Non-Surgical Periodontal Management Flashcards
Non surgical management is also called…..
cause related therapy
hygiene phase therapy
3 aims of periodontal treatment
to arrest the disease process
ideally, to regenerate lost tissue
to maintain periodontal health long term
result = keep teeth
treatment plan stages
emergency care
disease control
re- evaluation
periodontal surgery
reconstruction
supportive care
parts of disease control phase in Tx plan
extraction of hopeless teeth
hygiene phase therapy
caries management
endodontic therapy (RCT)
provisional prostheses
periodontitis
Loss of attachment and true pocket formation colonisation of the root surface
parts of hygiene phase therapy
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
how to carry out dental health education for periodontal management
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
3 components of oral hygiene instruction to cover
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
scaling
removal of plaque and calculus from the tooth surfaces
root surface debridement (RSD)
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
progressive alveolar bone loss per year if sub-gingival plaque impregnate pocket
1mm/year
2 types of scaling instruments
Hand instruments
Powered instruments
- Ultrasonic (predominate)
- Sonic
- Rotating
- Reciprocating
All equal effective if used correctly and mastered (not damaging teeth)
where can ultrasonic instruments be used
supra and sub-gingivally
3 possible problems in restorations that can contribute to periodontal disease
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
3 ways to measure success in periodontal treatment
Inflammation (bleeding on probing indices)
Reduction in probing depth
Gain in probing attachment level
how far apart are the bands on a PCP 12 probe
3mm
what probe is used for 6PPC
PCP 12 probe
coronal gingival overgrowth is
negative
gingival recession is
positive
probing depth indicates
the difficulty of treatment and the likelihood of recurrence
attachment levels are
measure of tissue destruction (pre-treatment) and the extent of repair (post-treatment)
6 factors which influence manual probing measurements/depths
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
what does successful periodontal therapy require
both supra and sub gingival plaque control
effect of supra-gingival plaque control alone
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
effects of RSD (sub gingival) without supra-gingival
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
effects of RSD with supragingival plaque control
both supra and sub
decreased gingival inflammation
reduction in probing depth
gain in probing attachment level
marked changed in the subgingival microbial flora
- shrinks from both ends
what causes gain in attachment of periodontal pockets
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
2 periodontal treatment approached
quadrant
full mouth disinfection
effectiveness of full mouth disinfection periodontal treatment approach
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
2 main effects of debridement
Reduces microbial challenge
- decreased inflammation
Inoculation with plaque organisms
- boots immune response
parts to look at in re-evaluation of periodontal Tx
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
periodontal Tx success is
Good oral hygiene
No bleeding on probing
No pockets >4mm
No increasing tooth mobility
A functional and comfortable dentition
poor OH and persistent inflammation on re-evaluation leads to
identify reason for poor OH
then supportive care or repeat cause-related therapy
good OH and inflammation resolved on re-evaluation leads to
supportive care and process with Tx plan
good OH and persistent deep pockets with BOP on re-evaluation leads to
surgical access or repeat RSD
then re-evaluate
3 reasons why periodontal treatment may fail
Poor compliance
- Complex – lazy, understanding, physically unwell
Inadequate debridement
- Access can be hard
Host factors
- Mainly smoking
5 limitations of non-surgical therapy of periodontal disease
Root morphology
Furcation involvement
- Bone loss in furcation Almost impossible to completely debrine furaction
Deep pockets
Skill level
Time
- Less of issue in GDH
4 reasons for supportive periodontal care (management)
Maintain periodontal health
Detect and treat recurrence
Maintain an accepted level of disease
Manage tooth loss
components of supportive periodontal care Tx
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
