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2g. BDS2 CDS Periodontology > L77: Non-Surgical Treatment > Flashcards

L77: Non-Surgical Treatment Flashcards

1
Q

L77: A BPE probe is used to do a periodontal exam, what are the different banding measurements?

A
  • 0.5mm diameter ball end;
  • First black band: 3.5-5.5mm;
  • Second black band: 8.5-11.5mm.
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2
Q

L77: What does a BPE score of 0 mean?

A
  • Pockets < 3.5mm;
  • First black band clearly visible;
  • Healthy periodontal tissues;
  • No calculus/ overhangs;
  • No BOP.
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3
Q

L77: What does a BPE score of 1 mean?

A
  • Pockets < 3.5mm;
  • First black band clearly visible;
  • No calculus/ overhangs;
  • BOP.
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4
Q

L77: What does a BPE score of 2 mean?

A
  • Pockets < 3.5mm;
  • First black band completely visible;
  • Supra or sub gingival calculus or plaque retention factor (overhang).
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5
Q

L77: What does a BPE score of 3 mean?

A
  • Probing depth of 3.5-5.5mm;

- First black band partially visible indicating pocket of 4-5mm.

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6
Q

L77: What does a BPE score of 4 mean?

A
  • Probing depth of >5.5mm;

- First black band entirely within pocket indicating a pocket of 6mm or more.

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7
Q

L77: What does a BPE score of * mean?

A
  • Furcation involvement;

- Detection of furcation.

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8
Q

L77: What guidance or tx is indicated with a BPE score of 0?

A
  • No need for tx;
  • No special investigations;
  • Repeat at next appt.
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9
Q

L77: What guidance or tx is indicated with a BPE score of 1?

A
  • OHI;
  • Plaque and bleeding charts;
  • Repeat at next appt.
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10
Q

L77: What guidance or tx is indicated with a BPE score of 2?

A
  • As for code 1;
  • Plus removal of plaque retentive factors (inc. supra and sub gingival calculus);
  • Repeat at next appt.
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11
Q

L77: What guidance or tx is indicated with a BPE score of 3?

A
  • As for code 1 + 2;
  • RSD if required;
  • Periodontal charting of sextants scoring 3, after initial therapy.
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12
Q

L77: What guidance or tx is indicated with a BPE score of 4?

A
  • As for code 2 + 3;
  • Possible need for more complex tx and referral to specialist;
  • Full periodontal charting before and after tx.

[N.B. SDCEP says full perio. charting before AND after tx]

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13
Q

L77: What guidance or tx is indicated with a BPE score of *?

A
  • Treat according to BPE score 0-4;
  • Assess the need for more complex tx and referral to specialist;
  • Full periodontal charting before and after tx.
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14
Q

L77: What percentage of patients have periodontal disease?

A

50%

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15
Q

L77: What percentage of patients have gingivitis?

A

80%

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16
Q

L77: NST, CRT and HPT all mean the same thing, what do they stand for?

A
  • Non-surgical treatment;
  • Cause-related therapy;
  • Hygiene phase therapy.
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17
Q

L77: What are the aims of periodontal therapy?

A
  • To arrest the disease process;
  • Regenerate lost tissue (ideally);
  • Maintain periodontal health long term.
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18
Q

L77: What are the series of events in a tx plan?

A
  • Emergency care;
  • Disease control;
  • Re-evaluation;
  • (Surgery);
  • Re-construction;
  • Supportive care.
19
Q

L77: What defines periodontal disease?

A
  • Loss of attachment;
  • True pocket formation;
  • Colonisation on the root surface.
20
Q

L77: What treatments are involved in ‘disease control’?

A
  • Extraction of hopeless teeth;
  • HPT;
  • Caries management;
  • Endodontic therapy;
  • Provisional prostheses.
21
Q

L77: What treatments are involved in ‘HPT’?

A
  • Dental health education;
  • OHI;
  • Scaling and RSD;
  • Removal of other plaque retention factors, e.g. defective restoration margins;
  • Re-evaluation.
22
Q

L77: What is involved in dental health education?

A
  • Evaluate patients reasons for attendance, attitudes to health care, motivation etc.;
  • Explain the nature of disease using diagrams, photographs, models etc.;
  • Discuss findings of examination.
23
Q

L77: What is involved in oral hygiene instruction?

