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Periodontology > Non-Surgical Treatment of Periodontitis 1 > Flashcards

Non-Surgical Treatment of Periodontitis 1 Flashcards

1
Q

Give examples of periodontal diseases

A

Plaque induced gingivitis

Periodontitis

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2
Q

What causes periodontal disease

A

The formation and persistence of biofilm

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3
Q

Describe plaque and what it causes

A

Plaque is the biofilm
Sticky colourless deposit
Plaque bacteria can attach to tooth surfaces, periodontal tissues and connective tissues changing the microbial composition from health to disease

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4
Q

Describe calculus

A

Calcified deposits found attached to the surfaces of teeth
Often brown or pale yellow
Is always covered by plaque biofilm
Can be supra and subgingival
Is detected by direct vision, probing or on radiographs

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5
Q

What are the risk factors of developing periodontal disease

A

Environmental - smoking, dental plaque accumulation, socioeconomic status
Host-specific - genetic factors and overall inflammatory burden

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6
Q

What are the clinical presentations of plaque induced gingivitis (7)

A

Change in colour of the gingivae
Marginal gingival swelling
Loss of contour (blunting) of interdental papilla
Bleeding from the gingival margin on probing or brushing
Plaque present at gingival margin
No alveolar bone loss
Gingival sulcus measures 3mm or less from the gingival margin to the base of the junctional epithelium - which is still at the CEJ

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7
Q

What are the clinical presentations of periodontitis (3)

A

Loss of periodontal connective tissue attachment
Gingival sulcus measures >3.0mm from the gingival margin to the base of the junctional epithelium which has migrated apical with the formation of a true periodontal pocket
Alveolar bone loss

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8
Q

What resistance is present to preventing periodontal disease (3)

A

Innate immune response
Adaptive immune response
Inflammation

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9
Q

What are the 4 stages of periodontal management

A

Screening
Assessment
Treatment - as part of an overall treatment strategy
Monitoring

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10
Q

What should be carried out during screening for periodontal disease

A

Basic Periodontal Examination (BPE)

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11
Q

What are the different types of BPE probe

A

WHO probe

UNC probe

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12
Q

Describe a WHO probe

A

A ball end 0.5mm in diameter
Black band from 3.5-5.5mm
Second black band from 8.5-11.5mm

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13
Q

Describe a UNC probe

A

15mm long

Markings at each mm and colour coding at the 5th, 10th and 15th mm

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14
Q

Describe how the dentition is divided for periodontal screening

A

Into 6 sextants:
UR7-UR4 UR3-UL3 UL4-UL7
LR7-LR4 LR3-LL3 LL4-LL7

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15
Q

When should 3rd molars be examined on a BPE

A

Only when the 1st and 2nd molars are missing

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16
Q

What qualifies a sextant for recording on a BPE

A

Each sextant must have at least 2 teeth

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17
Q

How should a BPE be carried out

A

The probe should be walked around the sulcus/pockets in each sextant and the highest score should be recorded

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18
Q

What does the score 0 mean on a BPE

A 
Pockets <3.5mm
First black band entirely visible
Actual pocket depth range <3mm
No bleeding on probing
No calculus or overhangs

No need for periodontal treatment

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19
Q

What does the score 1 mean on a BPE

A 
Pockets <3.5mm
First black band entirely visible
Actual pocket depth range <3mm
Bleeding on probing
No calculus or overhangs

Give oral hygiene instruction

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20
Q

What does the score 2 mean on a BPE

A 
Pockets <3.5mm
First black band entirely visible
Actual pocket depth range <3mm
Possible bleeding on probing
Calculus or overhangs present

OHI, removal of plaque retentive factors including all supra- and sub-gingival calculus

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21
Q

What does the score 3 mean on a BPE

A 
Probing depth 3.5-5.5mm
First black band partially visible
Actual pocket depth range 4-5mm
Possible bleeding on probing
Possible calculus or overhangs

OHI, root surface debridement

22
Q

What does the score 4 mean on a BPE

A 
Probing depth >5.5mm
First black band disappears
Actual pocket depth range >6mm
Possible bleeding on probing
Possible calculus or overhangs

OHI, RSD, Assess the need for more complex treatment ie - referral to a specialist

23
Q

What does * mean on a BPE

A

Furcation involvement if identified (visibly or on probing)
Should be recorded in additional to the numerical score

OHI, RSD, Assess the need for more complex treatment ie - referral to a specialist

24
Q

What is furcation involvement

A

??

