Perio treatment planning/charting extra info

Question 1

What are the 5 treatment planning phases

Answer 1

1. Initial examination and pain relief
2. Cause related (non-surgical) therapy
3. re-examination
4. definitive treatment plan
5. maintenance

Question 2

What do we do in phase 1 of treatment planning

Answer 2

Initial examination and pain relief:
- pain relief is a priority
then
- a full and thorough examination should be completed
- perio diagnosis which allows INITIAL tp

Question 3

What is the GOAL of Cause Related therapy (phase 2) NSPT:

Answer 3

the objectives of cause related therapy are
- to resolve the disease process
- to create conditions that will MITIGATE AGAINST THE RECURRENCE OF THE DISEASE
- INVOLVES CONTROLLING DENTAL PLAQUE SUPRA/SUB

Question 4

What clinical considerations are there (what can we take into account) for cause related therapy(6)

Answer 4

suggested by clinical examinations and radio reports:
- caries
- restoration overhangs etc
- furcation involvement
- sensitivity testing
- occlusal trauma
- mobility

Question 5

what ADVICE can we give within stage 2 (cause related therapy) to our patients? - THIS IS THE HYGIENE PHASE (6)

Answer 5

OHI
denture hygiene
smoking cessation
alcohol reduction
dietary advice
dentine hypersensitivity

Question 6

What is the point of cause related therapy

Answer 6

Designed to identify and control risk factors for perio disease and begin active therapy.
INDIVIDUALISED FOR EACH PATIENT

Question 7

what is involved with phase 3 - the re-examination

Answer 7

this is necessary to determine the patients RESPONSE to treatment

Question 8

what ocurrs if the treatment provided is a sucess

Answer 8

if stability is achieved the patient should progress DIRECTLY to maintenance therapy (phase 5!!!!) or supportive therapy. pt is NOT cured and recurrence is likely if plaque levels rise above the disease threshold. hence why maintenance is so important

Question 9

what occurs if tx is a failure

Answer 9

ESTABLISH the cause of failure - there are many causes but the most likely is inadequate OH/pt compliance. if the cause can be corrected, further treatment may be given with the intent of achieving treatment success
if the cause CANNOT be corrected the patient goes to palliative care

Question 10

what is palliative care?

Answer 10

this is NOT the same as maintenance
maintenance is a recall system for patients once their disease is established and stabilised!
it is designed to try and maintain disease stability - MAIN AIM IS TO SLOW DISEASE DOWN WHILE ATTEMPTING TO KEEP PATIENT COMFORTABLE WITH FUNCTIONING DENTITION - because the pt cannot maintain plaque control - physical disability etc

Question 11

what is involved in phase 4 (definitive treatment)

Answer 11

may include:
- rsd (second time round? - due to unresponsive patient)
- perio surgery - dependant on findings at the re-examination stage
- endo tx
- definitive rests and prosthetic treatment

PATIENTS CAN ONLY PROGRESS ONTO PHASE 5 ONCE THE PERIODONTIUM IS STABLE

Question 12

what is involved in phase 5 - MAINTENANCE

Answer 12

recall system which attempts to maintain periodontal stability - tailored to each individual it terms of how often they are seen.

Question 13

What does susceptibility to disease mean

Answer 13

this describes an INDIVIDUALS HOST RESPONSE TO PLAQUE
can be determined by the level of disease relative to patients age and OH

Question 14

What is involved in a simple perio assessment/review

Answer 14

BOP - present or absent?
PPDs - measured in mms using a CP12 probe
LOA - measured using the CP12. Base of the pocket to the ACJ
Furcation - probe can be inserted into the space between multi-rooted teeth
Mobility - movement out-with norm

Question 15

What can radiographs identify

Answer 15

• overhangs/ledges
• calculus
• impacted teeth
• suggestion of furcation (arrow head lesions)
• pathology PA

Question 16

list the different aspects of 2017 classification of perio

Answer 16

HEALTHY, GINGIVITIS OR PERIO - ID recession or radiographic bone loss?
DISEASE PATTERN - MI pattern, localised or generalised

STAGING - based on HOW MUCH bone loss
GRADING - proportion of bone loss against the patients age

STABLE - BOP is less than 10% overall and no bop at 4mm sites and no pocketing over 4mm
REMISSION - BOP is more than 10%, no bleeding at 4mm sites
UNSTABLE - pockets of 5mm or more OR bleeding at sites of 4mm or deeper

RISK FACTORS - eg uncontrolled type 1 db or smoker, stress

Question 17

What is the definition of a diagnosis

Answer 17

this gives concise description of presenting disease in a particular mouth at a particular time
useful on its own and helps indicate any change over a perio of time
should always be recorded in the patients notes

Question 18

IN terms of diagnosis, what is the criteria for clinical gingival health?

Answer 18

• less than 10% BOP
• no ID recession
• pt able to maintain low plaque scores

Question 19

in terms of dx, what is the criteria for localised gingivitis

Answer 19

• no obvs signs of id recession
• redness, sweeling
• 10-30% bop
• ? false pocketing
• reversible

Question 20

in terms of diagnosis, what is the criteria for generalised gingivitis

Answer 20

• no obvious ID recession
• redness, swelling
• more than 30% bop
• ?false pocketing
• reversible

Question 21

what % of teeth affected to get a localised perio dx

Answer 21

up to 30% of teeth affected

Question 22

What % of teeth affected do we need for gen perio

Answer 22

more than 30% of teeth affected

Question 23

When is staging and grading of perio performed?

Answer 23

this is performed once periodontitis has been diagnosed - this will help to assess severity and extent of disease

Question 24

what does staging reflect?

Answer 24

• this reflects the SEVERITY of disease at presentation.
• it is based on radiographic bone loss assessment alone
• based on the % of bone loss in relation to the root length
• BASED ON THE MOST SEVERE SITE IN THE MOUTH
• staged 1-4

Question 25

What does grading involve

Answer 25

grade A = slow rate (bone loss is less than 0.5)
grade B = moderate rate of progression (0.5-1.0)
grade C = rapid rate (more than 1.0)

Question 26

what is prognosis?

Answer 26

this is a prediction of the way the tissues are likely to respond to treatment

allows the clinician to establish what treatment is feasible and justified in an attempt to achieve long term perio stability

Question 27

what are the 2 main prognostic factors

Answer 27

general prognostic factors
local prognostic factors

Question 28

what do radiographs NOT tell us regarding perio disease

Answer 28

• they do not tell us about disease ACTIVITY
• they are a snapshot of established previous disease
• dont show us pocket depths and LOA
• only OBVIOUS changes can be interpreted

Question 29

Give some examples of non surgical therapy treatment (6)

Answer 29

• correction of faulty restoration margins
• scaling and polishing
• rsd
• treatment of furcation involvement
• treatment of dentine hypersensitivity
• XLA of teeth with poor prog