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BDS2: Oral Disease > Non Surgical Management Of Plaque Related Periodontal Diseases > Flashcards

Non Surgical Management Of Plaque Related Periodontal Diseases Flashcards

1
Q

What is calculus?

A

Calcified deposits found attached to the surfaces of teeth and other solid structures - often brown or pale yellow

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2
Q

What are clinical manifestations of plaque induced gingivitis

A
  1. Change in gingiva colour
  2. Marginal gingival swelling
  3. Loss of contour (blunting) of interdental papilla
  4. Bleeding from gingival Margin on probing and brushing
  5. No clinical attachment loss or alveolar bone loss
  6. Gingival sulcus measures 3 mm or less from gingival margin to base of junctional epithelium
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3
Q

What are clinical manifestations of periodontitis?

A

1.loss of connective tissue attachment
2. Gingival sulcus measures >3.0 mm from the gingival Margin to the base of the junctional epithelium Which has migrated apically with the formation of a true periodontal pocket
3. Alveolar bone loss
4. Irreversible changes

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4
Q

What is the order of events that should be carried out in periodontal management ?

A

1.Screening
2.Assessment
3.Treatment - as part of an overall treatments strategy
4.Monitoring

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5
Q

What process is carried out during the screening process for periodontitis patients?

A

BPE

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6
Q

What does performing a BPE entail?

A

‘Walking’ the probe around each tooth and taking note of bleeding score and distance from the gingival margin to the base of junctional epithelium

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7
Q

WHO probe description

A
  1. Ball end 0.5mm in diameter
  2. Black band from 3.5-5.5
  3. Second black band 8.5-11.5
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8
Q

UNC probe description

A
  1. 15 mm long
  2. Markings at each mm and colour coding at the 5th 10th and 15th mm
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9
Q

What probing force should be used

A

Light probing force of 20-25g

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10
Q

What are the six sextants that the dentition is divided into for a BPE?

A

UR7-UR4
UR3-UL3
UL4-UL7
LR7-LR4
LR3-LL3
LL4-LL7

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11
Q

What do pocket chart scores 0 - * mean?

A

0 - no need for periodontal treatment
1 - OHI
2 - OHI, removal of plaque retentive factors, including all supra- and subgingival calculus
3- OHI, root surface debridement
4 - OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated
* - OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated

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12
Q

When are 3rd molars examined in a BPE screening

A

When 1st and 2nd molars are missing

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13
Q

Are all pocket scores from each sextant recorded?

A

No - the highest score from each sextant is recorded

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14
Q

Describe code 0 in terms of: BPE probing depth, banding visible on probe, actual pocket depth range, bleeding on probing and presence of calculus/overhangs.

A

•0 - pockets <3.5mm, 1st black band entirely visible, APDR <3mm, no BOP, no calculus or overhangs

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15
Q

Describe code 1 in terms of: BPE probing depth, banding visible on probe, actual pocket depth range, bleeding on probing and presence of calculus/overhangs.

A

•1 - pockets <3.5mm, 1st black band entirely visible, APDR <3mm, BOP, no calculus/overhangs

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16
Q

Describe code 2 in terms of: BPE probing depth, banding visible on probe, actual pocket depth range, bleeding on probing and presence of calculus/overhangs.

A

•2 - pockets <3.5mm, 1st black band entirely visible, APDR <3mm, possible BOP, calculus/overhangs present

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17
Q

Describe code 3 in terms of: BPE probing depth, banding visible on probe, actual pocket depth range, bleeding on probing and presence of calculus/overhangs.

A

•3 - probing depth <3.5-5.5mm, 1st black band partially visible, APDR 4-5mm, possible BOP, possible calculus/overhangs

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18
Q

Describe code 4 in terms of: BPE probing depth, banding visible on probe, actual pocket depth range, bleeding on probing and presence of calculus/overhangs.

A

•4 - probing depth >5.5mm, 1st black band disappears, APDR >/6mm, possible BOP, possible calculus/overhangs

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19
Q

What is the % of BOP in a sextant for:
1.clinical gingival health
2. Localised gingivitis
3. Generalised gingivitis

A
  1. <10%
  2. 10-30%
  3. > 30%
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20
Q

Describe the code 3 pathway to reach diagnosis clinical practice for periodontal diseases

A
  1. Code 3 with no obvious evidence of interdental recession
  2. Appropriate radiographic assessment
  3. Initial periodontal therapy and review in 3 months with localised 6 point pocket chart in involved sextants
  4. No pockets >=4mm and no radiographic evidence of bone loss due to periodontitis: continue with code 0/1/2 pathway
  5. Pockets >=4mm remain and/or radiographic evidence of bone loss due to periodontitis: continue with code 4 pathway
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21
Q

