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Periodontology BDS2 > Non-Surgical Management of Plaque Related Periodontal Diseases > Flashcards

Non-Surgical Management of Plaque Related Periodontal Diseases Flashcards

1
Q

what are the 2 types of periodontal diseases?

A

plaque induced gingivitis and periodontitis

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2
Q

what do both plaque induced gingivitis and periodontitis have in common?

A

they are periodontal diseases, are inflammatory conditions, caused by the formation and persistence of biofilm

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3
Q

what is plaque?

A

biofilm with a sticky colourless deposit

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4
Q

what does plaque attach to?

A

tooth surfaces, periodontal tissues, connective tissues

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5
Q

what is calculus?

A

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

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6
Q

what covers calculus?

A

plaque

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7
Q

where can calculus be present?

A

supra or subgingival

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8
Q

what is calculus detected by?

A

direct vision, probing or on radiographs

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9
Q

name a plaque retentive factor

A

calculus

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10
Q

what are the resistance factors for microbial dysbiosis?

A

innate immune response, adaptive immune response, inflammation, other structural components

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11
Q

what are the risk factors for microbial dysbiosis?

A

smoking, dental plaque accumulation, socioeconomic status, genetic factors, overall inflammatory burden

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12
Q

what are the clinical manifestations of plaque induced gingivitis?

A

change in colour of the gingivae, marginal gingival swelling, loss of contour of interdental papilla, bleeding from the gingival margin on probing/brushing, plaque is presentation 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, reversible

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13
Q

what are the clinical manifestations of periodontitis

A

loss of periodontal connective tissue attachment, gingival sulcus >3mm from the gingival margin to the base of the junctional epithelium which has migrated apically with the formation of a true periodontal pocket, alveolar bone loss, irreversible

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14
Q

what are the stages of periodontal management?

A

screening, assessment, treatment, monitoring

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15
Q

what are treatment outcomes affected by?

A

early diagnosis, prevention and prompt intervention, screening using BPE

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16
Q

how do you perform a BPE?

A

walking the probe around each tooth and recording only the worst score

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17
Q

describe the WHO probe

A

ball ended 0.5mm in diameter, black band from 3.5-5.5mm, second black band 8.5-11.5mm

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18
Q

describe the UNC probe

A

15mm long, markings at each mm and colour coding at the 5th, 10th and 15th mm

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19
Q

what sort of probing forces is used for BPE?

A

20-25grams

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20
Q

which probes are used for BPE?

A

WHO and UNC

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21
Q

what teeth are used for the BPE?

A

all teeth in each sextant with the exception of 3rd molars unless 1st and 2nd molars are missing, each sextant must have at least 2 teeth for recording

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22
Q

what score is the recorded for each sextant in BPE?

A

the highest score

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23
Q

what is a code 0 BPE?

A

probing depth <3.5mm, first black band visible, pocket depth <3mm, no BOP, no calculus

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24
Q

what is a code 1 BPE?

A

probing depth <3.5mm, first black band visible, <3mm pocket depth, BOP, no calculus

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25
Q

what is a code 2 BPE?

A

probing depth <3.5mm, first black band visible, pocket depth <3mm, possible BOP, calculus present

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26
Q

what is a code 3 BPE?

A

probing depth 3.5-5.5mm, partially visible first black band, pocket depth 4-5mm, possible BOP, calculus BOP

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27
Q

what is a code 4 BPE?

A

probing depth >5.5mm, first black band completely disappeared, pocket depth >6mm, possible BOP, possible calculus

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28
Q

how do you mark furcation involvement on BPE?

A

use of a *

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29
Q

what is the treatment for BPE 0?

A

no need for treatment

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30
Q

what is the treatment for BPE 1?

A

oral hygiene

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31
Q

what is the treatment for BPE 2?

A

OHI, removal of plaque retentive factors including all supra and sub gingival calculus

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32
Q

what is the treatment for BPE 3?

A

OHI, RSD

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33
Q

what is the treatment for BPE 4?

A

OHI, RSD, asses need for specialist referral

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34
Q

what is the treatment for BPE *

A

OHI, RSD, assess need for specialist referral

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35
Q

what is generalised gingivitis classified by?

