Non-Surgical Treatment of Periodontal Disease Flashcards
What is 1st step in sequence for treatment of periodontitis?
Patient motivation, supragingival plaque control and risk factor control
What is 2nd step in sequence for treatment of periodontitis?
Cause related therapy, control subgingival biofilm and calculus
What is 3rd step in sequence for treatment of periodontitis?
Treatment of areas non-responding to second step (surgery)
What is 4th step in sequence for treatment of periodontitis?
Supportive periodontal care: maintain periodontal stability
What are the goals of non-surgical management/subgingival PMPR?
Control of risk factors, removal and disruption of biofilm, reduction of bacterial load, reduce gingival inflammation, reduce deepened pockets, regain periodontal attachment of tooth, and prevent tooth loss and loss of dental functions
What is step 1 in the management of periodontitis?
Supra-gingival plaque control, patient behaviour modification, risk factor control, OHI and PMPR
What is supragingival PMPR?
Disruption of plaque biofilm and removal of hard deposits and stain in accessible areas
What are accessible areas sometimes defined as?
Up to 3-4mm subgingival
What is polishing (prophylaxis)?
Removal of soft deposits and unacceptable stain
What are ‘prophy’ pastes usually?
Abrasive
What else can be used for polishing (prophylaxis)?
Pumice and water
What is the potential effectiveness of OHI on its own?
Can reduce 50% of number of diseased sites
What is the potential effectiveness of OHI with addition of supragingival PMPR?
A 2/3 reduction
What does calculus not itself induce?
Inflammation
What has calculus not been shown to be always linked with?
More severe attachment loss
When should you re-evaluate?
After 2 weeks to allow resolution of inflammation (eliminate chances of false pocketing)
How should you re-evaluate?
Do PI, BI and potentially comprehensive periodontal examination
What is the comprehensive periodontal examination?
6 PPC, recession, CAL, mobility, and furcation
What is a non-engaging patient?
Insufficient improvement in OH < 50% in PI and BI, plaque levels >20% and BI >30%, and patient states preferences for a palliative approach to periodontal care
What is an engaging patient?
Favourable improvement in OH by 50%, plaque levels ≤20%, bleeding scores ≤ 30%, and patient has met targets outlined by their self-care plan
What should you do if you have a non-engaging patient after re-evaluate?
Return to step 1 and repeat
What should you do if you have an engaging patient after re-evaluate?
Move to step 2 or consider referral
What is subgingival PMPR?
Subgingival debridement/scaling, root planing, subgingival scaling/curettage, subgingival instrumentation, and RSD
When you should you only do RSD?
After successful first step therapy
What is step 2 in the management of periodontitis?
Reinforce OH, subgingival PMPR: US/Hand/US, and adjunctive antibiotics
Why should you do subgingival PMPR?
Reduce soft and hard deposits –> reduce soft tissue inflammation –> pocket closure, no BoP
Who needs step 2 in the management of periodontitis?
Periodontally susceptible, engaged patients with periodontal pockets
How should you carry out subgingival PMPR?
With hand instrumentation/powered isntrumentation/both
What should you bear in mind when deciding to do quadrants/full mouth subgingival PMPR?
Medical history and patient preference
What is full mouth disinfection?
Undertake S&P/RSD with extensive additional use of chlorhexidine
What can full mouth disinfection do?
Prevent re-infection of previously treated sites
What other adjunctive therapies should not be used?
Laser, antimicrobial photodynamic therapy, host modulating agents (statins), probiotics, local/systemic NSAIDs, and bisphosphonates
What other adjunctive therapies may be used?
Chlorhexidine mouth rinses and subgingivally sustained release, locally sustained-release antibiotics, and systemic antibiotics
What are the new tendencies in periodontal disease?
Minimally invasive Non-surgical Management (MINST), use of Magnification loupes/microscope, use of slim line thin US tips and micro curettes (Micro mini 5 Gracey curettes), avoid over–instrumentation, attempt to stimulate a stable blood clot after debridement
How long should you wait to re-evaluate after step 2?
3 months
What should you do for patients with residual pockets <6mm after re-evaluate after 3 months?
Repeat subgingival PMPR
What should you do for patients with residual pockets >6mm after re-evaluate after 3 months?
Repeat subgingival PMPR but if in practice consider referral
What should you do for stable and remission patients after re-evaluate after 3 months?
Can progress to step 4 (supportive periodontal therapy)
What are the clinical features of a currently unstable periodontitis patient?
PPD >5mm/PPD at >4mm and Bop
What are the clinical features of a currently stable periodontitis patient?
BoP <10%, PPD <4mm, and no BoP at 4mm sites
What are the clinical features of a periodontitis patient currently in remission?
BoP >10%, PPD <4mm, and no BoP at 4mm sites
