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Periodontology > Non-Surgical Treatment of Periodontitis 2 > Flashcards

Non-Surgical Treatment of Periodontitis 2 Flashcards

1
Q

What is the most important factor in prevention and treatment of periodontal disease

A

The patient’s oral hygiene

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2
Q

Explain how oral hygiene instruction should be carried out

A

Ask patient to bring current oral hygiene aids
Ask how the are being used in a non-judgmental way
Ask patient to demonstrate technique and modify accordingly
Use disclosing tablets to identify areas patient is missing

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3
Q

When are single tufted brushes used

A

To clean maligned teeth
To clean distal surfaces of last molar tooth
For teeth affected by localised gingival recession

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4
Q

When should interdental brushes be used

A

If there is any primal attachment loss

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5
Q

What advice for mouthwash should be given to patients

A

Use fluoridated mouthwash with no alcohol

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6
Q

When should a patient be advised to use a chlorhexidine mouthwash

A

When pain limits mechanical plaque removal

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7
Q

Why is scaling and root surface debridement necessary

A

To remove both supra gingival and sub gingival plaque and calculus deposits
To create a root surface compatible with biological reattachment

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8
Q

What is root surface debridement

A

The removal of contaminated material leaving the root surface smooth and hard

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9
Q

What are the different types of scalers

A 
Chisel - push scaler
Sickle scaler - for supra gingival plaque and calculus removal
Hoe
Curettes
Jacquettes
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10
Q

Why are sharp instruments preferred over dull ones

A

To improve efficiency
More likely to remove deposits than burnish them
Reduces the amount of forced used so reduced fatigue

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11
Q

What are the differences between powered and hand instruments

A

No difference in effectiveness of debridement
Powered are quicker, less fatiguing and easier to use
Powered have a poorer tactile sensation
Powered may leave a rougher surface
Powered produces aerosols

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12
Q

What is the aim of full mouth disinfection

A

Prevent treated pockets being re-colonised by intra-oral translocation of bacteria

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13
Q

How should full mouth disinfection be carried out

A

At one or more sittings on the same day

Use chlorhexidine for subgingival irrigation, tongue brushing and mouth rinsing

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14
Q

What is the difference between full mouth disinfection and a quadrant approach

A

Both methods are equally effective

FMD is intense and may not be realistic in practice

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15
Q

What effect does scaling and RSD have on the micro flora

A

Significantly reduces the levels and prevalence of pathogenic species such as P.gingivalis and T.denticola
Complete elimination is unrealistic

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16
Q

What effect does scaling and RSD have on the hard and soft tissues

A

Decrease in gingival inflammation
Shrinkage of the gingival tissues leads to recession
Increase in collagen fibres in the connective tissue beneath the pocket and formation of long junctional epithelial attachment

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17
Q

Describe the healing following RSD

A

Gain in attachment is due to long junctional epithelium formation and improved tissue tone - inflammatory infiltrate is replaced with collagen
Greatest changes observed 4-6 weeks after therapy
Gradual repair and maturation of tissues over 9-12 months

18
Q

What plaque retentive factors are present in restorations

A

Overhang margins
Marginal discrepancies
Subgingival margins
Overcontoured crowns

19
Q

What plaque retentive factors are present in RPDs

A

Gingival coverage
Direct trauma
Uncontrolled loads

20
Q

What plaque retentive factors are present in orthodontic appliances

A

Access to interdental cleaning may be compromised

Bands can lie close to the gingival margin

21
Q

How is success measured in non-surgical periodontal treatment

A 
Good oral hygiene
No bleeding on probing
No pockets >4mm
No increasing tooth mobility
A functional and comfortable dentition
22
Q

What does probing depth indicate

A

The difficulty of treatment and the likelihood of recurrence

23
Q

What are attachment levels a measure of

A

Tissue destruction (pre-treatment) and the extend of repair (post-treatment)

24
Q

What effect does supragingival plaque control alone have

A

Decreased gingival inflammation
Limited effect on probing depth
No change in attachment levels
No alteration in subgingival microflora in deep pockets

25
Q

What are the effects of RSD without supragingival plaque control

A

Initial reduction in inflammation and pocket depth
Pockets are re-colonised by bacteria from supragingival plaque
Disease recurs

26
Q

What are the effects of RSD with supragingival plaque control

A

Decreased gingival inflammation
Reduction in probing depth
Gain in probing attachment level
Marked changes in the subgingival microflora

27
Q

What should be compared during re-evaluation

A 
Probing depths
Bleeding score
Plaque score
Attachment levels
Tooth mobility
Furcation
28
Q

Why does periodontal treatment fail

A

Inadequate patient plaque control
Residual subgingival deposits - deep pockets, furcation lesions, inexperienced operator
Systemic risk factors - smoking, diabetes

29
Q

How often should periodontal treatment be carried out

A

Intervals of approximately 3 months are appropriate for most patients

30
Q

What does periodontal charting measure

A 
Probing depth
Recession - works out attachment level
Bleeding on probing - disease activity
Mobility 
Furcation
31
Q

What is measured on periodontal probing

A

From top of pocket (gingival margin) to base of pocket

32
Q

Describe grade 1 furcation involvement

A

Initial furcation involvement

The furcation opening can be felt on probing but the involvement is less than one third of the tooth width

33
Q

Describe grade 2 furcation involvement

A

Partial furcation involvement

Loss of support exceeds one third of the tooth wife the but does not include the total width of the furcation

34
Q

Describe grade 3 furcation involvement

A

Through-and-through involvement

The probe can pass through the entire furcation

35
Q

Describe grade 0 tooth mobility

A

Physiological mobility measured at the crown level

The tooth is mobile within the alveolus to approx 0.1-0.2mm in a horizontal direction

36
Q

Describe grade 1 tooth mobility

A

Increased mobility of the crown of the tooth to at the most 1mm in a horizontal direction

37
Q

Describe grade 2 tooth mobility

A

Visually increased mobility of the crown of the tooth exceeding 1mm in a horizontal direction

38
Q

Describe grade 3 tooth mobility

A

Severe mobility of the crown of the tooth in both horizontal and vertical directions impinging on the function of the tooth

39
Q

What is the difference between a PCP and WHO probe

A

PCP doesn’t have a ball end

40
Q

What may influence manual probing measurements

A

The resistance of the tissues
Size, shape and tip diameter of the probe
Site and angle of probe insertion
Pressure applied
Presence of obstructions such as calculus
Patient discomfort

Periodontology (3 decks)

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