A

> 30% BOP

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36
Q

what is localised gingivitis classified by?

A

10-30% BOP

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37
Q

when should a code 3 BPE continue with treatment in line with code 4?

A

with pockets >4mm and/or radiographic evidence of bone loss due to periodontitis

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38
Q

what is generalised periodontitis classified by?

A

> 30% of teeth

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39
Q

what is localised periodontitis classified by?

A

<30% of teeth

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40
Q

what are the 3 different types of periodontitis?

A

molar-incisor, localised, generalised

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41
Q

what is interproximal recession a sign of?

A

bone loss and periodontitis

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42
Q

what is screening information useful fo?

A

reaching a diagnosis of gingivitis/periodontitis, assist in formulation of treatment plan or specialist referral, determine whether detailed charting or special tests needed

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43
Q

what is the BSP guidelines for BPE code 3

A

if there is a code 3 then this sextant should be reviewed AFTER treatment and a 6 point pocket chart completed for that sextant only

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44
Q

what is the SDCEP guidelines for code 3

A

6 point pocket chart should be completed for that sextant BEFORE and AFTER treatment

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45
Q

why do we take radiographs

A

aid diagnosis and helps with staging and grading of the disease, helps determine prognosis of teeth, assessment of the morphology of affected teeth, pattern and degree of alveolar bone loss, monitoring of the long-term stability of periodontal health

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46
Q

which radiographs can be used?

A

horizontal and vertical bitewings, periapicals, dental panoramic tomographs (panorama)

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47
Q

what do horizontal bitewings show?

A

early localised bone loss, presence of poorly contoured restorations, subgingival calculus

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48
Q

what do vertical bitewings show?

A

non-distorted views of bone levels in relation to CEJ

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49
Q

what is the gold standard radiograph for periodontal assessment?

A

periapicals

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50
Q

what is the structure of the periodontal treatment plan?

A

immediate/emergency care, initial disease control, re-evaluation, reconstructive, maintenance/supportive care

51
Q

what types of disease control is there?

A

extraction of hopeless teeth, hygiene phase therapy, caries management, endodontic therapy, provisional prostheses

52
Q

what are the components of hygiene phase therapy?

A

dental health education, OHI, scaling and RSD, removal of other plaque-retention factors, re-evaluation

53
Q

what is the aim of disease control through hygiene phase therapy?

A

arrest to disease process, regenerate los tissue, maintain periodontal health long term - keep teeth

54
Q

what do you educate patients on with dental health education?

A

modifiable risk factors, plaque control, behavioural change (risk factor management, effective plaque removal), gingivitis and periodontitis

55
Q

what does SOLER mean in terms of communication?

A 
S = square on to patient 
O = open posture 
L = lean forward
E = eye contact 
R = relaxed demeanor
56
Q

what can you use to help explain disease and patient’s role in management?

A

pictures and diagrams, radiographs, plaque disclosing tablets, sites of gingivitis compared to health in mouth, toothbrushing technique, check patient understands

57
Q

which medical issues may be risk factors for periodontitis and should be looked out for in medical history taking?

A

diabetes, medications (Ca channel blockers cause hyperplasia), dental attendance, smoking, holistic approach (diet, stress etc,)

58
Q

what are modified plaque and bleeding scores?

A

partial mouth recording systems rather than full mouth plaque and bleeding scores

59
Q

what teeth are used to assess modified plaque and bleeding scores?

A

Ramfjords teeth

60
Q

how many surfaces of teeth are used for plaque and bleeding scores?

A

3

61
Q

what is a code 0 for modified plaque?

A

no plaque visible even when probe used

62
Q

what is code 1 for modified plaque?

A

some plaque visible only when probe was used to skim the tooth surface

63
Q

what is code 2 for modified plaque?

A

visible amount of plaque which can be seen without use of probe

64
Q

which surfaces are used for modified plaque?

A

interproximal, buccal, palatal/lingual

65
Q

which teeth are used as Ramfjord’s teeth

A

16, 21 and 24, 36, 41 and 44

66
Q

how do you calculate the modified plaque/bleeding score

A

scores for each surface are added to get a total, these are then divided by total number (36)

67
Q

what does modified bleeding measure?

