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
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
3
Q
what is plaque?
A
biofilm with a sticky colourless deposit
4
Q
what does plaque attach to?
A
tooth surfaces, periodontal tissues, connective tissues
5
Q
what is calculus?
A
calcified deposits found attached to the surfaces of tooth and other solid structures - often brown or pale yellow
6
Q
what covers calculus?
A
plaque
7
Q
where can calculus be present?
A
supra or subgingival
8
Q
what is calculus detected by?
A
direct vision, probing or on radiographs
9
Q
name a plaque retentive factor
A
calculus
10
Q
what are the resistance factors for microbial dysbiosis?
A
innate immune response, adaptive immune response, inflammation, other structural components
11
Q
what are the risk factors for microbial dysbiosis?
A
smoking, dental plaque accumulation, socioeconomic status, genetic factors, overall inflammatory burden
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
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
14
Q
what are the stages of periodontal management?
A
screening, assessment, treatment, monitoring
15
Q
what are treatment outcomes affected by?
A
early diagnosis, prevention and prompt intervention, screening using BPE
16
Q
how do you perform a BPE?
A
walking the probe around each tooth and recording only the worst score
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
18
Q
describe the UNC probe
A
15mm long, markings at each mm and colour coding at the 5th, 10th and 15th mm
19
Q
what sort of probing forces is used for BPE?
A
20-25grams
20
Q
which probes are used for BPE?
A
WHO and UNC
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
22
Q
what score is the recorded for each sextant in BPE?
A
the highest score
23
Q
what is a code 0 BPE?
A
probing depth <3.5mm, first black band visible, pocket depth <3mm, no BOP, no calculus
24
Q
what is a code 1 BPE?
A
probing depth <3.5mm, first black band visible, <3mm pocket depth, BOP, no calculus
25
what is a code 2 BPE?
probing depth <3.5mm, first black band visible, pocket depth <3mm, possible BOP, calculus present
26
what is a code 3 BPE?
probing depth 3.5-5.5mm, partially visible first black band, pocket depth 4-5mm, possible BOP, calculus BOP
27
what is a code 4 BPE?
probing depth >5.5mm, first black band completely disappeared, pocket depth >6mm, possible BOP, possible calculus
28
how do you mark furcation involvement on BPE?
use of a *
29
what is the treatment for BPE 0?
no need for treatment
30
what is the treatment for BPE 1?
oral hygiene
31
what is the treatment for BPE 2?
OHI, removal of plaque retentive factors including all supra and sub gingival calculus
32
what is the treatment for BPE 3?
OHI, RSD
33
what is the treatment for BPE 4?
OHI, RSD, asses need for specialist referral
34
what is the treatment for BPE *
OHI, RSD, assess need for specialist referral
35
what is generalised gingivitis classified by?
>30% BOP
36
what is localised gingivitis classified by?
10-30% BOP
37
when should a code 3 BPE continue with treatment in line with code 4?
with pockets >4mm and/or radiographic evidence of bone loss due to periodontitis
38
what is generalised periodontitis classified by?
>30% of teeth
39
what is localised periodontitis classified by?
<30% of teeth
40
what are the 3 different types of periodontitis?
molar-incisor, localised, generalised
41
what is interproximal recession a sign of?
bone loss and periodontitis
42
what is screening information useful fo?
reaching a diagnosis of gingivitis/periodontitis, assist in formulation of treatment plan or specialist referral, determine whether detailed charting or special tests needed
43
what is the BSP guidelines for BPE code 3
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
44
what is the SDCEP guidelines for code 3
6 point pocket chart should be completed for that sextant BEFORE and AFTER treatment
45
why do we take radiographs
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
46
which radiographs can be used?
horizontal and vertical bitewings, periapicals, dental panoramic tomographs (panorama)
47
what do horizontal bitewings show?
early localised bone loss, presence of poorly contoured restorations, subgingival calculus
48
what do vertical bitewings show?
