Non-surgical Periodontitis Treatment

Question 1

What is non-surgical period treatment also known as?

Answer 1

Hygiene phase therapy

Question 2

When are 6 point pocket charts recorded in a patient with a BPE score of 3?

Answer 2

Can either carry out;
BSP- After treatment

SDCEP- Before and after treatment

Question 3

What are the aims of periodontal therapy?

Answer 3

Arrest the disease process
Regenerate attachment
Maintain periodontal health

Question 4

Describe the steps of a periodontal treatment plan.

Answer 4

Emergency care

Disease control via:
Hygiene phase therapy 
Extraction
Caries management 
Endo
Provisional prosthesis 

Re-evalutaion:
Carry out more disease control
Move on to reconstructive - if disease control not effective.

Reconstructive -surgery

Supportive care

Question 5

What is periodontal disease characterised by?

Answer 5

Loss of attachment = true pocket

Bone loss

Question 6

What is involved in hygiene phase therapy?

Answer 6

Education
Oral hygiene instruction 
Scaling and root surface debridement 
Removal of plaque retentive factors 
Re-evaluation

Question 7

When educating patients as part of hygiene phase therapy what must you explain, discuss and investigate?

Answer 7

Investigate:
Reasons for attendance/non-attendance
Attitudes to their health
Motivation

Explain:
Disease process
Benefits of treatment
Consequences of neglecting oral hygiene/the disease

Discuss:
Findings from the clinical examination

Question 8

What points must you cover in oral hygiene instruction?

Answer 8

Investigate dental history initially:
How often do you brush daily? 
For how long?
What tooth paste do you use? 
Do you use a manual or electric toothbrush? 
Do you used interdental cleaning aids?
Mouthwash? 

Using TIPPS: (Talk, instruct, practice, plan and support)

Modified bass technique - 45 degree angle at the gingival margin, brush away from the margin towards the incisal/occlusal edge.
Use vibrating motions.

Fluoride toothpaste 1350-1500ppm

Interdental cleaning aids - brushes come in a variety of sizes ensure the bristles engage both surfaces and ensure the wire does not contact the tooth surfaces = too tight.

Flossing: place floss in a ‘C’ shape around both the mesial and distal surfaces of the tooth and swipe towards the biting surface. Wrap floss around 4th finger and use index and thumb to direct/control the floss. Do not use a sawing motion - will damage the papilla/gum.

Question 9

What is scaling?

Answer 9

Removal of plaque and calculus from tooth surfaces

Question 10

What is root surface debridement?

Answer 10

Removal of dead, contaminated and adherent tissue/foreign material from the root surface

Question 11

What scaling instruments can be used both supra and subgingivally?

Answer 11

Both hand and powered instruments

Question 12

What is the benefit of hand scaling instruments?

Answer 12

Have tactile stimulation - can feel the base of pockets

Question 13

What is the benefit of powered scaling instruments?

Answer 13

Greater access to furcations

With experience - can be faster.

Question 14

What are plaque retentive factors that must be removed?

Answer 14

Defective restorations with overhangs.

Defective crown margins with shelves.

Prosthesis that cover gingival margins

Question 15

What does probing depth indicate?

Answer 15

How difficult treatment will be and the probability of recurrence.

Question 16

What do attachment levels indicate?

Answer 16

The extent of the disease before treatment and the extent of repair/success of treatment .

Question 17

What is the aim of mouth disinfection? How is this carried out?

Answer 17

Prevent treated pockets from being recolonised by bacteria

RSD of full mouth over a few sessions within the same day.
Chlorohexide used alongside this to;
Rinse mouth
Irrigate the subgingival pockets 
Brush tongue

Question 18

What is assessed in the reevaluation stage of hygiene phase therapy?

Answer 18

Is the plaque control improving?
Is there a reduction in bleeding on probing?
Is there a reduction in mobility?
Are levels of attachment improving? (pockets less than 4mm)

Question 19

After reevaluation; what steps are taken if there is still poor OH and persistant inflammation?

Answer 19

Identity the reasons for poor oral hygiene
Continue with hygiene phase therapy
Supportive care

Question 20

After reevaluation; what steps are taken if there is improved oral hygiene and a resolution of inflammation?

Answer 20

Supportive care and proceed with treatment plan

Question 21

After reevaluation; what steps are taken if there improved oral hygiene and persistent deep pockets?

Answer 21

Repeat hygiene phase therapy

If unsuccessful = Try reconstructive surgical methods

Question 22

What are the suggested reasons for treatment failure?

Answer 22

Poor compliance:
Patient doesn’t understand what is asked of them, patient has physical limitations.

Inadequate debridement:
Lack of still/technique
Difficult area to remove foreign material from.

Host factors:
Patient continues to smoke
Patient is medially compromised

Question 23

What is involved in supportive care?

Answer 23

Appointments every 3 months
- To detect and treat recurrence

Maintain health of periodontium via reinforced OHI at every appointment.