A

marginal bleeding

68
Q

what does marginal bleeding reflect?

A

how well the patient can carry out effective plaque control daily

69
Q

how do you measure marginal bleeding?

A

probe run gently at 45 degrees around the gingival sulcus in a continuous sweep and then check for bleeding for up to 30s after

70
Q

how many and which surfaces are used for modified bleeding?

A

4 - mesial, distal, buccal, palatal/lingual

71
Q

what is code 0 modified bleeding?

A

no bleeding

72
Q

what is code 1 modified bleeding?

A

bleeding present

73
Q

how do you calculate modified bleeding?

A

scores for each surface should be added to get a total score, divide by the maximum bleeding score (24)

74
Q

what do you do if there is one of Ramfjords teeth missing?

A

if there is an appropriate alternative tooth use that tooth and if not then use code N, deduct the number of surfaces form the total maximum score

75
Q

how do you know if a patient is engaged or not after taking modified plaque and bleeding scores?

A

less than 35% bleeding score and less than 30% plaque score OR greater than 50% improvement in both

76
Q

what do you do with a non-engaging patient?

A

RSD should be delayed, patient should be informed, identify any barriers, continue with OHI, motivation and behaviour change

77
Q

what does periodontal charting measure?

A

probing depth, recession, bleeding on probing, mobility, furcation

78
Q

what is grade 1 furcation involvement?

A

furcation opening can be felt on probing but involvement is less than one third of the tooth width

79
Q

what is grade 2 furcation involvement

A

loss of support exceeds one third of the tooth width but does not include whole furcation

80
Q

what is grade 3 furcation involvement

A

through and through involvement

81
Q

what is grade 0 mobility?

A

physiological mobility of 0.1-0.2mm

82
Q

what is grade 1 mobility?

A

increased mobility of the crown of the tooth - 1mm

83
Q

what is grade 2 mobility?

A

visually increased mobility of the crown of tooth exceeding 1mm in horizontal direction

84
Q

what is grade 3 mobility?

A

severe mobility of crown of tooth in both horizontal and vertical directions

85
Q

what can manual probing measurements be influenced by in full periodontal charting?

A

the resistance of the tissues, size, shape and tip diameter, site and angle of probe insertion, pressure applied, presence of obstructions such as calculus, patient discomfort

86
Q

what sort of things are discussed in OHI?

A

ask patient to bring current oral hygiene aids, ask how often they are being used and replaced in a non-judgemental way, discuss toothbrushes, dental floss and tape, interdental sticks and brushes, ask patient to demonstrate and then modify technique, use disclosing tablets, carry out modified plaque and bleeding scores

87
Q

what advice is given for manual toothbrushing?

A

the Bass technique, bristles directed into gingival sulcus at 45 degrees, warn against vigorous brushing, medium soft filament brush, wait 30mins to an hour after eating prior to brushing

88
Q

what toothbrushing advice should be given in general?

A

direct bristles onto gumline and over whole tooth, brush twice a day for at least 2mins, be systematic, look in a mirror when brushing, use brush with a small head

89
Q

what are single tufted brushes used for?

A

to clean maligned teeth, clean distal surfaces of last molar tooth, teeth affected by localised gingival recession

90
Q

what is used for interdental cleaning?

A

dental floss and interdental brushes

91
Q

how do you use interdental brushes?

A

should be a snug fit without the wire rubbing against tooth and patient should perform 8-10 back and forth strokes in each space

92
Q

what is the most effective mouthwash?

A

chlorhexidine

93
Q

what are the advantages of chlorhexidine?

A

possesses the property of adsorption to oral surfaces, long substantivity, broad antimicrobial spectrum

94
Q

what is the disadvantage of chlorhexidine?

A

interferes with taste and discolours teeth

95
Q

when do you prescribe chlorhexidine?

A

when patients have pain which limits mechanical plaque removal (following sub-gingival instrumentation or patients with acute conditions)

96
Q

when patients have behavioural changes to make what structure should you follow?

A

explain - about the risk factor
obtain - consent and demonstrate removal in patients mouth
ask - patient to clean teeth and modify as necessary
make - make a plan with patient (goal setting, planning, self monitoring)

97
Q

what does TIPPS stand for?