Describe the code 4 classification pathway for diagnosis of periodontal diseases

A
  1. Code 4 and/or no obvious evidence of interdental recession
  2. Appropriate radiographic assessment
  3. Full periodontal assessment (including detailed 6 point pocket chart)
  4. Molar incisor pattern —> periodontitis molar incisor pattern
  • <30% of teeth —> localised periodontitis
  • > = 30% of teeth —> generalised periodontitis
  1. Staging and grading, current disease status and risk factor assessment
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22
Q

What is screening information useful for when dealing with periodontal diseases?

A
  1. Assists in reaching a diagnosis of gingivitis or periodontitis
  2. Assists in the formulation of a treatment plan or decision to refer to a specialist
  3. To determine whether detailed periodontal charting is indicated, or if special tests like radiographs may be required
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23
Q

List what actions should be taken after BPE scores have been recorded.

A
  1. Radiographs for all codes 3 and 4 if justified
  2. Modified plaque and bleeding charts if necessary
  3. FMPC if one code 4 and/or evidence of interdental recession
  4. FMPC of code 3 sextant (SDCEP guidelines)
  5. Code 3 - initial therapy then FMPC of that sextant (BSP guidelines)
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24
Q

What should BPE scores NOT be used for?

A
  1. Do not use for monitoring - BPE is based upon BOP and PPD, rather than recording attachment and bone loss
  2. Do not use for implants
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25
Q

Describe the formula for an overall treatment plan

A
  1. Emergency treatment/care
  2. Initial disease/control
  3. Re-evaluation.
                             Periodontal surgery
  4. Reconstructive
  5. Maintenance/supportive care
26
Q

What does hygiene phase therapy entail?

A
  1. Dental health education
  2. Oral hygiene instruction
  3. scaling and root surface debridement
  4. Removal of other plaque retention factors such as:
    - defective restoration margins, overhangs or crown margins
    - dentures
    - orthodontic retainers
  5. Re-evaluation
27
Q

What action is involved in the 1st stage of hygiene phase therapy (dental education)?

A
  1. Modifiable risk factors i.e smoking, diet, diabetes management
  2. Plaque control
  3. Encouraging behavioural change
    - risk factor management
    - effective plaque removal
    - professional mechanical plaque removal
28
Q

List ramfjords teeth

A

16 21 24
44 41 36

29
Q

What qualifies as an engaged patient in terms of plaque and bleeding scores?

A
  1. <35% bleeding score
    AND
  2. <30% plaque score
    OR
  3. > 50% improvement in both
30
Q

What action should be taken when the patient is non engaging?

A
  1. If patient is non engaging root surface debridement should be delayed
  2. Patient should be informed
  3. Identify barriers
  4. Continue with oral health education, motivation and behaviour change
31
Q

Describe a grade 1 furcation

A

Initial furcation involvement. The furcation opening can be felt on probing but the involvement is less than 1/3 of tooth width.

32
Q

What is used to measure furcation involvement?

A

Naburs furcation probe

33
Q

Describe a grade 2 furcation

A

Partial furcation involvement. Loss of support exceeds 1/3 of the tooth width but does not include the total width of furcation

34
Q

Describe a grade 3 furcation

A

Through and through involvement. The probe can pass through the entire furcation

35
Q

Describe grade 0 tooth mobility

A

‘Physiological’ mobility measured at the crown level. Tooth is mobile within the alveolus to approximately 0.1-0.2mm horizontally.

36
Q

Describe grade 1 tooth mobility.

A

Increased mobility of the crown of the tooth up to 1mm horizontally

37
Q

Describe grade 2 tooth mobility

A

Visually increased mobility of the crown which exceeds 1mm in a horizontal direction

38
Q

Describe grade 3 tooth mobility

A

Severe mobility of the crown in both horizontal and vertical directions impinging on the function of the tooth

39
Q

Describe what actions are taken/what is discussed during Oral Hygiene Instruction

A
  1. Ask patient to bring current oral hygiene aids
  2. Ask how often they are being used and replaced in a non-judgmental way
  3. Discuss:
    - toothbrushes
    - dental floss and tape
    - interdental sticks
    - interdental brushes
  4. Ask patient to demonstrate and modify technique accordingly and practice using a face mirror
  5. Use disclosing tablets to identify areas patient is missing and coach them to better plaque control
  6. Carry out modified plaque and bleeding scores
40
Q

Describe the criteria for selecting the correct interdental brush as well as the technique for proper use.

