Perio Treatment Flashcards
What radiographs were taken based on the patient’s BPE?
The patient had 3’s in all quadrants- requires either full mouth PA’s or OPT.
We already had left and right bitewings, where you could see the bone levels but were planning for los of 48, so a sectional OPT was indicated already.
Why did you choose to do a full mouth OPT?
The patient had BPE’s of 3- this would indicate a requirement for either full mouth PA’s or a full mouth OPT in order to see the bone levels.
We already had left and right bitewings from 9 months prior, where you could see the bone levels but we also needed a sectional OPT anyway in order to assess 48 prior to third molar surgery.
Options- sectional OPT and then PA’s to supplement view or full mouth OPT.
- decision made to do full mouth OPT for ease of patient, reduced radiation dosage and the fact that the patient is high caries risk and would require new radiographs every 6 months anyway.
What do the BSP guidelines say with regards to PAs vs OPT?
Either is acceptable- it depends on the circumstances.
PAs give more detailed assessment of bone loss but OPTs may be indicated based on patient factors- ease of imaging, more comfortable, other pathologies indicated.
What is the justification for a full mouth OPT?
Assessment of 48 and adjacent structures
- Root anatomy, crown anatomy, pathology, presence of close relationship to inferior alveolar canal, working distance, volume of cortical bone, angulation of tooth.
Assess bone levels- argument for PA vs OPT mentioned previously.
- this will allow full determination of perio diagnosis and this will influence further treatment.
What is the patient’s perio diagnosis?
Generalised Periodontitis
Stage I
Grade A
Currently unstable
No known risk factors
What does the stage represent?
Severity- the patient is stage I, less than 15% bone loss.
What does the grade represent?
Rate of progression of the disease- the patient has 15% bone loss and he is 35
- 15/35 is less than 0.5- so grade A.
What makes this patient unstable?
He has pocket depths of 4mm that are BOP.
For someone to be unstable- they need to have pockets greater than or equal to 5mm or 4mm pockets that are BOP.
What guidelines did you follow for the perio treatment?
BSP clinical practice guidelines for the treatment of periodontal disease.
What is step 1 of treatment?
Explain the disease to the patient.
Importance of good OH- the bulk of the treatment for this disease is done at home.
Explain risk factors- poor OH, plaque retentive factors.
Remove plaque retentive factors.
Supragingival PMPR
What should be done at the re-evaluation stage?
Full 6PPC- determine pockets 4mm or greater that will require subgingival PMPR
Check engagement
- plaque levels should be less than or equal to 20% and bleeding should be less than or equal to 30%.
Why do you need to check if a patient is engaged prior to starting subgingival PMPR?
Measuring marginal bleeding and plaque levels at the gingival margin- this is a measure of how well the patient is adhering to OHI that you have given them.
If they are not engaged and plaque and bleeding is still occurring, if you went ahead and did subgingival PMPR, the plaque would eventually work it’s way down the root surface again and re-colonise, promoting further inflammation.
Was this patient engaged after step 1?
No- his plaque and bleeding scores were still high.
Based on the plaque and bleeding scores after step 1, what detailed OHI did you give the patient?
Patient was struggling with reaching the posterior teeth on the RHS- gave the patient a single tufted contra-angled brush to try get to these areas.
Demonstration again with manual toothbrush using the modified bass technique.
Based on the plaque and bleeding scores after step 1, where had the patient improved and where was the patient missing during oral hygiene?
Patient had improved oral hygiene buccally and labially but was still missing lingually and interpoximally.
