Initial Periodontal Therapy

Question 1

what are the 3 stages of periodontal therapy

Answer 1

initial - NON-SURGICAL
corrective -surgical/ restorative/ re-constructive phase
supportive

they follow history exam and diagnosis.

Question 2

a treatment plan is dependant on

Answer 2

correct diagnosis which is dependant on screening/ classification of disease

Question 3

what is the aims of initial therapy

Answer 3

1. to eliminate ALL the infections and inflammatory processes that cause periodontitis and other oral health problems which may hinder the patients GENERAL health
2. bring back the oral cavity to a state of health: this can occur via periodontal procedures, other dental therapy, liase with GP

Question 4

as part of initial therapy you have to…

Answer 4

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

Question 5

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)

Answer 5

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

Question 6

CAL is measured from

Answer 6

CEJ to base of pocket

Question 7

recession is measured from

Answer 7

gingival margin to base of pocket

Question 8

initial therapy includes instruction in OH techniques

what interdental brushes would you recommend for gingivitis and perio patients respectively

Answer 8

Gingivitis= TePe brushes

Periodontitis= TePe brushes, vision brushes (curvature depresses inflammed papilla)

Question 9

to which patient would you recommend super-floss

Answer 9

bridge with pontics

Question 10

what is a dentrifice

Answer 10

e.g. toothpaste

something to clean teeth with

Question 11

toothpaste can be focused on preventing specific OH problems. give examples

Answer 11

fluroride- prevent caries

gum health toothpaste- prevents gingivitis

total care- prevents caries and gingivitis

tartar control - prevents calculus therefore gingivtiis

sensitive teeth

Question 12

which toothpaste would you recommend for gum health

Answer 12

cordodyl daily gum toothpaste:

Na bicarbonate, 6 plant extracts, NaF 1400 ppm

Question 13

which toothpaste would you recommend for total care

Answer 13

colgate total:

triclosan 0.3%, co-polymer PVM/MA (gantrez) 2%, 0.24% NaF

Question 14

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

Answer 14

anti-plaque feature can come from catonic surfactants (corsodyl = chlorohexidinedigluconate gold standard)
OR
from phenolic compounds (listerine= essential oils like thymol, eucaliptol)

Question 15

corsodyl mouthrinse contains the gold standard called

Answer 15

chlorohexidinedigluconate/ biguanide

Question 16

why is chlorohexidinedigluconate the gold standard

Answer 16

high efficacy, high substantivity but side effects= staining, taste alteration

Question 17

colgate plax mouthrinse contains a popular compound measured against the gold standard known as

Answer 17

quaternary ammonium/ cetyl pyridinium chloride

Question 18

smoking cessation is a part of initial therapy. but after cessation there are time dependant changes which include

Answer 18

as patient recovers from inflammatory response= transient high bleeding for 3 months approx

for patient to return to normal architecture- 12 months

Question 19

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

Answer 19

removing plaque, stain from tooth surface, calculus

sonic or ultrasonic scaler

Question 20

what does root planing involve

Answer 20

removing SUB gingival plaque, SUB gingival calculus, SUB gingival necrotic/ softened cementum from the ROOT surface

NB. NOT advocated to do, technically demanding

Question 21

what is RSD

Answer 21

a newer term for root planing but IT DOES NOT INVOLVE REMOVAL OF NECROTIC CEMENTUM

Question 22

what are the challenges of removing sub-gingival CALCULUS

Answer 22

1. requires skill since morphology can differ
2. complete removable is not predictable
3. less calculus left on buccal/ lingual than on mesial/ distal on a single rooted tooth BUT residual calculus = PRF
4. residual calculus is hard to detect since it is below gingiva thus depends on ‘feel’
5. in a study it was found that after initial therapy treatment of shallow sits <3.5mm there was LOA

Question 23

after initial therapy is complete, monitoring occurs to determine if corrective/ supportive therapy is needed.
how do you monitor a response and when

Answer 23

re-evaluate the PERIO indices 8-12 weeks ( a minimum of 6 weeks) after initial therapy