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BDS3 Periodontology > Non Surgical Perio Therapy > Flashcards

Non Surgical Perio Therapy Flashcards

1
Q

2 types of periodontal disease

A
  1. plaque induced gingivitis (reversible)
  2. periodontitis (irreversible)
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2
Q

plaque vs calculus

A

plaque is biofilm (sticky colourless deposit) and calculus is calcified deposits attached to surfaces of teeth that is often brown or yellow and is always covered by plaque biofilm

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3
Q

risk factors

A

environmental - smoking, plaque accumulation, socio-economic status,
host specific - genetic factors, inflammatory burden

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4
Q

clinical manifestation of plaque induced gingivitis (6)

A

gingivae colour change from pale pink to dark pink/red
marginal gingival swelling
loss of contour of interdental papilla
bleeding on probing
plaque present at gingival margin
gingival sulcus measures 3mm or less from gingival margin to base of junctional epithelium which is still at ACJ

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5
Q

clinical manifestations of periodontitis (3)

A

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

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6
Q

what is BPE

A

basic periodontal exam

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7
Q

how to carry out bpe

A

walk the probe around the teeth recording worse score

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8
Q

2 probes used for bpe

A

bpe probe - ball end 0.5mm diameter, black bands at 3.5-5.5mm and 8.5-11.5mm
UNC probe - 15mm long, marking at each mm and colour coding at 5, 10, 15mm

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9
Q

probing force to be used

A

20-25g i.e. very light

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10
Q

how is mouth divided for bpe

A

split into sextants. all teeth in each sextant are examined with the exception of 3rd molars unless 1st and 2nd molars are missing. each sextant must contain 2 teeth to qualify for recording.

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11
Q

bpe score 0

A

pockets <3.5mm, black band entirely visible, no BOP, no calculus or overhangs

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12
Q

bpe score 1

A

pockets less than 3.5mm, black band entirely visible, BOP, no calculus or overhangs

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13
Q

bpe score 2

A

pockets <3.5mm, black band entirely visible, BOP, calculus and overhangs

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14
Q

bpe score 3

A

probing depth 3.5-5.5mm, black band partially visible, BOP, calculus and overhangs

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15
Q

bpe score 4

A

probing depth >5.5mm, black band disappears, BOP, calculus and overhangs

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16
Q

bpe *

A

indicates furcation involvement

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17
Q

BSP guidelines for interpreting BPE scores

A

0 - no need for perio treatment
1 - OHI
2 - OHI, removal of plaque retentive factors i.e. supra and sub gingival calculus
3 - OHI, RSD (root surface debridement)
4 - OHI, RSD, assess need for more complex treatment i.e. referral to specialist
* - same as above

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18
Q

why screen for perio (3)

A
  1. assists in reaching a diagnosis of gingivitis or periodontitis
  2. assists in formulation of treatment plan or decision to refer
  3. to determine whether detailed perio charting is indicated or special tests like radiographs are required
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19
Q

what codes require radiographs

A

3 and 4

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20
Q

if you have a code 4 and/or evidence of interdental recession

A

carry out FMPC

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21
Q

if you have a code 3

A

SDCEP - FMPC of code 3 before and after treatment
BSP - initial therapy then FMPC of that sextant

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22
Q

why take radiographs

A
  1. aids diagnosis and helps with staging and grading
  2. helps determine prognosis of teeth
  3. assessment of morphology of affected teeth
  4. pattern and degree of alveolar bone loss
  5. monitoring long term stability of periodontal health
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23
Q

pros and cons of bitewings

A

horizontal - might show early localised bone loss, presence of poorly contoured restorations
vertical - non distorted views of bone levels in relation to ACJ, better visualisation of bone level than horizontal, difficult to position accurately

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24
Q

why use periapicals

A

2D picture of bone levels in relation to both ACJ’s and total root length, can identify furcation involvement and possible endodontic complications

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25
Q

pros and cons of OPT

A

quicker, less uncomfortable, useful to assess other pathologies but may need periapical views in anterior sextants due to risk of distortion and difficult to adequately view bone levels

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26
Q

to control perio disease (5)

A

extraction of hopeless teeth
hygiene phase therapy
caries management
endodontic therapy
provisional prosthesis

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27
Q

what does hygiene phase therapy involve

A

dental health education // OHI // PMPR // removal of other plaque retentive factors // re evaluation

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28
Q

ramfjord’s teeth

A

16 21 24 36 41 44

29
Q

modified plaque score

A

code 0 - no plaque visible even when probe is used
code 1 - some plaque visible only when probe is used
code 2 - visible plaque seen without use of probe

30
Q

to calculate MPS

A

plaque score = x/36 x 100 to give %

31
Q

how to carry out modified bleeding score

A

run periodontal probe at 45 degrees around gingival sulcus in continuous sweep then check for presence/absence of bleeding up to 30s

32
Q

to calculate MBS

A

bleeding score = x/24 x 100 to give %

33
Q

what is an engaged patient

A

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

34
Q

what kind of probe is used to measure furcation involvement

A

Naber’s furcation probe

35
Q

grading furcation involvement

A

grade 1 - furcation opening can be felt on probing but is less than 1/3 of the tooth wide
grade 2 - loss of support exceeds 1/3 of tooth width but does not include the total width of the furcation
grade 3 - through and through involvement

