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BDS2 - periodontitis > non-surgical management of plaque-related periodontal disease > Flashcards

non-surgical management of plaque-related periodontal disease Flashcards

1
Q

what percentage of patients will have periodontitis

A
  • 50%
  • 80% will have gingivitis
  • 10-15% will have severe periodontitis
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2
Q

what is the BPE

A
  • basic periodontal exam
  • simple and rapid screening tool that is used to indicate the level of further examination needed and provide basic guidance if needed
  • represent a minimum standard of care
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3
Q

what should the BPE be used for

A
  • for screening only and not for diagnosis
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4
Q

how do you record the BPE

A
  • dentition is split into 6 extents and highest score for each sextant is recorded
  • all teeth in each sextant are examined
  • for sextant to qualify must contain 2 teeth
  • a WHO probe is used
  • probe is walked around each tooth in each sextant
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5
Q

what are the sextants

A
  • 17 to 14
  • 13 to 23
  • 24 to 27
  • 37 to 34
  • 33 to 43
  • 44 to 47
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6
Q

what is the WHO probe like

A
  • has a ‘ball end’ of 0.5mm in diameter and a black band from 3.5mm to 5.5mm
  • light probing force should be used = enough to blanche a fingernail
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7
Q

how is the probe used

A
  • all sites should be examined to ensure that the highest score in the sextant is recorded
  • if a code of4 is identified in a sextant, continue to examine all sites in the sextant
  • this will make sure that any furcation involvement is not missed
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8
Q

what does a BPE score of 0 mean

A
  • pockets <3.5mm, no calculus, no bleeding on probing and black band completely visible
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9
Q

what does a BPE score of 1 means

A

pockets <3.5mm, no calculus/overhangs, bleeding on probing and black band completely visible

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10
Q

what does a BPE score of 2 mean -

A

pockets<3.5mm, supra or sub gingival calculus/overhangs, black band completely visible

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11
Q

what does a BPE score of 3 mean

A
  • pocket depths of 3.5mm-5.5.mm black band partially visible indicating a pockets
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12
Q

what does a BPE score of 4 means

A
  • probing depth of >5.5mm black band disappears indicating pocket of 6mm or more
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13
Q

what does a * mean on BPE chart

A
  • furcation involvement
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14
Q

what do you do for patients with a BPE score of 0,1 or 2

A

should be recorded at every routine examination

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15
Q

what do you do for patients with BPE code 3 or 4

A
  • more detailed periodontal charting is required
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16
Q

what must you do for BPE code 3

A
  • initial therapy including self-care advice (oral hygiene instruction and risk factor control) then post initial therapy and record 6PPC in that sextant only after treatment
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17
Q

what must you do for BPE score of 4

A
  • if score of 4 in any sextant then do a 6PPC through whole mouth
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18
Q

why can’t BPE be sued to monitor the reasons to periodontal therapy

A
  • it does not provide information about how sites within a sextant change after treatment
  • 6PPC must be sued to record pre and post treatment
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19
Q

where should BPE not be used

A
  • around implants
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20
Q

what radiograph is regarded as the gold standard to be taken for scores of 3 or 4

A
  • periapical
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21
Q

what level of pocket must you record for 6PPC

A
  • only over 4mm
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22
Q

how do you interpret a BPE score of 0

A

no need for periodontal treatment

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23
Q

how do you interpret a BPE score of 1

A

oral hygiene instruction (OHI)

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24
Q

how do you interpret a BPE score of 2

A

as for code 1, plus removal of plaque retentive factors, including all supra and sub gingival calculus

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25
Q

how do you interpret a BPE score of 3

A
  • as for code 2 plus RSD if required
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26
Q

how do you interpret a BPE score of 4

A

OHI, RSD and assess the need for more complex treatment, refer to specialist if need be

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27
Q

how do you interpret a * BPE

A

treat according to BPE code and assess the need for more complex treatment and referral to specialist may be indicated

