Non-surgical Periodontitis Treatment Flashcards
What is non-surgical period treatment also known as?
Hygiene phase therapy
When are 6 point pocket charts recorded in a patient with a BPE score of 3?
Can either carry out;
BSP- After treatment
SDCEP- Before and after treatment
What are the aims of periodontal therapy?
Arrest the disease process
Regenerate attachment
Maintain periodontal health
Describe the steps of a periodontal treatment plan.
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
What is periodontal disease characterised by?
Loss of attachment = true pocket
Bone loss
What is involved in hygiene phase therapy?
Education Oral hygiene instruction Scaling and root surface debridement Removal of plaque retentive factors Re-evaluation
When educating patients as part of hygiene phase therapy what must you explain, discuss and investigate?
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
What points must you cover in oral hygiene instruction?
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.
What is scaling?
Removal of plaque and calculus from tooth surfaces
What is root surface debridement?
Removal of dead, contaminated and adherent tissue/foreign material from the root surface
What scaling instruments can be used both supra and subgingivally?
Both hand and powered instruments
What is the benefit of hand scaling instruments?
Have tactile stimulation - can feel the base of pockets
What is the benefit of powered scaling instruments?
Greater access to furcations
With experience - can be faster.
What are plaque retentive factors that must be removed?
Defective restorations with overhangs.
Defective crown margins with shelves.
Prosthesis that cover gingival margins
What does probing depth indicate?
How difficult treatment will be and the probability of recurrence.
What do attachment levels indicate?
The extent of the disease before treatment and the extent of repair/success of treatment .
What is the aim of mouth disinfection? How is this carried out?
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
What is assessed in the reevaluation stage of hygiene phase therapy?
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)
After reevaluation; what steps are taken if there is still poor OH and persistant inflammation?
Identity the reasons for poor oral hygiene
Continue with hygiene phase therapy
Supportive care
After reevaluation; what steps are taken if there is improved oral hygiene and a resolution of inflammation?
Supportive care and proceed with treatment plan
After reevaluation; what steps are taken if there improved oral hygiene and persistent deep pockets?
Repeat hygiene phase therapy
If unsuccessful = Try reconstructive surgical methods
What are the suggested reasons for treatment failure?
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
What is involved in supportive care?
Appointments every 3 months
- To detect and treat recurrence
Maintain health of periodontium via reinforced OHI at every appointment.