A

Interdental brushes should be a snug fit without the wire rubbing against teeth.

The patient should perform 8-10 back and forth strokes in each space

41
Q

List advantages and disadvantages of Chlorhexidine mouthwash

A

Advantages

  1. Possesses the property of adsorption to oral surfaces, notably enamel
  2. Long substantivity
  3. Fairly broad antimicrobial spectrum

Disadvantages:

  1. Interferes with taste, discolours teeth
42
Q

What are the 4 main categories of mouthwashes?

A
  1. Bibisguanides - chlorhexidine
  2. Phenols essential oil - thymol, menthol
  3. Oxygenating agents - hydrogen peroxide
  4. Quaternary ammonium compounds - cetylpyridinum chloride
43
Q

What are the detriments of alcohol containing mouthwashes?

A
  1. Dry mouth
  2. Oral cancer
44
Q

What are the SDCEP guidelines in relation to prescribing mouthwash?

A

Only prescribe an anti-plaque mouthwash, such as 0.2% chlorhexidine gluconate, for patients where pain limits mechanical plaque removal (e.g. following sub-gingival instrumentation or for patients with acute conditions)

45
Q

List the 4 phases to facilitate behaviour change for more effective plaque removal

A
  1. Explain
    - explain that coaching is necessary for excellent plaque control
  2. Obtain
    - Obtain consent and demonstrate plaque removal in the patient’s mouth - tailor it to each individual patient
  3. Ask
    - Ask patient to clean his/her teeth with toothbrush and modify technique as necessary
  4. Make
    - make a plan with patient
    i.e. goal setting, planning, self monitoring
46
Q

When should sub gingival root surface instrumentation be carried out

A

Once patient has adequate plaque control - engaged

47
Q

What are the effects of RSD on hard and soft tissues?

A
  1. Decrease in gingival inflammation
  2. Shrinkage of the gingival tissues leads to recession
  3. Increase in collagen fibres in the connective tissue beneath the pocket and formation of long junctional epithelial attachment
  4. This results in a decrease in pocket depth and increase in attachment level
  5. Very little change in bone height at sites with horizontal bone loss
  6. Vertical defects display some infill and gain in bone height
48
Q

When do the greatest changes in periodontal health occur?

A

4-6 weeks after therapy

49
Q

What does supragingival scaling alone NOT have an effect on?

A
  1. No change in attachment levels
  2. No alteration in subgingival Micro flora in deep pockets (>6mm)
50
Q

What measurements/tests are repeated at the re evaluation stage of hygiene phase therapy?

A
  1. Probing depths
  2. Bleeding score
  3. Plaque score
  4. Attachment levels
  5. Tooth mobility
  6. Furcation
51
Q

List reasons why treatment may fail

A
  1. Inadequate patient plaque control
    - lack of compliance
    - lack of dexterity
  2. Residual subgingival deposits
    - deep pockets
    - furcation lesions, Concavities and root grooves
    - inexperienced operator or not enough time spent performing RSD
  3. Smoking
    - uncontrolled diabetes
52
Q

What actions are carried out during supportive periodontal therapy?

A
  1. Plaque control must be reinforced - re motivate / re educate the patient
  2. Examine for signs of recurrent disease
  3. Retreat any recurrence or new disease - scaling, RSD, polishing and other treatment as necessary
  4. Arrange recall to review the patient and monitor periodontal status
53
Q

Describe stage I periodontitis

A

Stage 1 = early/mild

  • <15% Interproximal bone loss

Or

  • <2mm attachment loss from CEJ
54
Q

Describe stage II periodontitis

A

Stage II (moderate)

  • interproximal bone loss only extends to the coronal 3rd of the root
55
Q

Describe stage III periodontal disease

A

Stage III (severe)

  • interproximal bone loss extends to the middle 3rd of the root
56
Q

Describe stage IV periodontal disease

A

Stage IV (very severe)

  • interproximal bone loss extends to the apical 3rd of the root
57
Q

How is the grade of periodontal disease calculated?

A

% bone loss divided by patient age

58
Q

What value correlates with Grade A periodontal disease?

A

Grade A (slow rate of progression) = <0.5

59
Q

What value correlates with grade B periodontal disease?

A

Grade B (moderate rate of progression) = 0.5 - 1.0

60
Q

What value correlates with Grade C periodontal disease?

A

Grade C (rapid rate of progression) = >1

BDS2: Oral Disease (1 decks)

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