Non-Surgical Management of Periodontal Disease

Question 1

Describe the 2 key components of non-surgical periodontal treatment

Answer 1

1. Removal and control of plaque bacteria and their products

2. Removal of plaque retentive factors

Question 2

What are 3 components of plaque control?

Answer 2

1. Oral hygeine instruction
2. Education
3. Motivation

Question 3

What can be an aid to demonstrate plaque on teeth for the patient?

Answer 3

Disclosing agent

Question 4

Name and describe the widely accepted method for toothbrushing

Answer 4

• Bass technique

- Brush in small circles at a 45 degree angle to tooth surface

Question 5

Describe a chemical plaque control agent

Answer 5

Chlorhexidine mouthwash (0.2% chlorhexidine gluconate)

Question 6

Describe how chlorhexidine mouthwash works in reducing plaque in the mouth

Answer 6

• Bacteriasidal properties disrupts bacterial cell membranes

- Increased retention in the mouth provides lasting coverage

Question 7

How does plaque become calculus?

Answer 7

Plaque becomes calculus when it is calcified

Question 8

How is sub-gingival calculus detected?

Answer 8

It can be detected with a probe or seen on a radiograph

Question 9

What probe tends to be used in the detection of sub-gingival calculus?

Answer 9

WHO probe is used as there is resistance from the ball on the end so calculus can be easily detected

Question 10

Describe 4 ways root surface debridement (RSD) can be carried out

Answer 10

1. Ultrasonic scalers (mechanical)
2. Sonic scalers (mechanical)
3. Site specific curettes (hand instrumentation)
4. Hoes (hand instrumentation)

Question 11

What are 4 principles of ultrasonic instrumentation?

Answer 11

1. Mechanical energy
2. Irrigation
3. Cavitation
4. Acoustic microstreaming

Question 12

How is mechanical energy used in ultrasonic scaling?

Answer 12

Electrical energy converted to high frequency sound waves which removes calculus from the tooth surface

Question 13

Describe the advantage of irrigation (Not cooling instrument)

Answer 13

Flushes debris out of periodontal pocket

Question 14

Describe cavitation as a principle of mechanical RSD

Answer 14

• Bubbles in water collapse inward, releasing energy and enhancing biofilm removal
• Air bubbles increase oxygen which can kill anaerobic bacteria

Question 15

Discuss 2 types of ultrasonic scalers

Answer 15

1. Piezo-electric
   Vibrations caused by oscillation of quartz crystals
   Linear movements of tip
2. Magnetostrictive
   Magnetic energy converted to mechanical energy to create vibrations
   Eliptical movements of tip

Question 16

Why may magnetostrictive inserts be contraindicated for RSD?

Answer 16

They may interfere with cardiac pacemakers

Question 17

What are 4 advantages of ultrasonic scalers?

Answer 17

1. Irrigation which clears field of debris and blood
2. Allow removal of gross deposits quickly
3. Less tiring for operator
4. Use to remove overhanging margins on amalgam restorations

Question 18

What are 5 disadvantages of ultrasonic scaling?

Answer 18

1. Generate significant heat
2. Generate contaminated aerosols
3. Water and aerosol can obscure vision
4. Can damage tooth or restoration
5. Can cause significant sensitivity during and after procedure

Question 19

What are 4 advantages of hand scaling?

Answer 19

1. Hand instrument allows the operator tactile sensitivity
2. No aerosol is generated
3. Can provide better access esp. deeper sites
4. Less sensitivity and discomfort

Question 20

What are 3 disadvantages of hand scaling?

Answer 20

1. Cause more operator fatigue
2. More time consuming
3. More difficult to use effectively

Question 21

Describe the 5 A’s of smoking cessation

Answer 21

Ask - What do they smoke / How often
Assess - Willingness to quit
Advise - Harmful effects of smoking
Assist - Create plan best for patient
Arrange - Arrange follow up

Question 22

Name 4 components of successful non-surgical periodontal treatment

Answer 22

1. High standard of plaque control
2. Smoking cessation
3. Good quality root surface debridement
4. Good quality restorative treatment