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2 - Periodontology > Non-Surgical Management of Periodontal Disease > Flashcards

Non-Surgical Management of Periodontal Disease Flashcards

1
Q

What do plaque induced gingivitis and periodontitis have in common?

A

both periodontal diseases
inflammatory conditions
caused by the formation and persistence of biofilm

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2
Q

What is plaque?

A

biofilm of bacteria
sticky, soft colourless deposit

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3
Q

What can plaque bacteria attach to?

A

tooth surfaces
periodontal tissues
connective tissues

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4
Q

What is calculus?

A

Calcified solid deposits found attached to the surfaces of teeth and other solid structures – often brown or pale yellow

always covered by plaque biofilm

can be supra and subgingival

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5
Q

What is an example of a plaque retentive factor?

A

calculus
must be disrupted

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6
Q

In young patients, what is advanced PD usually due to?

A

genetic factors

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7
Q

What are the clinical manifestations of plaque induced gingivitis?

A
  • Change in colour of the gingivae
  • Marginal gingival swelling
  • Loss of contour(blunting) of interdental papilla
  • Bleeding from the gingival margin on probing or
    brushing
  • Plaque is present at gingival margin
  • Clinical changes are reversible mainly due to plaque deposits being disrupted
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8
Q

What is the main difference between gingivitis and periodontitis?

A

there is no attachment loss or alveolar bone loss in gingivitis

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9
Q

What are the clinical manifestations of periodontitis?

A
  • Loss of periodontal connective tissue attachment
  • Gingival sulcus measures more than 3.0mm from the gingival margin to the base of the junctional epithelium which has migrated apically with the formation of a true periodontal pocket
  • Alveolar bone loss
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10
Q

What is the aim of periodontal treatment?

A
  • Arrest the disease process
  • Ideally, to regenerate lost tissue
  • To maintain periodontal health long term

keep tooth

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11
Q

What is the basis of therapy?

A

Examination
Assessment of risk factors
Diagnosis

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12
Q

What is the BPE part of?

A

part of examination

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13
Q

What is key to early diagnosis (prevention and prompt intervention)?

A

Screening using BPE

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14
Q

What probes are used for BPE?

A

WHO probe
UNC probe

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15
Q

What is the difference between the two probes and which probe is more commonly used?

A

WHO probe
* A ball end 0.5mm in diameter
* Black band from 3.5-5.5mm
* Second black band 8.5-11.5mm

UNC-15 probe
* 15mm long
* markings at each mm and colour coding at the 5th, 10 th and 15th mm

UNC probe is used for more detailed charting
WHO is used for BPE

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16
Q

How many teeth in each sextant is require to qualify for recording scores?

A

at least two teeth

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17
Q

When are the 3rd molars examined?

A

when 1st and 2nd molars are missing

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18
Q

Where should the probe be walked around?

A

walked around the sulcus/ pockets in each sextant with the highest score recorded

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19
Q

At what score is RSD (root surface debridement) applied?

A

3

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20
Q

At what score and up is OHI given?

A

1

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21
Q

At what score should more complex treatment be assessed?

A

4
furnication involvement

22
Q

At score two, what treatment is used in addition to OHI?

A

removal of plaque retentive factors, including all supra- and subgingival calculus

23
Q

If there is evidence of interdental rcession what should be carried out?

A
  • If there is evidence at initial presentation of periodontitis through interproximal recession this should trigger a full periodontal assessment
  • Interproximal recession is a sign of bone loss and periodontitis but with the current regulations you still need to carry out a BPE for all new patients even if there is clinical evidence of periodontitis
24
Q

When should the BPE not be used?

A

do not use for implants

25
Q

If the BPE scores 3, what are the guidelines (BSP and SDCEP)?

A
  • Option 1 (BSP Guidelines)
  • If a sextant scores 3, this sextant should be reviewed AFTER treatment and a 6 point pocket completed for that sextant only (and only after treatment)
  • Option 2 (SDCEP)
  • If a sextant scores 3, a 6 point pocket chart should be completed for that sextant BEFORE treatment and AFTER. ‘full periodontal examination of all teeth and root surface instrumentation where necessary (N.B. Where code 3 is observed in only one sextant, carry out full periodontal examination and root surface instrumentation of affected teeth in that sextant only)
26
Q

Why do we take radiographs?

A
  • Aid diagnosis and helps with staging and grading of the disease
  • Helps determine prognosis of teeth
  • Assessment of the morphology of affected teeth
  • Pattern and degree of alveolar bone loss
  • Monitoring the long-term stability of periodontal health
27
Q

When can horizontal bitewings be used?

A
  • as long as alveolar crest is visible might show early localised bone loss
  • Presence of poorly contoured restorations
  • Subgingival calculus
28
Q

Why may vertical bitewings be used instead?

A
  • Provides non distorted views of bone levels in realation to CEJ
  • Can provide better visualization of bone level than horizontal bitewings
29
Q

What are the gold standard radiographs for PD assessment?