25
Q

What do codes 0, 1 and 2 indicate on a BPE

A

Clinical gingival health or gingivitis

26
Q

What does code 3 indicate on a BPE

A

Can be bone loss and interdental recession, or gums can be swollen creating a false pocket
If false pocket the patient should follow the same rules as gingivitis

27
Q

What does code 4 indicate on a BPE

A

Periodontitis

28
Q

What can the BPE screening information be used for

A

Radiographs for all codes 3 and 4 if justified
Modified plaque and bleeding charts if necessary
FMPC if one code 4 or evidence of interdental recession
FMPC of code 3 sextant or initial therapy of code 3 then FMPC

29
Q

What is a FMPC

A

Full mouth pocket chart

30
Q

When should a BPE test not be used

A

For monitoring

If the patient has implants as they will give deeper pockets

31
Q

What is included in assessment for periodontal disease

A

Further investigations such as taking radiographs if necessary

32
Q

What are the pros and cons of using horizontal bitewings for periodontal disease

A

If alveolar crest is visible if might show early localised bone loss
Shows sublingual calculus
Presence of poorly contoured restorations

33
Q

What are the pros and cons of using vertical bitewings for periodontal disease

A

Provides a non distorted view of bone levels in relation to the CEJ
Can provide better visualisation of bone level than horizontal bitewings
Difficult to position accurately

34
Q

What are the pros and cons of using periapicals in periodontal disease

A

Gold standard
2-dimensional picture of bone levels in relation to both CEJ and total root length
Identifies furcation involvement and possible endodontic complications

35
Q

What are the pros and cons of using panoramic radiographs in periodontal disease

A

Quicker
More comfortable
Might need supplemented with periapical views especially in anterior sextants due to risk of distortion

36
Q

How can periodontal disease be controlled (5)

A 
Extraction of hopeless teeth
Hygiene phase therapy
Caries management
Endodontic therapy
Provisional prosthesis
37
Q

What is included in hygiene phase therapy (5)

A 
Dental health education
Oral hygiene instruction
Scaling and root surface debridement
Removal of other Plaque-Retentive Factors
Re-evaluation
38
Q

Give examples of some Plaque-Retentive Factors

A

Defective restoration margins - overhangs or crown margins
Dentures
Orthodontic retainers

39
Q

What is the aim of hygiene phase therapy

A

Arrest the disease process
Regenerate lost tissue
Maintain periodontal health long term

Result in keeping teeth

40
Q

What should be discussed during dental health management

A

Modifiable risk factors
Plaque control
Behavioural change

Aim to educate the patient

41
Q

What does solar mean in relation to communication

A 
Square on to patient
Open posture, not crossed arms
Lean forward, look interested
Eye contact
Relaxed demeanour
42
Q

Which teeth are used for modified plaque and bleeding scores

A

Ramfjord’s teeth
UR6 UL1 UL4
LR4 LR1 LL6

43
Q

What is the modified plaque score

A

An index to measure status of oral hygiene by measuring dental plaque

44
Q

Describe the different codes in a modified plaque score

A

0 - No plaque visible, even when a probe is used
1 - Some plaque visible only when a probe was used to skim the tooth surface
2 - Visible amount of plaque which can be seen without use of a probe
N - No measurement could be made for this surface/tooth

45
Q

How is each Ramfjord tooth divided for a modified plaque score

A

Into 3 surfaces:
Interproximal
Buccal
Palatal/Lingual

46
Q

How is a modified plaque score calculated

A

Scores for each surface are added to get a total

These are then divided by total number - maximum value is 36

47
Q

Describe the modified bleeding score

A

Measures marginal bleeding rather than bleeding on probing because marginal bleeding reflects how well the patient can carry out effective plaque control daily
Periodontal probe is run gently at 45 degrees around the gingival sulcus in a continuous sweep
Check presence or absence of bleeding for up to 30s after probing

48
Q

How is each Ramfjord tooth divided for a modified bleeding score

A 
Into 4 surfaces:
Mesial
Distal
Buccal
Palatal/Lingual
49
Q

Describe the different codes in a modified bleeding score

A

0 - Absence of bleeding on probing

1 - Presence of bleeding on probing

50
Q

How is a modified bleeding score calculated

A

Scores for each surface should be added to get a total score

This is then divided by the maximum bleeding score possible - 24

51
Q

What should be done if a Ramfjord tooth is missing

A

If there is an appropriate alternative tooth then use it for charting
If not then use the code N

Periodontology (3 decks)

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