non-distorted views of bone levels in relation to CEJ
49
what is the gold standard radiograph for periodontal assessment?
periapicals
50
what is the structure of the periodontal treatment plan?
immediate/emergency care, initial disease control, re-evaluation, reconstructive, maintenance/supportive care
51
what types of disease control is there?
extraction of hopeless teeth, hygiene phase therapy, caries management, endodontic therapy, provisional prostheses
52
what are the components of hygiene phase therapy?
dental health education, OHI, scaling and RSD, removal of other plaque-retention factors, re-evaluation
53
what is the aim of disease control through hygiene phase therapy?
arrest to disease process, regenerate los tissue, maintain periodontal health long term - keep teeth
54
what do you educate patients on with dental health education?
modifiable risk factors, plaque control, behavioural change (risk factor management, effective plaque removal), gingivitis and periodontitis
55
what does SOLER mean in terms of communication?
```
S = square on to patient
O = open posture
L = lean forward
E = eye contact
R = relaxed demeanor
```
56
what can you use to help explain disease and patient's role in management?
pictures and diagrams, radiographs, plaque disclosing tablets, sites of gingivitis compared to health in mouth, toothbrushing technique, check patient understands
57
which medical issues may be risk factors for periodontitis and should be looked out for in medical history taking?
diabetes, medications (Ca channel blockers cause hyperplasia), dental attendance, smoking, holistic approach (diet, stress etc,)
58
what are modified plaque and bleeding scores?
partial mouth recording systems rather than full mouth plaque and bleeding scores
59
what teeth are used to assess modified plaque and bleeding scores?
Ramfjords teeth
60
how many surfaces of teeth are used for plaque and bleeding scores?
3
61
what is a code 0 for modified plaque?
no plaque visible even when probe used
62
what is code 1 for modified plaque?
some plaque visible only when probe was used to skim the tooth surface
63
what is code 2 for modified plaque?
visible amount of plaque which can be seen without use of probe
64
which surfaces are used for modified plaque?
interproximal, buccal, palatal/lingual
65
which teeth are used as Ramfjord's teeth
16, 21 and 24, 36, 41 and 44
66
how do you calculate the modified plaque/bleeding score
scores for each surface are added to get a total, these are then divided by total number (36)
67
what does modified bleeding measure?
marginal bleeding
68
what does marginal bleeding reflect?
how well the patient can carry out effective plaque control daily
69
how do you measure marginal bleeding?
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
how many and which surfaces are used for modified bleeding?
4 - mesial, distal, buccal, palatal/lingual
71
what is code 0 modified bleeding?
no bleeding
72
what is code 1 modified bleeding?
bleeding present
73
how do you calculate modified bleeding?
scores for each surface should be added to get a total score, divide by the maximum bleeding score (24)
74
what do you do if there is one of Ramfjords teeth missing?
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
how do you know if a patient is engaged or not after taking modified plaque and bleeding scores?
less than 35% bleeding score and less than 30% plaque score OR greater than 50% improvement in both
76
what do you do with a non-engaging patient?
RSD should be delayed, patient should be informed, identify any barriers, continue with OHI, motivation and behaviour change
77
what does periodontal charting measure?
probing depth, recession, bleeding on probing, mobility, furcation
78
what is grade 1 furcation involvement?
furcation opening can be felt on probing but involvement is less than one third of the tooth width
79
what is grade 2 furcation involvement
loss of support exceeds one third of the tooth width but does not include whole furcation
80
what is grade 3 furcation involvement
through and through involvement
81
what is grade 0 mobility?
physiological mobility of 0.1-0.2mm
82
what is grade 1 mobility?
increased mobility of the crown of the tooth - 1mm
83
what is grade 2 mobility?
visually increased mobility of the crown of tooth exceeding 1mm in horizontal direction
84
what is grade 3 mobility?
severe mobility of crown of tooth in both horizontal and vertical directions
85
what can manual probing measurements be influenced by in full periodontal charting?