A

talk, instruct, practise, plan, support

98
Q

what are the forms needed to sign by the patient for periodontal treatment?

A

patient agreement form, consent form

99
Q

what is the difference between the patient agreement form and the consent form?

A

patient agreement form outlines the diagnosis, self care plan and agreement statement whereas the consent form has information about the clinical periodontal treatment and risks of said treatment

100
Q

how are deeply located subgingival calculus found?

A

probing fine pointed probe or ball-ended probe

101
Q

when is subgingival root scaling done?

A

once the patient has adequate plaque control

102
Q

what is root surface debridement

A

the act of removing dead, contaminated adherent tissue, or foreign material

103
Q

what is a mini-sickle used for and which tooth surfaces?

A

supragingival - buccal and lingual

104
Q

what are columbias used for and which tooth surfaces?

A

sub-gingival, can be used anywhere but limited access to deep pockets

105
Q

what are hoe scalers used for and which tooth surfaces?

A

supra and sub gingival. The yellow is for buccal and lingual and the red is for mesial and distal

106
Q

what are gracey curettes used for and for which surfaces?

A 
sub gingival. 
grey = upper and lower anterior 
orange = mesial of posterior teeth 
green = buccal and lingual surfaces of posterior teeth 
blue = distal of posterior teeth
107
Q

where are universal scalers used and for which tooth surfaces?

A

supra and especially sub-gingival. used anywhere throughout the mouth

108
Q

what are the differences between powered and hand instruments?

A

powered leaves a rougher surface, powered produces aerosols, water coolant causes cavitations in calculus, ultrasonic may result in less unwanted tooth tissue removal

109
Q

what is the objective of full mouth disinfection?

A

prevent treated pockets being re-colonised by intra-oral translocation of bacteria

110
Q

with full mouth disinfection what do you use for irrigation, tongue brushing and mouth rinsing?

A

chlorhexidine

111
Q

what are the effects of scaling and RSD on the microflora?

A

significantly reduces the levels and prevalence of pathogenic species, complete elimination of these species is unrealistic

112
Q

what is the effect of scaling and RSD on the hard and soft tissues?

A

decrease in gingival inflammation, shrinkage of the gingival tissues leads to recession, increase in collagen fibres in the connective tissue beneath the pocket and formation of long junctional epithelial attachment, results in decrease in pocket depth and increase in attachment level, very little change in bone height at sites with horizontal bone loss, vertical defects display some infill and gain in bone height

113
Q

what is the gain in epithelial attachment due to?

A

long junctional epithelium formation and improved tissue tone

114
Q

how do you measure success after RSD?

A

inflammation, reduction in probing depth, gain in probing attachment level

115
Q

what does probing depth indicate?

A

the difficulty of treatment and the likelihood of recurrence

116
Q

what does attachment levels measure?

A

tissue destruction and the extent of repair

117
Q

what is the effect of supragingival plaque control alone?

A

decreased gingival inflammation, limited effect on probing depth, no change in attachment levels, no alteration in subgingival microflora in deep pockets

118
Q

what is the effects of RSD without supragingival plaque control?

A

initial reduction in inflammation and pocket depth, pockets are re-colonised by bacteria from supragingival plaque, disease recurs

119
Q

what are the effects of RSD with supragingival plaque control?

A

decreased gingival inflammation, reduction in probing depth, gain in probing attachment level, marked changes in the subgingival microbial flora

120
Q

what do you do at re-evaluation?

A

repeat the indices taken at baseline and the findings are then compared

121
Q

how is success measured after re-evaluation?

A

good oral hygiene, no bleeding on probing, no pockets >4mm, no increasing tooth mobility, functional and comfortable dentition

122
Q

why does treatment fail?

A

inadequate patient plaque control, residual subgingival deposits, systemic risk factors

123
Q

what are the advantages of supportive periodontal therapy?

A

prevents recurrence of disease, stabilises periodontal condition, maintains optimum periodontal health

124
Q

what occurs during supportive periodontal therapy?

A

plaque control must be reinforced, examine for signs of recurrent disease, retreat any recurrence or new disease, arrange recall to review the patient (every 3 months)

Periodontology BDS2 (2 decks)

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