36
Q

grading tooth mobility

A

0 - tooth is mobile within alveolus to 0.1-0.2mm in a horizontal direction
1 - mobile to almost 1mm in a horizontal direction
2 - visually increased mobility exceeding 1mm
3 - severe mobility in a horizontal and vertical direction

37
Q

manual probing measurements can be influenced by

A

resistance of tissues // size, shape and tip diameter of probe // site and angle of probe insertion // pressure applied // presence of obstructions i.e. calculus // patient discomfort

38
Q

mouthwashes available

A

bisbiguanides - chlorhexidine
phenols essential oil - thymol, menthol
oxygenating agents - hydrogen peroxide
quaternary ammonium compounds - cetylpyridinum chloride

39
Q

when should you prescribe an anti-plaque mouth wash

A

where pain limits mechanical plaque removal

40
Q

TIPPS

A

talk
instruct
practise
plan
support

41
Q

effects of PMPR (4)

A

reduces prevalence of p.gingivalis and t.denticola, decrease in gingival inflammation, increase in collagen fibres in connective tissue beneath pocket and formation of long junctional epithelial attachment

42
Q

effect of supra gingival 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 (>6mm)
43
Q

effects of RSD without supra gingival plaque control

A
  • initial reduction in inflammation and pocket depth
  • pockets are re colonised by bacteria from supra gingival plaque
  • disease recurs
44
Q

effects of RSD with supra gingival plaque control

A
  • decreased gingival inflammation
  • reduction in probing depth
  • gain in probing attachment level
  • marked changes in subgingival microbial flora
45
Q

how is successful treatment measured

A

good OH
no BOP
no pockets >4mm
no increasing tooth mobility
a functional and comfortable dentition

46
Q

why does treatment fail? (3)

A
  1. inadequate patient plaque control - lack of compliance / dexterity
  2. residual subgingival deposits - deep pockets, furcation lesions, concavities and root grooves, inexperienced operator or not enough time spent performing RSD
  3. systemic risk factors - smoking, uncontrolled diabetes
47
Q

at appointments -

A
  • plaque control must be reinforced
  • examine for signs of recurrent disease
  • retreat any recurrent or new disease; scaling, RSD, polishing and other treatment as necessary
  • arrange recall to review the patient and monitor periodontal status
48
Q

BSP Stage I

A

IP bone loss = <15% / <2mm attachment loss from CEJ

49
Q

BSP Stage II

A

IP bone loss = coronal 1/3 of root

50
Q

BSP Stage III

A

IP bone loss = mid 1/3 of root

51
Q

BSP stage IV

A

IP bone loss = apical 1/3 of root

52
Q

BSP stage IV

A

IP bone loss = apical 1/3 of root

53
Q

BSP grade A

A

% bone loss / patient age = <0.5

54
Q

BSP grade B

A

% bone loss / patient age = 0.5-1.0

55
Q

BSP grade C

A

% bone loss / patient age = >1.0

56
Q

what does currently stable mean

A

BoP <10%
PPD <4mm
no BoP at 4mm sites

57
Q

what does currently in remission mean

A

BoP >10%
PPD <4mm
no BoP at 4mm sites

58
Q

currently unstable means

A

PPD >5mm
PPD >4mm & BoP

59
Q

BSP hygiene phase therapy step 1

A
  • explain disease, risk factors, treatment
  • individual OHI
  • reduce risk factors
  • PMPR of clinical crown
  • select recall period
60
Q

BSP hygiene phase therapy step 2

A
  • reinforce OH, risk factor control, behaviour change
  • subgingival instrumentation (PMPR)
  • use of adjunctive systemic antimicrobials
61
Q

BSP hygiene phase therapy step 4

A

stable
- supportive perio care
- reinforce OH, risk factor control, behaviour change
- regular targeted PMPR as required to limit tooth loss
- consider adjunctive efficacious toothpaste and/or mouthwash

62
Q

BSP hygiene phase therapy step 3

A

unstable / non-responding
- reinforce OH, risk factor control, behaviour change
- re-perform subgingival instrumentation for pockets 4-5mm
- deep pocketing >6mm consider referral for pocket management / regenerative surgery

63
Q

mechanical destruction of biofilm

A

toothbrushing // flossing // interdental cleaning // PMPR

64
Q

when would you use systemic antibiotics

A
  • aggressive periodontitis
  • young people with grade B/C perio
65
Q

what antibiotics would you prescribe

A

500mg amoxicillin 3x daily for 7 days
OR
200mg BSP (400mg) metronidazole 3x daily for 7 days

66
Q

what antibiotics would you give to someone on warfarin or allergic to amoxicillin

A

100mg doxycycline 1x daily for 21 days with 200mg loading dose during 1st day
OR
500mg azithromycin 1x daily for 3 days

67
Q

contraindications of doxycycline

A

pregnancy
tetracycline staining of teeth

68
Q

contraindications of metronidazole

A

increases anti-coagulant effect of warfarin
pregnancy
alcohol intake

BDS3 Periodontology (3 decks)

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