Non-Surgical Treatment of Periodontitis 2 Flashcards
What is the most important factor in prevention and treatment of periodontal disease
The patient’s oral hygiene
Explain how oral hygiene instruction should be carried out
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
When are single tufted brushes used
To clean maligned teeth
To clean distal surfaces of last molar tooth
For teeth affected by localised gingival recession
When should interdental brushes be used
If there is any primal attachment loss
What advice for mouthwash should be given to patients
Use fluoridated mouthwash with no alcohol
When should a patient be advised to use a chlorhexidine mouthwash
When pain limits mechanical plaque removal
Why is scaling and root surface debridement necessary
To remove both supra gingival and sub gingival plaque and calculus deposits
To create a root surface compatible with biological reattachment
What is root surface debridement
The removal of contaminated material leaving the root surface smooth and hard
What are the different types of scalers
Chisel - push scaler Sickle scaler - for supra gingival plaque and calculus removal Hoe Curettes Jacquettes
Why are sharp instruments preferred over dull ones
To improve efficiency
More likely to remove deposits than burnish them
Reduces the amount of forced used so reduced fatigue
What are the differences between powered and hand instruments
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
What is the aim of full mouth disinfection
Prevent treated pockets being re-colonised by intra-oral translocation of bacteria
How should full mouth disinfection be carried out
At one or more sittings on the same day
Use chlorhexidine for subgingival irrigation, tongue brushing and mouth rinsing
What is the difference between full mouth disinfection and a quadrant approach
Both methods are equally effective
FMD is intense and may not be realistic in practice
What effect does scaling and RSD have on the micro flora
Significantly reduces the levels and prevalence of pathogenic species such as P.gingivalis and T.denticola
Complete elimination is unrealistic
What effect does scaling and RSD have on the hard and soft tissues
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
Describe the healing following RSD
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
What plaque retentive factors are present in restorations
Overhang margins
Marginal discrepancies
Subgingival margins
Overcontoured crowns
What plaque retentive factors are present in RPDs
Gingival coverage
Direct trauma
Uncontrolled loads
What plaque retentive factors are present in orthodontic appliances
Access to interdental cleaning may be compromised
Bands can lie close to the gingival margin
How is success measured in non-surgical periodontal treatment
Good oral hygiene No bleeding on probing No pockets >4mm No increasing tooth mobility A functional and comfortable dentition
What does probing depth indicate
The difficulty of treatment and the likelihood of recurrence
What are attachment levels a measure of
Tissue destruction (pre-treatment) and the extend of repair (post-treatment)
What effect does supragingival plaque control alone have
Decreased gingival inflammation
Limited effect on probing depth
No change in attachment levels
No alteration in subgingival microflora in deep pockets
