Non-Surgical Treatment of Periodontitis 1 Flashcards by David Jack

Give examples of periodontal diseases

Plaque induced gingivitis

Periodontitis

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What causes periodontal disease

The formation and persistence of biofilm

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Describe plaque and what it causes

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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Describe calculus

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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What are the risk factors of developing periodontal disease

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

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

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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What are the clinical presentations of periodontitis (3)

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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What resistance is present to preventing periodontal disease (3)

Innate immune response
Adaptive immune response
Inflammation

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What are the 4 stages of periodontal management

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

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What should be carried out during screening for periodontal disease

Basic Periodontal Examination (BPE)

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What are the different types of BPE probe

WHO probe

UNC probe

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Describe a WHO probe

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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Describe a UNC probe

15mm long

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

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Describe how the dentition is divided for periodontal screening

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

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When should 3rd molars be examined on a BPE

Only when the 1st and 2nd molars are missing

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What qualifies a sextant for recording on a BPE

Each sextant must have at least 2 teeth

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How should a BPE be carried out

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

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What does the score 0 mean on a BPE

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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What does the score 1 mean on a BPE

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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What does the score 2 mean on a BPE

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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What does the score 3 mean on a BPE

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

What does the score 4 mean on a BPE

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

What does * mean on a BPE

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

What is furcation involvement

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

Clinical gingival health or gingivitis

What does code 3 indicate on a BPE

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

What does code 4 indicate on a BPE

Periodontitis

What can the BPE screening information be used for

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

What is a FMPC

Full mouth pocket chart

When should a BPE test not be used

For monitoring | If the patient has implants as they will give deeper pockets

What is included in assessment for periodontal disease

Further investigations such as taking radiographs if necessary

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

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

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

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

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

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

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

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

How can periodontal disease be controlled (5)

``` Extraction of hopeless teeth Hygiene phase therapy Caries management Endodontic therapy Provisional prosthesis ```

What is included in hygiene phase therapy (5)

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

Give examples of some Plaque-Retentive Factors

Defective restoration margins - overhangs or crown margins Dentures Orthodontic retainers

What is the aim of hygiene phase therapy

Arrest the disease process Regenerate lost tissue Maintain periodontal health long term Result in keeping teeth

What should be discussed during dental health management

Modifiable risk factors Plaque control Behavioural change Aim to educate the patient

What does solar mean in relation to communication

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

Which teeth are used for modified plaque and bleeding scores

Ramfjord’s teeth UR6 UL1 UL4 LR4 LR1 LL6

What is the modified plaque score

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

Describe the different codes in a modified plaque score

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

How is each Ramfjord tooth divided for a modified plaque score

Into 3 surfaces: Interproximal Buccal Palatal/Lingual

How is a modified plaque score calculated

Scores for each surface are added to get a total | These are then divided by total number - maximum value is 36

Describe the modified bleeding score

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

How is each Ramfjord tooth divided for a modified bleeding score

``` Into 4 surfaces: Mesial Distal Buccal Palatal/Lingual ```

Describe the different codes in a modified bleeding score

0 - Absence of bleeding on probing | 1 - Presence of bleeding on probing

How is a modified bleeding score calculated

Scores for each surface should be added to get a total score | This is then divided by the maximum bleeding score possible - 24

What should be done if a Ramfjord tooth is missing

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