Management of periodontitis in the maintenance phase

Question 1

What is the management of periodontitis treatment strategy?

Answer 1

Initial treatment
Cause-related therapy
Non-surgical treatment
Maintenance/supportive

Question 2

What is the initial treatment management based on?

Answer 2

Emergency treatment
Extraction of teeth which are irrational to treat
Patient information
Plaque control including correction of retentive factors
RSD
Initial occlusal adjustment where necessary
Reassessment and monitoring

Question 3

What is the aim of initial treament?

Answer 3

Shallow pockets with no bleeding on probing <4mm

Question 4

What is done at the review?

Answer 4

Check all treatment has been carried out 
Check OH
6-point charting 
Evalutation - is treatment aim reached
Plan follow up

Question 5

If the initial phase is complete and treatment aims are achieved, what is the follow up?

Answer 5

Individualised recall programme

Question 6

If the initial phase is complete and treatment aims are partially achieved, what is the follow up?

Answer 6

Perio-surgery

Question 7

If the initial phase is incomplete, what is the follow up?

Answer 7

Review diagosis and treatment plan then reasses

Question 8

Good initial therapy but poor result =

Answer 8

Refractory periodontitis
Need further investigation
e.g. bacteriological, medical, genetic

Question 9

Initial treatment incomplete =

Answer 9

Treatment carried out well?
Patient compliance?
OHI, smoking?

Question 10

Why do patients need maintenance?

Answer 10

Changing habits is difficult
Re-motivation
Patients cannot clean subgingivall
Re-infection issues
Episodic nature of disease

Question 11

What is the aim of maintenance phase?

Answer 11

maintain infection control

this aim can be achieved through a well structures quality maintenance programme

Question 12

What is the structure of a maintenance appointment?

Answer 12

S&P, OHI, F-
Notes 
Diagnosis
Risk-level
InterVal RSD

Question 13

What are the clinical criteria for diagnosis?

Answer 13

BOP
PD
Furcation, analysis pocket
Occlusion and articulation, mobility 
Evaluation restorations/prosthese 
Examination for caries

Question 14

What are the causes of periodontitis?

Answer 14

Type of bacteria (quality)
And quantitiy, influenced by:
Compliance/concordance
OH 15% plaque = acceptable
Number and depths of pockets
Furcation involvement
Restorative retention factors

Question 15

What influences the resistence to periodontitis?

Answer 15

Systemic factors:
Diabetes, medication, pregnancy, HIV, Chron’s, Sjogren’s syndrome, RT, menopause
Genetic factors
Age
Lifestyle; stess, smoking >10 a day incrases risk, drinking

Question 16

What are the % risk for BOP and perio disease?

Answer 16

BOP>25% > risk

BOP <10%

Question 17

What % of chlorhexidine is used in perio treatment?

Answer 17

0.05%

Question 18

How do you work out the bone level: age ratio?

Answer 18

Divide the % bone loss by the patient’s age
if >1 = high risk
0.5-1 medium
0.5 = low risk

Question 19

If have a low risk patient, what is the recall interval?

Answer 19

6 monthly

Question 20

If have a medium risk patient what is the recall interval?

Answer 20

4 monthly

Question 21

If have a high risk paritne what is the recall interval?

Answer 21

3 monthly

Question 22

What is the long term maintenance?

Answer 22

Full perio assessment every 2 years

Radiological assessment every 5 years