Non surgical management of periodontitis Flashcards
What are the stages of Hygiene Phase therapy?
- Dental Health Education
- Oral Hygiene Instruction
- Scaling and Root Surface Debridement
- Removal of other Plaque-Retention Factors
e.g. defective restoration margins; overhangs or crown margins
Dentures
Orthodontic retainers - Re-evaluation
Aim of disease control in periodontal treatment?
Arrest disease process
Maintain periodontal health long-term
Ideally - regenerate lost tissue
RESULT = keep teeth
What to do if perio treatment is successful & patient progresses to <4mm in all quadrants & no BOP?
Supportive care - review appointments, re-enforce OHI and managements of modifiable risk factors
Why does period treatment fail?
Inadequate OH - lack of patient compliance or manual dexterity
Residual sub-gingival calculus - not enough time or correct technique used on RSD, furcation or root grooves, deep pockets
Systemic risk factors - smoking, uncontrolled diabetes
What to do if good OH but persistent deep pockets and BOP following perio therapy?
Surgical access
Further RSD
Adviser to modify risk factors - smoking, uncontrolled diabetes
THEN RE-EVALUATE
Effects of RSD
Decrease gingival inflammation
Increase gingival recession
Inflammatory infiltrate replaced with collagen in CT at base of pocket - leads to increase in attachment due to formation of long junctional epithelium
ALL ABOVE LEAD TO DECREASE IN POCKET DEPTH
Horizontal bone loss - very little change
Vertical defects - more likely to display some infill and gain in bone height
When are the greatest changes after RSD observed?
4-6 weeks
What is the purpose of a full mouth dis-infection?
To prevent treated pockets being re-colonised by intra-oral translocation of bacteria
What are the stages of disease control?
Extraction of hopeless teeth Hygiene Phase Therapy Caries management Endodontic therapy – dressing and temporisation Provisional prostheses
What are the most important parts/ purpose of dental health education?
EDUCATE PATIENT
Modifiable risk factors
Plaque control
Behavioural change - management of risk factors, effective plaque removal (importance of OH and give OHI)
What are the 6 ramfjord teeth and when and why do you use these?
16, 21, 24, 36, 41, 44
(if teeth are missing then use a suitable alternative or miss out)
Used to determine whether a patient is engaging or non-engaging, would determine if they could progress to specific repeated root surface instrumentation.
What are the thresholds for engaging patients with perio treatment?
Plaque and bleeding scores
• Less than 30% plaque score AND • Less than 35% bleeding score OR Greater than 50% improvement in both
When should you record plaque and bleeding scores?
At every treatment and review visit
What are some benefits of a full mouth pocket chart?
Gives the picture of the entire patient’s mouth
What are some drawbacks of a full mouth pocket chart?
Very time consuming
Possibility for variable measurements between professionals
Can be uncomfortable for the patient
What are the benefits of doing modified plaque and bleeding scores?
Simple and quick
Allows snapshot assessment of patient’s OH over a period of time
Clear objective results easily presentable to patients
Identifies engaging patients
What does modified bleeding score measure?
Marginal bleeding rather than BOP - reflects how well patient can carry out plaque control daily
What to do with a non-engaging patient?
RSD delayed Patient informed Identify barriers Continue with OH education, motivation and behavioural change Review
What does BOP at base of pocket indicate vs marginal bleeding?
BOP at base of pockets - indicates disease activity and periodontal breakdown
Marginal bleeding - reflects how well patient is able to carry out effective plaque control daily
What is the max score a patient can get for plaque and bleeding?
plaque - 36
bleeding - 24
What is supportive perio therapy?
Re-enforce plaque control (re-motivate and re-educate patient)
Examine for signs of recurrent disease
Re-treat as necessary - RSD, scaling, polishing etc.
Review appointments to monitor perio status
What are the purposes of supportive care?
Prevents recurrence of the disease
Stabilises periodontal condition
Maintains optimal perio health
3 month intervals are usually appropriate
