti-plaque feature can come from catonic surfactants (corsodyl = chlorohexidinedigluconate gold standard)
OR
from phenolic compounds (listerine= essential oils like thymol, eucaliptol)
corsodyl mouthrinse contains the gold standard called
chlorohexidinedigluconate/ biguanide
why is chlorohexidinedigluconate the gold standard
high efficacy, high substantivity but side effects= staining, taste alteration
colgate plax mouthrinse contains a popular compound measured against the gold standard known as
quaternary ammonium/ cetyl pyridinium chloride
smoking cessation is a part of initial therapy. but after cessation there are time dependant changes which include
as patient recovers from inflammatory response= transient high bleeding for 3 months approx
for patient to return to normal architecture- 12 months
as part of initial therapy there is scaling/ RSD (root surface debridement) thus you will have to use your perio kit as part of initial therapy
what does scaling involve
removing plaque, stain from tooth surface, calculus
sonic or ultrasonic scaler
what does root planing involve
removing SUB gingival plaque, SUB gingival calculus, SUB gingival necrotic/ softened cementum from the ROOT surface
NB. NOT advocated to do, technically demanding
what is RSD
a newer term for root planing but IT DOES NOT INVOLVE REMOVAL OF NECROTIC CEMENTUM
what are the challenges of removing sub-gingival CALCULUS
- requires skill since morphology can differ
- complete removable is not predictable
- less calculus left on buccal/ lingual than on mesial/ distal on a single rooted tooth BUT residual calculus = PRF
- residual calculus is hard to detect since it is below gingiva thus depends on ‘feel’
- in a study it was found that after initial therapy treatment of shallow sits <3.5mm there was LOA
after initial therapy is complete, monitoring occurs to determine if corrective/ supportive therapy is needed.
how do you monitor a response and when
re-evaluate the PERIO indices 8-12 weeks ( a minimum of 6 weeks) after initial therapy
