Non-surgical management of plaque related periodontal diseases Flashcards
ILO 1.5c: have knowledge of periodontal examination and monitoring procedures, inducing screening BPEs, plaque and gingivitis indices
what is calculus?
- plaque retentive factor
- calcified deposits found attached to the surfaces of teeth
- appear brown or pale yellow
what are the clinical manifestations of plaque induced gingivitis?
7
- change of colour of gingivae
- marginal gingival swelling
- loss of contouring of interdental papilla
- bleeding from the gingival margin on probing/brushing
- plaque is present at gingival margin
- no clinical attachment loss or alveolar bone loss
- gingival sulcus measures 3mm or less from gingival margin to the base of the junctional epithelium at the ACJ
what are the clinical manifestations of periodontitis?
3
- loss of periodontal connective tissue attachment
- alveolar bone loss
- 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 periodontal pocket
what is the aim of periodontal treatment?
4
- arrest the disease process
- regenerate tissue lost
- maintain periodontal health long term
- keep teeth
what are the steps of periodontal treatment?
5
- basis of therapy - immediate/emergency care
- initial / disease control
- re-evaluation
- recontructive
- maintenance / supportive care
what is carried out in the basis of therapy step in periodontal treatment?
3
- examination
- assessment of risk factors
- diagnosis
what is carried out in step 1 of periodontal treatment?
3
- control of local and systemic factors
- OHI
- professional mechanical plaque removal (PMPR)
what is carried out in step 2 of periodontal treatment?
4
- step 1- control of local and systemic factors, OHI, PMPR
- subgingival and instrumentation +/- adjunctive measures
what is carried out in step 3 of periodontal treatment?
2
- repeated subgingival instrumentation
- periodontal surgery - access flap, resective, regenerative
what is carried out in step 4 of periodontal treatment?
- supportive periodontal therapy
- continuous monitoring of local and systemic factors
what types of radiographs are used when diagnosing periodontitis?
3
- horizontal / vertical bitewings
- periapicals
- dental panoramic tomographs
what is the importance of radiographs in diagnosing for periodontitis?
5
- aids in diagnosis and helps with staging and grading
- helps determining prognosis of teeth
- can assess morphology of affected teeth
- can find pattern and degree of alveolar bone loss
- can monitor the long term stability of periodontal health
what are the benefits of horizontal bitewings when diagnosing periodontitis?
3
- might show early localised bone loss
- can show presence of poorly contoured restorations
- can identify subgingival calculus
what are the benefits of vertical bitewings when diagnosing periodontitis?
- provides non-distorted views of bone levels in relation to ACJ
- can provide better visualisation of bone level than horizontal bitewings
what are the benefits of periapical radiographs when diagnosing periodontitis?
- gold standard in periodontal assessment
- picture of bone levels in relation to both ACJ and total root length
- can identify furcation involvement and possible endodontic complications
what are the advantages and disadvantages of using dental panoramic tomographs (DPT)?
- less uncomfortable
- quicker
- might need supplement periapical views due to risk of distortion of anterior teeth
what are Ramfjord’s teeth? which teeth are they?
6 index teeth distributed in order to best reflect the condition of the whole mouth
* UR6 (16)
* UL1 (21)
* UL4 (24)
* LL6 (36)
* LR1 (41)
* LR4 (44)
what would you do if a Ramfjord’s tooth is missing?
use the adjacent teeth
what would you do if a whole quadrant was missing teeth for a modified chart?
mark as missing with ‘N’
how would you take a modified plaque score?
- each Ramfjord’s tooth is split into 3 surfaces - IP, B, P/L
- each surface can get a score of 0,1,2
- scores from each tooth surface are added up and divided by 36
- if a tooth is missing and cannot be replaced, record X and divide by 30 not 36
- use code N if no teeth present in quadrant
work out the modified plaque score for this patient
12/30 = 40%
what does each score on the modified plaque score mean?
- 0 - no plaque
- 1 - no visible plaque but a probe skimmed over tooth reveals plaque
- 2 - visible plaque without use of probe
how would you take a modified bleeding score?
- each Ramfjord’s tooth is split into 4 surfaces - M, D, B, P/L
- each surface can get a score of 0,1
- scores from each tooth surface are added up and divided by 24
- if a tooth is missing and cannot be replaced, record X and divide by 20 not 24
- use code N if no teeth present in quadrant
work out the modified bleeding score for this patient
10/20 = 50%
how would you tell if a patient is engaged or not?
- less than 35% bleeding score AND less than 30% plaque score
- OR greater than 50% improvement in bleeding and plaque scores
- OR patient meets target agreed with clinician
what should you do if a patient is not engaged?
- don’t use the word engagement as can be negative
- patient should be informed
- subginigval PMPR should be delayed
- identify any barriers e.g. manual dexterity
- continue with oral health education, motivation and behaviour change
what order should you carry out a baseline pocket chart?
- record missing teeth
- probing depth
- record gingival margin in relation to ACJ
- bleeding on probing
- mobility
- furcation
- any suppuration
what is the difference between a baseline pocket chart and a modified pocket chart?
- baseline includes gingival margin, pocket depth, LOA, BOP, furcation and mobility
- modified includes furcation, mobility, pocket depth and BOP
what kind of pocket chart is this?
modified pocket chart
what kind of pocket chart is this?
baseline pocket chart
how would you calculate loss of attachment with a baseline pocket chart?
- record gingival margin - if gingival margin is coronal to ACJ, record as negative number and if apical to ACJ, record as positive number
- record pocket depth
- add pocket depth and gingival margin figure
what order would you go around the mouth when charting a 6ppc?
- buccal of upper right arch
- buccal of upper left
- palatal of upper left
- palatal of upper right
- buccal of lower right
- buccal of lower left
- lingual of lower left
- lingual of lower right
what probe do you use to measure furcation involvement?
Nabers furcation probe
what are the gradings for furcation involvement? what do they mean?
- grade 1: initial furcation involvement less than 1/3 of the tooth width - up to 3mm horizontal attachment loss
- grade 2: partial furcation involvement exceeding 1/3 of the tooth width but not the total width - greater than 3mm attachment loss
- grade 3: through-and-through involvement where probe can pass through entire furcation
how do you test tooth mobility?
- use an index finger and instrument handle to move tooth bucco-lingually
- graded 0,1,2,3
what are the gradings for tooth mobility? what do they mean?
- grade 0: physiological mobility - 0.1-0.2mm in horizontal direction
- grade 1: 0.2-1.0mm mobility in horizontal direction
- grade 2: mobility exceeding 1mm in horizontal direction but no mobility in vertical direction
- grade 3: severe mobility of crown in both horizontal and vertical directions, impinging on function of the tooth - greater than 2mm
what can manual probing measurements be influenced by?
6
- resistance of the tissues
- size, shape and tip diameter of probe
- site and angle of probe insertion
- pressure applied
- presence of obstruction e.g. calculus
- patient discomfort
smokers have tender gingival margins so you tend to under-probe
