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BDS2 Periodontics > Non-Surgical Periodontal Management > Flashcards

Non-Surgical Periodontal Management Flashcards

1
Q

Non surgical management is also called…..

A

cause related therapy

hygiene phase therapy

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2
Q

3 aims of periodontal treatment

A

to arrest the disease process

ideally, to regenerate lost tissue

to maintain periodontal health long term

result = keep teeth

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3
Q

treatment plan stages

A

emergency care

disease control

re- evaluation

                 periodontal surgery

reconstruction

supportive care

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4
Q

parts of disease control phase in Tx plan

A

extraction of hopeless teeth

hygiene phase therapy

caries management

endodontic therapy (RCT)

provisional prostheses

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5
Q

periodontitis

A

Loss of attachment and true pocket formation colonisation of the root surface

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6
Q

parts of hygiene phase therapy

A

Dental health education

Oral hygiene instruction

Scaling and root surface debridement

Removal of other plaque-retention factors
- E.g. defective restoration margins

Re-evaluation
- Establish if worked, if not figure out why

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7
Q

how to carry out dental health education for periodontal management

A

Evaluate patients’ reasons for attendance, attitudes to health care, motivation etc

Explain the nature of disease using diagrams, photographs, models etc.

Discuss findings of examination
- Demonstrate health and disease in the patients mouth
- Explain the nature and consequences of treatment
Why maintenance and commitment needed
- Use language the patient will understand
Booklets on clinics – ask for them to show pt
- Importance of interdental cleaning

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8
Q

3 components of oral hygiene instruction to cover

A

Tooth brushing – modified bass technique

Interdental cleaning
- Floss and tape
- Interdental sticks
- Interdental brushes
Why they don’t use regularly? -show how to use effectively
Many on market – make sure pt knows which they are to use and the right size
Fits but isn’t tight, displace the bristle but not touch the wire
Give them a few sizes to try but not to many to overwhelm

Disclosing agents

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9
Q

scaling

A

removal of plaque and calculus from the tooth surfaces

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10
Q

root surface debridement (RSD)

A

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

Encompasses the process of

  • Scaling and
  • Removal of supragingival calculus
  • removal of subgingival plaque in true pocket
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11
Q

progressive alveolar bone loss per year if sub-gingival plaque impregnate pocket

A

1mm/year

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12
Q

2 types of scaling instruments

A

Hand instruments

Powered instruments

  • Ultrasonic (predominate)
  • Sonic
  • Rotating
  • Reciprocating

All equal effective if used correctly and mastered (not damaging teeth)

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13
Q

where can ultrasonic instruments be used

A

supra and sub-gingivally

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14
Q

3 possible problems in restorations that can contribute to periodontal disease

A

Restoration margins

  • Location
  • Adaptation (fit)

Restoration contour

  • Contour emergence can make plaque trap
  • Shelves at gingival margin
  • Square, plaque trap

Partial dentures

  • Gingival convergence
  • Direct trauma
  • Uncontrolled loads
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15
Q

3 ways to measure success in periodontal treatment

A

Inflammation (bleeding on probing indices)

Reduction in probing depth

Gain in probing attachment level

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16
Q

how far apart are the bands on a PCP 12 probe

A

3mm

17
Q

what probe is used for 6PPC

A

PCP 12 probe

18
Q

coronal gingival overgrowth is

A

negative

19
Q

gingival recession is

A

positive

20
Q

probing depth indicates

A

the difficulty of treatment and the likelihood of recurrence

21
Q

attachment levels are

A

measure of tissue destruction (pre-treatment) and the extent of repair (post-treatment)

22
Q

6 factors which influence manual probing measurements/depths

A

the resistance of the tissues

size, shape and tip diameter of the probe

site and angle of the probe insertion

pressure applied

presence of obstructions such as calculus

patient discomfort
- pt complains

23
Q

what does successful periodontal therapy require

A

both supra and sub gingival plaque control

24
Q

effect of supra-gingival plaque control alone

A

decreased gingival inflammation

limited effect on probing depth

no change in attachment levels
- stabilisation

no alteration in subgingival microflora in deep pockets (>6mm)

reduction in inflammation but still pocket – root surface debridement wrong

25
Q

effects of RSD (sub gingival) without supra-gingival

A

initial reduction in inflammation and pocket depth

pockets are re-colonised by bacteria from supra-gingival plaque

disease recurs

no improvement in OHI
response initially but recurrence

26
Q

effects of RSD with supragingival plaque control

both supra and sub

A

decreased gingival inflammation

reduction in probing depth

gain in probing attachment level

marked changed in the subgingival microbial flora
- shrinks from both ends

27
Q

what causes gain in attachment of periodontal pockets

A

due to long junctional epithelium formation and improved tissue tone (inflammatory infiltrate is replaced by collagen)

greatest changes 4-6 weeks after therapy

gradual repair and maturation of tissues over 9-12 months

28
Q

2 periodontal treatment approached

A

quadrant

full mouth disinfection

29
Q

effectiveness of full mouth disinfection periodontal treatment approach

A

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

Full mouth RSD at one or more sittings on the same day

Use of chlorohexidine for subgingival irrigation, tongue brushing and mouth rinsing

30
Q

2 main effects of debridement

A

Reduces microbial challenge
- decreased inflammation

Inoculation with plaque organisms
- boots immune response

31
Q

parts to look at in re-evaluation of periodontal Tx

A

Patient plaque control
- From 100% to 50%

Bleeding on probing

Residual probing depths (and attachment levels)

Tooth mobility

Want improvement, measure, use flow charts on clinics

32
Q

periodontal Tx success is

A

Good oral hygiene

No bleeding on probing

No pockets >4mm

No increasing tooth mobility

A functional and comfortable dentition

33
Q

poor OH and persistent inflammation on re-evaluation leads to

A

identify reason for poor OH

then supportive care or repeat cause-related therapy

34
Q

good OH and inflammation resolved on re-evaluation leads to

A

supportive care and process with Tx plan

35
Q

good OH and persistent deep pockets with BOP on re-evaluation leads to

A

surgical access or repeat RSD

then re-evaluate

36
Q

3 reasons why periodontal treatment may fail

A

Poor compliance
- Complex – lazy, understanding, physically unwell

Inadequate debridement
- Access can be hard

Host factors
- Mainly smoking

37
Q

5 limitations of non-surgical therapy of periodontal disease

A

Root morphology

Furcation involvement
- Bone loss in furcation Almost impossible to completely debrine furaction

Deep pockets

Skill level

Time
- Less of issue in GDH

38
Q

4 reasons for supportive periodontal care (management)

A

Maintain periodontal health

Detect and treat recurrence

Maintain an accepted level of disease

Manage tooth loss

39
Q

components of supportive periodontal care Tx

A

Intervals approx.. 3 month for most patients

OH must be reinforced

Examine for signs of recurrent disease

Scaling, RSD, polishing and other treatment as necessary

BDS2 Periodontics (2 decks)

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