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28
Q

what are the 2 guidelines to follow for BPE of score 3

A
  • BSP guideline

- SDCEP

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29
Q

what are the BSP guidelines for a score of 3 BPE

A
  • if a sextant scores 3, it should be revised AFTER treatment and a 6PPc completed for that sextant only after treatment
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30
Q

what are the SDCEP guidelines for a score of 3 BPE

A
  • a 6PPC should be completed for that sextant BEFORE treatment and AFTER
  • full period exam of all teeth ad root surface instrumentation where necessary = where code 3 is observed in only one sextant, carry out only in that sextant
31
Q

what else can non surgical management known as

A
  • cause related therapy

- hygiene phase therapy (HPT)

32
Q

what is the aim of periodontal therapy

A
  • to arrest the disease
  • ideally, to regenerate lost tissue
  • to maintain periodontal healthy long term
  • result = keep teeth
  • important patient knows why they need to come
33
Q

what occurs along with periodontitis

A
  • gum recession,
  • bone loss,
  • loss of attachment,
  • calculus,
  • plaque,
  • inflamed gums
34
Q

what is the treatment plan

A

emergency care –> disease control –> re-evaluation –> reconstruction –> supportive care

35
Q

what occurs in the disease control phase of the treatment plan

A
  • extraction of hopeless teeth
  • hygiene phase therapy
  • caries management
  • endodontic therapy
  • provisional prostheses
36
Q

what can periodontal therapy do

A
  • supra gingival plaque control - including scaling
  • if get it right, can get return of health
  • can get reappearance of gingiva stippling, knife edge margin return
  • can remove plaque and calculus and staining
37
Q

what is an effect of periodontitis

A
  • loss of attachment and true pocket formation colonisation of the root surface
  • with the presence of a pocket, you have to worry about removing the biofilm in the pocket as well
38
Q

how fast will a pocket progress if not treated

A

1mm a year

39
Q

what is removed during root surface debridement

A
  • plaque and calculus on tooth surface stuck to root surface
  • needs removed
40
Q

what is done during the hygiene phase therapy stage of treatment plan

A
  • dental health education
  • oral hygiene instruction
  • scaling and root surface debridement
  • removal of other plaque retentive factors
41
Q

what is included in dental health education

A
  • explain nature of disease, use diagrams, photos etc
  • discuss findings of examination
  • use language patient understands
42
Q

what is the oral hygiene instruction

A
  • tooth brushing - modified Bass technique
  • interdental cleaning = floss and tape, interdental sticks
  • disclosing agents
43
Q

how do you know if the interdental brush is the correct size

A
  • should displace the bristles but tooth shouldn’t rub on wire
44
Q

what is scaling

A

the removal of plaque and calculus from tooth surfaces

45
Q

what is the definition of debridement

A
  • the act of removing dead, contaminated or adherent tissue, or foreign material
46
Q

what else if RSD called

A
  • RSI

- root surface instrumentation

47
Q

what does scaling and root surface debridement include

A
  • scaling and root planing and removal of supra gingival calculus
48
Q

what is root planing

A
  • the removal of contaminated cementum, leaving the root surface smooth and hard
  • but with root planing will experience pain and sensitivity = so don’t need to remove the calculus if right next to biofilm to prevent sensitivity
49
Q

what are scaling instruments

A
  • hand instruments

- powered instruments

50
Q

what is the difference between powered and hand instruments

A
  • no difference in plaque/calculus removal or healing response
  • ultrasonic/sonic tip designs may allow better access to furcations
  • powered instruments may be faster and less demanding on the operator = only in the right hands
  • ultrasonic may results in less unwanted tooth tissue removal
  • water coolant - cavitation and flushing effect in ultrasonic
  • powered produces aerosols
  • powered leave rougher surface
  • greater tactile with hand instruments
51
Q