A
  • Toothbrushing: modified bass technique;
  • Interdental cleaning (floss and tape, interdental sticks, interdental brushes);
  • Disclosing tablets.
24
Q

L77: How should an interdental brush fit a patient?

A

Snuggly - should displace bristles but not snap the wire

[give patients 2 or 3 sizes to start]

25
Q

L77: What is ‘scaling’?

A

The removal of plaque and calculus from tooth surfaces

26
Q

L77: What is RSD?

A

Debridement: The act of removing dead, contaminated or adherent tissue, or foreign material

RSD: scaling

27
Q

L77: Why do we stay away from the term ‘root planing’?

A

Planing: the removal or contaminated cementum, leaving the root surface smooth and hard

Suggests removing cementum (patients would experience sensitivity) and is not done

28
Q

L77: What type of scaling instruments are there?

A
  • Hand instruments;

- Powered instruments (ultrasonic and sonic, rotating and reciprocating)

29
Q

L77: What is the main advantage of hand instruments over powered?

A

More tactile feedback on the root and when you reach the base of the pocket

30
Q

L77: What are the advantages of powered scalers over hand scalers?

A
  • Less likely to scratch/ damage the root surface;
  • Water coolant: cavitation and flushing effect;
  • Ultrasonic/ sonic tips may allow for easier access to furcations;
  • Faster and less demanding on operator.
31
Q

L77: What are the disadvantages of powered scalers?

A
  • Can cause damage in the wrong hands;
  • Produce aerosols;
  • Can leave rougher surfaces.
32
Q

L77: What problems with restorations (caused by dentist) can result in plaque retentive factors on a tooth?

A
  • Poor margins;
  • Poor contour;
  • Partial dentures: gingival coverage, direct trauma, uncontrolled loads.
33
Q

L77: How is the success of periodontal therapy measured?

A
  • Inflammation (BOP);
  • Reduction in probing depth;
  • Gain in probing attachment level.
34
Q

L77: On measurement, what is a false pocket?

A

When pocket is coronal to ACJ, i.e. inflamed gingivae

[see L77]

35
Q

L77: What can manual probing measurements be influenced by?

A
  • Resistance of the tissues;
  • Size, shape and tip diameter of the probe;
  • Site and angle of the probe insertion;
  • Pressure applied;
  • Presence of obstruction such as calculus;
  • Patient discomfort.
36
Q

L77: Successful periodontal therapy requires both supra and sub gingival plaque control, why?

A

Sub:

  • Reduction in probing depth;
  • Gain in probing attachment level;
  • Marked changes in the sub gingival microbial flora.

Supra:

  • Removal alongside sub gingival plaque reduces inflammation;
  • Prevents re-colonisation of subgingival pocket;
  • Prevents reoccurrence of disease process.
37
Q

L77: What happens to the gingiva as they heal and probing depths decrease?

A

Gingival recession (alongside gain in attachment level) = decreased probing depth

38
Q

L77: What are the benefits of a full mouth disinfection? (i.e. full mouth debridement, over same day, and use of chlorohexidine)

A
  • Prevents treated pockets being re-colonised by intra oral translocation of bacteria;
  • Use of chlorohexidine for sub gingival irrigation, tongue brushing and mouth rinsing.
39
Q

L77: What is involved in re-evaluation?

A

Initial response to therapy:

  • Patient plaque control;
  • BOP;
  • Residual probing depths (+ attachment levels);
  • Tooth mobility.
40
Q

L77: What is considered successful HPT, when re-evaluating?

A
  • Good OH;
  • No BOP;
  • No pockets >4mm;
  • No increasing tooth mobility;
  • A functional and comfortable dentition.
41
Q

L77: If HPT is not considered successful at re-evaluation, what must be done next?

A

Source the cause (is it poor OH and why etc.) so you can figure out how to proceed

42
Q

L77: Why can HPT tx fail?

A
  • Poor compliance;
  • Inadequate debridement;
  • Host factors (often smoking).
43
Q

L77: What are the limitations of NST?

A
  • Root morphology;
  • Furcation involvement;
  • Deep pockets;
  • Skill level;
  • Time.

2g. BDS2 CDS Periodontology (2 decks)

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