Non-surgical management of plaque-related periodontal diseases Flashcards
what is option 1 on action on recording BPE 3 (BSP)
if a sextant scores 3, this sextant should be reviewed and a 6 point pocket completed for that sextant only (and only after treatment)
what is option 2 on action on recording BPE 3 (SDCEP)
if a sextant scores 3, a 6 point pocket chart should be completed for that sextant before treatment and after.
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
what is non surgical management also known as
cause related therapy
hygiene phase therapy
what is the aim of periodontal therapy
to arrest the disease process
ideally to regernate lost tissue
to maintain periodontal health long term
what is the disease control phase
extraction of hopeless teeth hygiene phase therapy caries management endodontic therapy provisional prostheses
what is periodontal therapy
supra gingival plaque control including scaling
what is periodontitis
loss of attachment and true pocket formation
colonization of the root surface - importance of removing this
what is hygiene phase therapy
dental health education oral hygiene instruction scaling and root surface debridement removal of other plaque retention factors reevaluation
how should dental health education be individualized
evaluate patients reasons for attendance, attitudes to health care, motivation tc
explain the natures of disease using diagrams, photographs, models ect
discuss findings of examination
what does dental health education consist of
demonstrate health and disease in the patients mouth
explain the nature and consequences of treatment
use language the patient will understand
what happens in oral hygiene instruction
talk about tooth brushing
interdental cleaning
disclosing agent
what is scaling
the removal of plaque and calculus from tooth surfaces
what is root surface debridement
encompasses the process of scaling and removal of supra gingival calculus
what are the scaling instruments
hand instruments
powered instruments
what are the powered scaling instruments
ultrasonic and sonic instruments
rotating and reciprocating instruments
what does the ultrasonic/sonic tip do better
may allow access to furcations
may be faster and less demanding on the operator
may result in less unwanted tooth tissue removal
how do the powered instruments work
the vibrations against calculus removes it
where can ultra sonic instruments be used
supra and sub gingival
what is the advantage of hand instruments
they have greater tactile sensitivity
can tell when you are at the base of the pocket
what is the disadvantages of powered instruments
the water coolant may produce cavitation
powered instruments produce aerosols
powered instruments may leave a rougher surface
what are problems with restorations
their margins (location and adaptation)
restoration contour
partial dentures
what are the problems seen with partial dentures
gingival coverage
direct trauma
uncontrolled loads
how is success of periodontal therapy treatment measured
inflammation (bleeding on probing indices)
reduction in probing depth
gain in probing attachment level
what does probing depth indicate
the difficulty of treatment and the likelihood of recurrence
what do attachment levels indicate
they are a measure of tissue destruction (pretreatment) and the extent of repair (post treatment)
what may manual probing measurements be influenced by
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
what is the effect of supra gingival plaque control alone
decreased gingival inflammation
limited effect on probing depth
no change in attachment levels
no alteration in sub gingival microflora in deep pockets
what is the effect of RSD alone
initial reduction in inflammation and pocket depth
pockets are recolonized by bacteria from supra gingival plaque
disease recurs
what are the effects of RSD with supra gingival plaque control
decreased gingival inflammation
reduction in proving depth
gain in probing attachment level
marked changes in the sub gingival microbial flora
what is the gain in attachment due to
long junctional epithelium formation and improved tissue tone (inflammatory infiltrate is replaced by collagen)
when is the greatest changes observed
4-6 weeks after therapy
when does gradual repair and maturation of tissues occur
over 9-12 months
what are the 2 ways treatment can be organized
quadrant approach or full mouth disinfection approach
what is the objective of the full mouth disinfection
prevent treated pockets being decolonized by intra oral translocation of bacteria
what happens in full mouth disinfection
full mouth RSD at one or more sittings on the same day
use of chlorhexidine for sub gingival irrigation, tongue brushing and mouth rinsing
what is the effect of debridement
reduces microbial challenge - decreased inflammation
inoculation with plaque organisms, boosts immune response
what is revaluation
what has been the response to the initial therapy
what do you look at in reevaluation
patient plaque control
bleeding on probing
residual probing depths and attachment levels
tooth mobility
what are the factors that determine the success of treatment
good oral hygeine no bleeding on probing no pockets > 4mm no increasing tooth mobility a functional and comfortable dentition
what are the 3 categories of the reevaluations age
poor OH (persistent inflammation) good OH (inflammation resolved) good OH (persistent deep pockets)
what should be done if there is poor OH and persistent inflammation
identify the reason for poor OH then supportive care or repeat cause related therapy
what should be done if there is good oral hygiene and the inflammation is resolved
support care and proceed with treatment plan
what should be done if there is good oral hygiene but persistent deep pockets
surgical access or repeat RSD then reevaluate
why does treatment fail
poor compliance
inadequate debridement
host factors (mainly smoking)
what are the limitations of non surgical therapy
root morphology furcation involvement deep pockets skill level time
what is the maintenance in supportive periodontal care
maintain periodontal health
detect and treat recurrence
maintain an accepted level of disease
manage tooth loss
what are the intervals for supportive periodontal care
3months for most
what happens in the supportive periodontal care
OH must be reinforced
examine for signs of recurrent disease
scaling: RSD, polishing and other treatment as necessary
What is the treatment plan for periodontal therapy
emergency care disease control re-evaluation reconstruction supportive care
