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BDS2 CDS Periodontology > Non-surgical management of plaque related periodontal diseases > Flashcards

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

1
Q

what is calculus?

A
  • plaque retentive factor
  • calcified deposits found attached to the surfaces of teeth
  • appear brown or pale yellow
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2
Q

what are the clinical manifestations of plaque induced gingivitis?

7

A
  • 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
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3
Q

what are the clinical manifestations of periodontitis?

3

A
  • 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
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4
Q

what is the aim of periodontal treatment?

4

A
  • arrest the disease process
  • regenerate tissue lost
  • maintain periodontal health long term
  • keep teeth
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5
Q

what are the steps of periodontal treatment?

5

A
  • basis of therapy - immediate/emergency care
  • initial / disease control
  • re-evaluation
  • recontructive
  • maintenance / supportive care
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6
Q

what is carried out in the basis of therapy step in periodontal treatment?

3

A
  • examination
  • assessment of risk factors
  • diagnosis
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7
Q

what is carried out in step 1 of periodontal treatment?

3

A
  • control of local and systemic factors
  • OHI
  • professional mechanical plaque removal (PMPR)
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8
Q

what is carried out in step 2 of periodontal treatment?

4

A
  • step 1- control of local and systemic factors, OHI, PMPR
  • subgingival and instrumentation +/- adjunctive measures
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9
Q

what is carried out in step 3 of periodontal treatment?

2

A
  • repeated subgingival instrumentation
  • periodontal surgery - access flap, resective, regenerative
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10
Q

what is carried out in step 4 of periodontal treatment?

A
  • supportive periodontal therapy
  • continuous monitoring of local and systemic factors
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11
Q

what types of radiographs are used when diagnosing periodontitis?

3

A
  • horizontal / vertical bitewings
  • periapicals
  • dental panoramic tomographs
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12
Q

what is the importance of radiographs in diagnosing for periodontitis?

5

A
  • 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
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13
Q

what are the benefits of horizontal bitewings when diagnosing periodontitis?

3

A
  • might show early localised bone loss
  • can show presence of poorly contoured restorations
  • can identify subgingival calculus
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14
Q

what are the benefits of vertical bitewings when diagnosing periodontitis?

A
  • provides non-distorted views of bone levels in relation to ACJ
  • can provide better visualisation of bone level than horizontal bitewings
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15
Q

what are the benefits of periapical radiographs when diagnosing periodontitis?

A
  • 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
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16
Q

what are the advantages and disadvantages of using dental panoramic tomographs (DPT)?

A
  • less uncomfortable
  • quicker
  • might need supplement periapical views due to risk of distortion of anterior teeth
17
Q

what are Ramfjord’s teeth? which teeth are they?

A

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)

18
Q

what would you do if a Ramfjord’s tooth is missing?

A

use the adjacent teeth

19
Q

what would you do if a whole quadrant was missing teeth for a modified chart?

A

mark as missing with ‘N’

20
Q

how would you take a modified plaque score?

A
  • 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
21
Q

work out the modified plaque score for this patient

A

12/30 = 40%

22
Q

what does each score on the modified plaque score mean?

A
  • 0 - no plaque
  • 1 - no visible plaque but a probe skimmed over tooth reveals plaque
  • 2 - visible plaque without use of probe
23
Q

how would you take a modified bleeding score?

A
  • 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
24
Q

work out the modified bleeding score for this patient

A

10/20 = 50%

25
Q

how would you tell if a patient is engaged or not?

A
  • 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
26
Q

what should you do if a patient is not engaged?

A
  • 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
27
Q

what order should you carry out a baseline pocket chart?

A
  • record missing teeth
  • probing depth
  • record gingival margin in relation to ACJ
  • bleeding on probing
  • mobility
  • furcation
  • any suppuration
28
Q

what is the difference between a baseline pocket chart and a modified pocket chart?

A
  • baseline includes gingival margin, pocket depth, LOA, BOP, furcation and mobility
  • modified includes furcation, mobility, pocket depth and BOP
29
Q

what kind of pocket chart is this?

A

modified pocket chart

30
Q

what kind of pocket chart is this?

A

baseline pocket chart

31
Q

how would you calculate loss of attachment with a baseline pocket chart?

A
  • 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
32
Q

what order would you go around the mouth when charting a 6ppc?

A
  1. buccal of upper right arch
  2. buccal of upper left
  3. palatal of upper left
  4. palatal of upper right
  5. buccal of lower right
  6. buccal of lower left
  7. lingual of lower left
  8. lingual of lower right
33
Q

what probe do you use to measure furcation involvement?

A

Nabers furcation probe

34
Q

what are the gradings for furcation involvement? what do they mean?

A
  • 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
35
Q

how do you test tooth mobility?

A
  • use an index finger and instrument handle to move tooth bucco-lingually
  • graded 0,1,2,3
36
Q

what are the gradings for tooth mobility? what do they mean?

A
  • 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
37
Q

what can manual probing measurements be influenced by?

6

A
  • 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

BDS2 CDS Periodontology (4 decks)

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