INITIAL PERIODONTAL THERAPY Flashcards
What is the treatment plan dependent on?
It is dependent on the correct diagnosis
What are the 3 stages of periodontal therapy?
- Initial cause related therapy
- Corrective therapy
- Supportive therapy
How should you explain the treatment plan to the patient?
- Be specific, use simple language, avoid medical /dental jargons
- Do not use a patronising tone
- Avoid vague statement
- Begin your discussion on a positive note
- Present the entire treatment plan as a unit
What is the aim of the initial cause related therapy step in periodontal therapy?
To eliminate all the infectious and inflammatory processes that cause periodontal and other oral problems that may hinder the patients general health
This should bring back the oral cavity to a state of health
What procedures can the initial therapy include?
- Periodontal procedures
2. Other dental therapy (E.g. endodontics /addressing oral lesion/extraction of hopeless teeth)
How can we Control or eliminate plaque infections when carrying out the initial therapy?
- Give instructions on oral hygiene techniques
- Give smoking cessation counselling
- Do scaling and root surface debridement and elimination of plaque retention factors
- Make sure the extractions/ endodontics/ restorations/ dentures are arranged properly
- baseline indices of periodontal status
What should we carry out when doing our initial therapy?
- Give Diet advice, luoride advice /OHI
- Give Preventive advice like looking at Lifestyle factors: stress reduction advice /alcohol moderation advice/regular exercise/smoking cessation advice/liaise with GP if necessary
- Remove calculus and root surface debridement
- Correct restorative and prosthetic irritational factors
- Excavate caries and restoration
- Can do Antimicrobial therapy (local or systemic)
- Can do Occlusal therapy
- Can look into Provisional splinting and prosthesis
What phases and steps must be pass before we can move onto corrective therapy?
- Emergency phase
- Initial therapy
- Recall and review
If review unsuccessful go back to initial therapy
If review is successful continue with treatment plan
What Is the relationship between periodontal therapy and dental therapy ?
Periodontal therapy is an inseparable part of dental therapy
What indices can we record to come to a diagnosis ?
- BPE
- Probing pocket depth
- Bleeding on probing
- Suppuration
- Furcation
- Recession
When should we record indices?
Before the initial therapy so that we can come to a diagnosis
If a patient has a BPE of 1 or 2 what should we do?
- record marginal bleeding free scores first
- then record plaque free scores
- repeat indices during initial therapy as needed
If a patient has a BPE of 3 or 4 what should we do?
- Record plaque free scores
- May be useful to record marginal bleeding free scores also
- Record probing pocket depth and bleeding on probing
- Record suppuration, furcation, recession & mobility
- Record bone levels, loss on any radiographs
What are the 3 grades we can give when testing mobility?
Grade I < 1mm horizontally
Grade II > 1 mm horizontally
Grade III > 1 mm horizontally + vertical
What is furcation?
Bone loss between roots of multicoated teeth
What are the 3 grades we can give when testing furcation involvement?
F1 < 3mm horizontally
F2 > 3mm horizontally but not right thro’
F3 through and through
What is a Fundamental requirement of successful periodontal therapy?
Plaque control
How can a patient control their plaque levels on their own?
By brushing their teeth and using inter dental brushes
Also use floss
How long do uninstructed patients brush their teeth for?
33 seconds
What type of inter dental brushed would be advised for patents with gingivitis or periodontitis?
TE-PE brushed
What can patients with bridges use to clean their bridges?
Superfloss
What are the 4 broad categories we can use to control plaque in patients?
- patient mechanical (brushing etc)
- patient pharmacological (mouthwash)
- professional mechanical (scaling, polishing etc)
- professional pharmacological
What falls under patient pharmacology to control plaque?
We can advice patient what tooth paste they should use or recommend a mouthwash
What tooth paste might we recommend to prevent caries?
A Fluoride toothpaste
Total care tooth paste (like Colgate total)
What tooth paste might we recommend to prevent gingivitis?
A gum health toothpaste (Like Corsodyl Daily Gum and tooth paste)
A total care tooth paste (like Colgate total)
What tooth paste might we recommend to a patient with sensitive teeth ?
Use desensitising toothpastes.
Why is it harder to treat patients who smoke?
Smokers respond less well to periodontal therapy (both non-surgical and surgical), presumably in part at least due to the local, systemic and microbiological effects of smoking described
If we know our patient smokes what should we do?
We should advise our patients of the adverse effects of smoking on their oral and periodontal health (+general health)
Record giving advice in patient’s notes (NB medico-legal reasons!)
We should explain poorer response to periodontal therapy
Give smoking cessation counselling
What does scaling do?
Removes plaque, calculus and stain from the tooth surface
What does root planing do?
Removes sub gingival plaque, calculus and softened cementum from the root surface
Why down we usually do root planing?
It is a technical demanding procedure
What do we do instead of root planing?
Root surface debridement
What type of scaler do we use?
A sonic scaler
What is a LM mini Sickle 311/312 XSI (red handle) used for?
For the removal of supragingival calculus
For all tooth surfaces, especially proximal surfaces
What shape is the LM mini Sickle 311/312 XSI (red handle) used for?
Fine, slightly angled blade
Scaler with ergonomic design, non-slip grip, long lasting sharpness and high tactile sensitivity
What is a Gracey curette 1/2, lm 201-202 xsi (grey handle) used for?
Area specific curettes for the removal of deep subgingival calculus
For incisors and canines
What is a Gracey curette 11/12, lm 211-212 xsi (orange handle) used for?
Area specific curettes for the removal of deep subgingival calculus
For mesial surfaces premolars and molars
What is a Gracey curette 13/14, lm 213-214 xsi (blue handle) used for?
Area specific curettes for the removal of deep subgingival calculus
For distal surfaces premolars and molars
What is a universal scalers/curettes –17/18 mCcall, double end lm 277-278 xsi (yellow handle) used for?
for the removal of moderate to heavy calculus from all supra- and subgingival tooth surfaces
Especially for broad molar surfaces
After root surface debridement and sub gingival scaling which teeth have the least calculus left?
Less calculus left :
- following surgery
- on buccal/lingual than mesial/distal
- on single rooted teeth
After using a hoe what should you finish with?
A curette