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
what sort of things are discussed in OHI?
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
what advice is given for manual toothbrushing?
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
what toothbrushing advice should be given in general?
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
what are single tufted brushes used for?
to clean maligned teeth, clean distal surfaces of last molar tooth, teeth affected by localised gingival recession
90
what is used for interdental cleaning?
dental floss and interdental brushes
91
how do you use interdental brushes?
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
what is the most effective mouthwash?
chlorhexidine
93
what are the advantages of chlorhexidine?
possesses the property of adsorption to oral surfaces, long substantivity, broad antimicrobial spectrum
94
what is the disadvantage of chlorhexidine?
interferes with taste and discolours teeth
95
when do you prescribe chlorhexidine?
when patients have pain which limits mechanical plaque removal (following sub-gingival instrumentation or patients with acute conditions)
96
when patients have behavioural changes to make what structure should you follow?
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
what does TIPPS stand for?
talk, instruct, practise, plan, support
98
what are the forms needed to sign by the patient for periodontal treatment?
patient agreement form, consent form
99
what is the difference between the patient agreement form and the consent form?
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
how are deeply located subgingival calculus found?
probing fine pointed probe or ball-ended probe
101
when is subgingival root scaling done?
once the patient has adequate plaque control
102
what is root surface debridement
the act of removing dead, contaminated adherent tissue, or foreign material
103
what is a mini-sickle used for and which tooth surfaces?
supragingival - buccal and lingual
104
what are columbias used for and which tooth surfaces?
sub-gingival, can be used anywhere but limited access to deep pockets
105
what are hoe scalers used for and which tooth surfaces?
supra and sub gingival. The yellow is for buccal and lingual and the red is for mesial and distal
106
what are gracey curettes used for and for which surfaces?
```
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
where are universal scalers used and for which tooth surfaces?
supra and especially sub-gingival. used anywhere throughout the mouth
108
what are the differences between powered and hand instruments?
powered leaves a rougher surface, powered produces aerosols, water coolant causes cavitations in calculus, ultrasonic may result in less unwanted tooth tissue removal
109
what is the objective of full mouth disinfection?
prevent treated pockets being re-colonised by intra-oral translocation of bacteria
110
with full mouth disinfection what do you use for irrigation, tongue brushing and mouth rinsing?
chlorhexidine
111
what are the effects of scaling and RSD on the microflora?
significantly reduces the levels and prevalence of pathogenic species, complete elimination of these species is unrealistic
112
what is the effect of scaling and RSD on the hard and soft tissues?
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
what is the gain in epithelial attachment due to?
long junctional epithelium formation and improved tissue tone
114
how do you measure success after RSD?
inflammation, reduction in probing depth, gain in probing attachment level
115
what does probing depth indicate?
the difficulty of treatment and the likelihood of recurrence
116
what does attachment levels measure?
tissue destruction and the extent of repair
117
what is the effect of supragingival plaque control alone?
decreased gingival inflammation, limited effect on probing depth, no change in attachment levels, no alteration in subgingival microflora in deep pockets
118
what is the effects of RSD without supragingival plaque control?
initial reduction in inflammation and pocket depth, pockets are re-colonised by bacteria from supragingival plaque, disease recurs
119
what are the effects of RSD with supragingival plaque control?
decreased gingival inflammation, reduction in probing depth, gain in probing attachment level, marked changes in the subgingival microbial flora
120
what do you do at re-evaluation?
repeat the indices taken at baseline and the findings are then compared
121
how is success measured after re-evaluation?
good oral hygiene, no bleeding on probing, no pockets >4mm, no increasing tooth mobility, functional and comfortable dentition
122
why does treatment fail?
inadequate patient plaque control, residual subgingival deposits, systemic risk factors
123
what are the advantages of supportive periodontal therapy?
prevents recurrence of disease, stabilises periodontal condition, maintains optimum periodontal health
124
what occurs during supportive periodontal therapy?
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)
