L77: Non-Surgical Treatment Flashcards
L77: A BPE probe is used to do a periodontal exam, what are the different banding measurements?
- 0.5mm diameter ball end;
- First black band: 3.5-5.5mm;
- Second black band: 8.5-11.5mm.
L77: What does a BPE score of 0 mean?
- Pockets < 3.5mm;
- First black band clearly visible;
- Healthy periodontal tissues;
- No calculus/ overhangs;
- No BOP.
L77: What does a BPE score of 1 mean?
- Pockets < 3.5mm;
- First black band clearly visible;
- No calculus/ overhangs;
- BOP.
L77: What does a BPE score of 2 mean?
- Pockets < 3.5mm;
- First black band completely visible;
- Supra or sub gingival calculus or plaque retention factor (overhang).
L77: What does a BPE score of 3 mean?
- Probing depth of 3.5-5.5mm;
- First black band partially visible indicating pocket of 4-5mm.
L77: What does a BPE score of 4 mean?
- Probing depth of >5.5mm;
- First black band entirely within pocket indicating a pocket of 6mm or more.
L77: What does a BPE score of * mean?
- Furcation involvement;
- Detection of furcation.
L77: What guidance or tx is indicated with a BPE score of 0?
- No need for tx;
- No special investigations;
- Repeat at next appt.
L77: What guidance or tx is indicated with a BPE score of 1?
- OHI;
- Plaque and bleeding charts;
- Repeat at next appt.
L77: What guidance or tx is indicated with a BPE score of 2?
- As for code 1;
- Plus removal of plaque retentive factors (inc. supra and sub gingival calculus);
- Repeat at next appt.
L77: What guidance or tx is indicated with a BPE score of 3?
- As for code 1 + 2;
- RSD if required;
- Periodontal charting of sextants scoring 3, after initial therapy.
L77: What guidance or tx is indicated with a BPE score of 4?
- 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]
L77: What guidance or tx is indicated with a BPE score of *?
- 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.
L77: What percentage of patients have periodontal disease?
50%
L77: What percentage of patients have gingivitis?
80%
L77: NST, CRT and HPT all mean the same thing, what do they stand for?
- Non-surgical treatment;
- Cause-related therapy;
- Hygiene phase therapy.
L77: What are the aims of periodontal therapy?
- To arrest the disease process;
- Regenerate lost tissue (ideally);
- Maintain periodontal health long term.
L77: What are the series of events in a tx plan?
- Emergency care;
- Disease control;
- Re-evaluation;
- (Surgery);
- Re-construction;
- Supportive care.
L77: What defines periodontal disease?
- Loss of attachment;
- True pocket formation;
- Colonisation on the root surface.
L77: What treatments are involved in ‘disease control’?
- Extraction of hopeless teeth;
- HPT;
- Caries management;
- Endodontic therapy;
- Provisional prostheses.
L77: What treatments are involved in ‘HPT’?
- Dental health education;
- OHI;
- Scaling and RSD;
- Removal of other plaque retention factors, e.g. defective restoration margins;
- Re-evaluation.
L77: What is involved in dental health education?
- 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.
L77: What is involved in oral hygiene instruction?
- Toothbrushing: modified bass technique;
- Interdental cleaning (floss and tape, interdental sticks, interdental brushes);
- Disclosing tablets.
L77: How should an interdental brush fit a patient?
Snuggly - should displace bristles but not snap the wire
[give patients 2 or 3 sizes to start]
L77: What is ‘scaling’?
The removal of plaque and calculus from tooth surfaces
L77: What is RSD?
Debridement: The act of removing dead, contaminated or adherent tissue, or foreign material
RSD: scaling
L77: Why do we stay away from the term ‘root planing’?
Planing: the removal or contaminated cementum, leaving the root surface smooth and hard
Suggests removing cementum (patients would experience sensitivity) and is not done
L77: What type of scaling instruments are there?
- Hand instruments;
- Powered instruments (ultrasonic and sonic, rotating and reciprocating)
L77: What is the main advantage of hand instruments over powered?
More tactile feedback on the root and when you reach the base of the pocket
L77: What are the advantages of powered scalers over hand scalers?
- 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.
L77: What are the disadvantages of powered scalers?
- Can cause damage in the wrong hands;
- Produce aerosols;
- Can leave rougher surfaces.
L77: What problems with restorations (caused by dentist) can result in plaque retentive factors on a tooth?
- Poor margins;
- Poor contour;
- Partial dentures: gingival coverage, direct trauma, uncontrolled loads.
L77: How is the success of periodontal therapy measured?
- Inflammation (BOP);
- Reduction in probing depth;
- Gain in probing attachment level.
L77: On measurement, what is a false pocket?
When pocket is coronal to ACJ, i.e. inflamed gingivae
[see L77]
L77: What can manual probing measurements be influenced by?
- 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.
L77: Successful periodontal therapy requires both supra and sub gingival plaque control, why?
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.
L77: What happens to the gingiva as they heal and probing depths decrease?
Gingival recession (alongside gain in attachment level) = decreased probing depth
L77: What are the benefits of a full mouth disinfection? (i.e. full mouth debridement, over same day, and use of chlorohexidine)
- Prevents treated pockets being re-colonised by intra oral translocation of bacteria;
- Use of chlorohexidine for sub gingival irrigation, tongue brushing and mouth rinsing.
L77: What is involved in re-evaluation?
Initial response to therapy:
- Patient plaque control;
- BOP;
- Residual probing depths (+ attachment levels);
- Tooth mobility.
L77: What is considered successful HPT, when re-evaluating?
- Good OH;
- No BOP;
- No pockets >4mm;
- No increasing tooth mobility;
- A functional and comfortable dentition.
L77: If HPT is not considered successful at re-evaluation, what must be done next?
Source the cause (is it poor OH and why etc.) so you can figure out how to proceed
L77: Why can HPT tx fail?
- Poor compliance;
- Inadequate debridement;
- Host factors (often smoking).
L77: What are the limitations of NST?
- Root morphology;
- Furcation involvement;
- Deep pockets;
- Skill level;
- Time.
