Non-surgical management of perio disease Flashcards
What additional brushes are useful to advise to use?
Single tufted brushes to clean misaligned teeth and also distal of last molars
What is the most effective mouthwash for perio patients, when should it be prescribed?
What are negatives of alcohol containing mouthwash?
0.2% chlorhexadine
Only prescribe where pain limits patient mechanical plaque removal
E.g. following sub gingival instrumentation or those with acute conditions
Negatives include xerostomia and carcinogenic
What is a good order to use for non surgical Management of patients?
OHI
Behaviour change
Hygiene phase therapy
Full mouth disinfection
Removal of PRF
Re-evaluation
Give OHI
Should use a medium textured brush with a small head, up to you if you prefer manual or electric
- recommend replace your brush every 2-3 months
Methodical approach: start at the back of the mouth on one side and work your way round, then come back on the inside, then repeat for the other jaw.
Then explain Modified bass technique
Then interdental cleaning:
- brush doesn’t reach right between the teeth, so use of interdental cleaning is recommended. Use floss or teepee brushes, these are more effective than floss.
Use the largest brush that will be a snug fit.
Describe the modified bass technique
45 degree angle of toothbrush to tooth surface, pointing down at the gum - half brush on tooth and half on gum
Use small back and forward strokes on no more than 2 teeth at a time
When cleaning lower teeth, tongue must be out of the way so that the brush is on the gum margin
What behaviour change can be done with the patient?
When a modifiable risk factor is identified, explain why it is a risk and offer advice to eliminate it.
What is hygiene phase therapy ? What is its effect?
Use of periodontal scalers
On the microflora:
- reduction in p.gingival is and t.denticola
On the hard and soft tissues:
- decrease in gingival inflammation
- increase in collagen fibres
- little change in horizontal bone loss areas but vertical areas gain some infill and bone height
How is a full mouth disinfection Carried out and what is the use?
To prevent recolonisation of pockets with plaque flora
Done twice during the same day, use chlorhexadine for subgingival irrigation along with tongue brushing and mouth rinsing
What can be done to remove PRF?
Altering restorations by:
- removing overhangs or contours
Changing RPDs to decrease gingival coverage
Reviewing orthodontics to allow for better interdental cleaning
How should a reevaluation be done?
- probing depths
- plaque and bleeding scores
- attachment levels
- grade mobility and furcations
How can alcohol reduction advice be given?
Ask, advise, act. Same as smoking
How often drink?
How many units on the day when you do drink?
How often more than 6/8 units a day during the year?
- if moderate or severe, encourage ways to reduce drinking, or visit GMP about it.
