Perio Examination & Treatment

Question 0

What are the scoring codes for a BPE and what do they mean?

Answer 0

0 - no pockets >3.5mm, no calculus, no BOP, black band visible
1 - no pockets >3.5mm, no calculus, BOP, black band visible
2 - no pockets >3.5mm, supra/subgingival calculus, bb visible
3 - pockets 3.5-5.5mm, bb partially visible
4 - pocket >5.5mm, bb not visible
* - furcation involvement

Question 1

What probe is used in a BPE?

Answer 1

CPITN Probe
Ball ended (0.5mm in diameter)
Black band from 3.5-5.5mm

Question 2

What should you do if a patient has a code 3 in BPE?

Answer 2

Record a full 6 point pocket chart on all teeth in that sextant
Radiograph to assess alveolar bone loss

Question 3

What should you do if a patient has a code 4 in BPE?

Answer 3

Record a full 6 point pocket chart of the entire dentition

Radiograph to assess alveolar bone loss

Question 4

What BPE codes are used in 7-11 year olds?

Answer 4

codes 0-2

Question 5

What BPE codes are used in 12-17 years olds?

Answer 5

Full range of codes

Question 6

What treatments should be undergone with the different BPE scores?

Answer 6

0 - no treatment
1 - OHI
2 - removal of plaque retentive factors, inc all supra/subgingival calculus
3 - root surface debridement
4 - assess need for more complex treatment, possible referral to specialist
* - same as 4

Question 7

What teeth are assessed in a BPE for children?

Answer 7

UR1, UR6, UL6

LL1, LL6, LR6

Question 8

When should you refer to a specialist?

Answer 8

Aggressive periodontitis
Chronic perio, not responding to treatment
Systemic medical condition causing perio
Non-plaque induced condition
Rare/complex clinical pathology
Drug induced gingival overgrowth
Evaluation for periodontal surgery

Question 9

What probe is used for a 6 point pocket chart?

Answer 9

PCP12

Question 10

What are the limitations of a BPE?

Answer 10

It relies on pocket depth which can be misleading - false pockets, gingival enlargement, incomplete eruption
Underestimation in loss of attachment
Fails to indicate the extent of the disease

Question 11

What are the other names for non-surgical management of periodontal disease?

Answer 11

Cause-related therapy
Hygiene phase therapy
Non-surgical treatment

Question 12

What are the components of hygiene phase therapy?

Answer 12

Dental health education
Oral hygiene instruction
Scaling & RSD
Removal of plaque retentive factors
Re-evaluation

Question 13

What is oral hygiene instruction?

Answer 13

Tooth brushing - modified Bass technique
Interdental cleaning - floss, tape, brushes, sticks
Disclosing agents

Question 14

What is root planing?

Answer 14

The removal of contaminated cementum, leaving the root surface smooth and hard.
Not used as much nowadays.

Question 15

What is scaling?

Answer 15

The removal of sub/supragingival plaque and calculus from tooth surfaces

Question 16

What are the benefits of ultrasonic/sonic scalers?

Answer 16

Better access to furcations
Faster & less demanding on operator
Less unwanted tooth tissue removal
Water coolant - cavitation & flushing effect

Question 17

What are the problems with ultrasonic/sonic scalers?

Answer 17

Produces aerosols
May leave a rougher surface
Greater tactile sensitivity with hand instruments

Question 18

What does probing depth indicate?

Answer 18

The difficulty of treatment and likelihood of recurrence

Question 19

What do attachment levels measure?

Answer 19

Measure of tissue destruction (pre-treatment) and the extent of repair (post-treatment)

Question 20

What causes gain in attachment after hygiene phase therapy?

Answer 20

Long junctional epithelium formation and improved tissue tone.
Inflammatory infiltrate is replaced by collagen.
Greatest changes observed 4-6 weeks after therapy.

Question 21

What are the two approaches to organising periodontal treatment?

Answer 21

Quadrant approach - 1/4 of the mouth at each visit

Full mouth disinfectant - all treatment at once

Question 22

What are the effects of debridement?

Answer 22

Reduces microbial challenge
Decreases inflammation
Inoculation w/ plaque organisms if pocket is accidentally lacerated - boosts immune response

Question 23

What are the signs of successful hygiene phase therapy?

Answer 23

Good oral hygiene - plaque scores 4mm - patient can clean pockets of this depth
No increased tooth mobility
Functional and comfortable dentition

Question 24

When would you repeat non-surgical therapy?

Answer 24

On reevaluation patient has:
poor OH, persistent inflammation
good OH, persistent deep pockets with BOP

Question 25

What are your options on evaluation of non-surgical management?

Answer 25

Maintenance
Repeat NST
Surgical access