A

periapical

30
Q

What are modified scores?

A
  • Modified scores are a more efficient yet “fit for purpose” method of recording plaque and bleeding scores.
  • The modified scores offer a standardised and reproducible method to assess patient engagement.

alternative to full mouth plaque and bleeding score which is time consuming

31
Q

What are ramfjord’s teeth used in modified scores?

A

16, 21, 24
36, 44, 41

32
Q

What are the 3 surfaces ramfjord’s teeth are split into?

A

interproximal
buccal
palatal/lingual

33
Q

What are the 3 scores possible for each surface?

A

o 2 = visible plaque without use of probe
o 1 = no visible plaque but a probe skimmed over tooth surface reveals plaque
o 0 = no plaque

34
Q

How is the final score calculated?

A
  • Scores for each surface should be added to get a total
  • This total score is then divided by the maximum plaque score possible for a
    patient max score possible is 36
  • If the patient is missing one of Ramfjord’s teeth – use the neighboring equivalent eg if 4 missing use 5; if 6 missing use 7. If no substitute available then record x and divide by 36 minus 6 (or more if more than one tooth not recorded)
35
Q

What if a similar tooth to a ramfjord’s tooth is not present?

A

code N is assigned

36
Q

How should the score be presented?

A

as a % out of 36

37
Q

In the modified bleeding score, what are the 4 surfaces?

A

mesial
distal
buccal
lingual/palatal

38
Q

What teeth are used for the modified bleeding score?

A

ramfjord’s teeth

39
Q

What are the two possible scores for modified bleeding?

A

o 1 = bleeding present
o 0 = no bleeding

40
Q

What does the modified bleeding score measure and assess?

A
  • Modified Bleeding Score measures marginal bleeding rather than bleeding on probing from the base of the pocket.
  • Marginal bleeding reflects how well the patient is able to carry out effective plaque control daily, whilst bleeding on probing from the base of the pockets indicates disease activity and periodontal breakdown.
41
Q

How should the MBS be carried out?

A

To carry out the MBS, each of the six Ramfjord’s teeth should have a periodontal probe run gently at 45 degrees around the gingival sulcus in a continuous sweep. For up to 30 seconds after probing check for the presence or absence of bleeding.

42
Q

How is the score calculated for MBS?

A

*Scores for each surface should be added to get a total score
* This total score is then divided by the maximum bleeding score possible for a patient i.e. a score of 1 on all surfaces = value is 24

43
Q

If code N is used for both MBS, and MPS, how do the scores change?

A
  • If all lower right molar teeth are missing there is no alternative substitute for the LL6
  • maximum possible plaque score is 30 rather THAN 36 for plaque score
  • And maximum bleeding score of 20 rather THAN 24 for bleeding score
44
Q

What scores indicate an enagaged patient?

A

If Less than 35% bleeding score AND
Less than 30% plaque score
OR
Greater than 50% improvement in both OR
Patient meets target agreed by patient and clinician (which may be brush teeth twice per week/show up to appointments)

45
Q

What score is more important in assessing engagement in non-smokers?

A

MBS

46
Q

If the patient is non-engaging, what treatment should be delayed and what should be done instead?

A
  • If patient is non-engaging subgingival PMPR should be delayed
  • Patient should be informed
  • Identify any barriers
  • Continue with oral health education, motivation and behaviour change
47
Q

In PD charting, what do attachment levels indicate?

A

measure of tissue destruction (pre-
treatment) and the extent of repair (post-treatment).

48
Q

What are the 3 grades of furcation involvement?

A

1 - Initial furcation involvement. The furcation opening can be felt on probing but the involvement is less than one third of the tooth width.

2 - Partial furcation involvement. Loss of support exceeds one third of the tooth width but does not include the total width of the furcation.

3 - Through-and-through involvement. The probe can pass through the entire furcation

49
Q

What are the 4 grades of tooth mobility?

A

0 - ‘Physiological’ mobility measured at the crown level. The tooth is mobile within the alveolus to approximately 0.1 – 0.2 mm in a horizontal direction.

1 - Increased mobility of the crown of the tooth to at the most 1 mm in a horizontal direction.

2 - Visually increased mobility of the crown of the tooth exceeding 1 mm in a horizontal direction.

3 - Severe mobility of the crown of the tooth in both horizontal and vertical directions impinging on the function of the tooth.

50
Q

What might manual probing measurements be influenced by?

A
  • The resistance of the tissues
  • Size, shape and tip diameter of the probe * Site and angle of probe insertion
  • Pressure applied
  • Presence of obstructions such as calculus
  • Patient discomfort
  • If the charting is wrong deep pockets won’t be treated and disease will progress
51
Q

When can a diagnosis be formulated?

A

following a full periodontal assessment and radiographs

52
Q

What is the aim of the S3 guidelines?

A
  • To reduce tooth loss associated with periodontitis
  • improve overall systemic health and quality of life
  • to improve quality of periodontal treatment in Europe

2 - Periodontology (9 decks)

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