Perio Examination & Treatment Flashcards
What are the scoring codes for a BPE and what do they mean?
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
What probe is used in a BPE?
CPITN Probe
Ball ended (0.5mm in diameter)
Black band from 3.5-5.5mm
What should you do if a patient has a code 3 in BPE?
Record a full 6 point pocket chart on all teeth in that sextant
Radiograph to assess alveolar bone loss
What should you do if a patient has a code 4 in BPE?
Record a full 6 point pocket chart of the entire dentition
Radiograph to assess alveolar bone loss
What BPE codes are used in 7-11 year olds?
codes 0-2
What BPE codes are used in 12-17 years olds?
Full range of codes
What treatments should be undergone with the different BPE scores?
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
What teeth are assessed in a BPE for children?
UR1, UR6, UL6
LL1, LL6, LR6
When should you refer to a specialist?
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
What probe is used for a 6 point pocket chart?
PCP12
What are the limitations of a BPE?
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
What are the other names for non-surgical management of periodontal disease?
Cause-related therapy
Hygiene phase therapy
Non-surgical treatment
What are the components of hygiene phase therapy?
Dental health education Oral hygiene instruction Scaling & RSD Removal of plaque retentive factors Re-evaluation
What is oral hygiene instruction?
Tooth brushing - modified Bass technique
Interdental cleaning - floss, tape, brushes, sticks
Disclosing agents
What is root planing?
The removal of contaminated cementum, leaving the root surface smooth and hard.
Not used as much nowadays.
What is scaling?
The removal of sub/supragingival plaque and calculus from tooth surfaces
What are the benefits of ultrasonic/sonic scalers?
Better access to furcations
Faster & less demanding on operator
Less unwanted tooth tissue removal
Water coolant - cavitation & flushing effect
What are the problems with ultrasonic/sonic scalers?
Produces aerosols
May leave a rougher surface
Greater tactile sensitivity with hand instruments
What does probing depth indicate?
The difficulty of treatment and likelihood of recurrence
What do attachment levels measure?
Measure of tissue destruction (pre-treatment) and the extent of repair (post-treatment)
What causes gain in attachment after hygiene phase therapy?
Long junctional epithelium formation and improved tissue tone.
Inflammatory infiltrate is replaced by collagen.
Greatest changes observed 4-6 weeks after therapy.
What are the two approaches to organising periodontal treatment?
Quadrant approach - 1/4 of the mouth at each visit
Full mouth disinfectant - all treatment at once
What are the effects of debridement?
Reduces microbial challenge
Decreases inflammation
Inoculation w/ plaque organisms if pocket is accidentally lacerated - boosts immune response
What are the signs of successful hygiene phase therapy?
Good oral hygiene - plaque scores 4mm - patient can clean pockets of this depth
No increased tooth mobility
Functional and comfortable dentition
When would you repeat non-surgical therapy?
On reevaluation patient has:
poor OH, persistent inflammation
good OH, persistent deep pockets with BOP
What are your options on evaluation of non-surgical management?
Maintenance
Repeat NST
Surgical access