what is the usual cause of plaque retention factors

A
  • usually caused by dentists

- defective restoration margins

52
Q

what can be problems with restorations

A
  • restoration margins = location, adaptation
  • restoration contour = can create plaque trap
  • partial dentures = gingival cover, direct trauma
53
Q

what must you look at at the re-evaluation stage

A
  • patient plaque control
  • bleeding on probing
  • residual probing depths and attachment levels
  • tooth mobility
54
Q

what would be success of therapy

A
  • good oral hygiene
  • no bleeding on probing
  • no pockets >4mm
  • no increasing tooth mobility
  • a functional and comfortable dentition
55
Q

what are the 3 categories patient will fall into after re-evaluation

A
  • poor OH = persistent inflammation
  • good Oh = inflammation resolved
  • good OH = persistent deep pockets wit BOP
56
Q

what can you offer if situation not getting any better

A

supportive treatment

57
Q

what are the next moves for each of the 3 branches after re-evaluation

A
  • poor OH = identify resin for poor OH and then supportive care or repeat cause-related therapy
  • good OH inflammation resolved = supportive care and proceed with treatment plan
  • good OH persistent pockets = surgical access or repeat RSD then re-evaluate
58
Q

why does treatment fail

A
  • poor compliance

- inadequate debridement

59
Q

what are the limitations of non-surgical therapy

A
  • root morphology
  • furcation involvement
  • deep pockets
  • skill level
  • time
60
Q

what is supportive periodontal care

A
  • maintain periodontal health
  • detect and treat recurrence
  • maintain an accepted level of disease
  • manage tooth loss
  • intervals of approximately 3 months are appropriate for most patients
  • OH must be reinforced
  • examine for signs of recurrent disease
  • scaling, RSD, polishing and other treatments as necessary
61
Q

how do you work out the attachment loss

A
  • record gingival margin and pocket probing depth then with these will know the attachment loss
62
Q

what do probing depths indicate

A
  • difficulty of treatment and recurrence of disease
63
Q

what are attachment levels an indication of

A
  • measure of tissue destruction and the extent of repair
64
Q

what can manual probing measurements influenced by

A
  • resistance of 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
65
Q

what is the effect of supra gingival plaque control alone

A
  • decreased gingival inflammation
  • limited effect on probing depths
  • no change in attachment levels
  • no alteration in sub gingival microflora in deep pockets (>6mm)
66
Q

what is the effect of RSD without supragingival plaque control

A
  • initially reduction in inflammation and pocket depth
  • pockets are re-colonised by bacteria from supra gingival plaque
  • disease recurs
67
Q

effects of RSD with supra gingival plaque control

A
  • decreased gingival inflammation
  • reduction in probing depths
  • gain in probing attachment levels
  • marked changes in the sub gingival microbial flora
68
Q

how is gain of attachment got

A
  • due to long junctional epithelium formation and improved tissue tone
  • inflammatory infiltrate is replaced by collagen
69
Q

when is the greatest changes noted during treatment

A
  • observed 4-6 weeks after therapy

- gradual repair and maturation of tissues over 9-12 months

70
Q

how should treatment be organised

A
  • quadrant approach or full mouth disinfection
71
Q

what is the full mouth disinfection approach for treatment

A
  • objective = prevent treated pockets being re-colonised by intra-oral translocation or bacteria
  • full mouth RSD at one or more sittings on the same day
  • use of chlorohexidine for subgingival irritation, tongue brushing and mouth rinsing
72
Q

what are the effects of RSD

A
  • reduces microbial challenge = decreased inflammation

- inoculation with plaque organisms = boosts immune response

73
Q

summary of non-surgical management of plaque related periodontal disease

A
  • must be incorporated into overall treatment plan
  • starts with hygiene phase therapy
  • success requires both operator and patient involvement
  • requires careful re-evaluation
  • requires careful maintenance following treatment

BDS2 - periodontitis (4 decks)

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