Periodontal and Per-Implant Diseases

Question 1

According to Therapeutic Guidelines, approximately how long would it take to resolve gingivitis if managed properly?

Answer 1

1 month

Question 2

What are the management strategies for gingivitis?

Answer 2

1. Remove plaque and calculus through thorough debridement.
2. Smooth over any rough edges from fillings that allow plaque to accumulate.
3. Improving oral hygiene through patient education.

Question 3

What do you do if the patient is experiencing pain and inflammation that prevents them from brushing?

Answer 3

To use mouthwash short-term (reduce plaque formation).

Question 4

What mouthwash (and how much) do you recommend for gingivitis patients?

Answer 4

Chlorhexidine.

1. CHX 0.2% mouthwash 10mL, rinsed in mouth for 1 min then spat out. 8-12 hourly for 5-10 days.

OR

2. CHX 0.12% mouthwash 15mL rinsed in the mouth for 1 min then spat out. 8-12 hourly for 5-10 days.

Question 5

What is a side effect of using chlorhexidine?

Answer 5

If used more than 2 weeks, CHX can cause extrinsic discolouration of the teeth, restorations and tongue. Can be removed professionally, though.

Can also increase calculus formation.

Question 6

What are the risk factors for periodontitis?

Answer 6

Smoking and poorly controlled diabetes.

Question 7

Periodontitis in children is rare. What is it usually associated with?

Answer 7

Systemic disease (e.g.: leukaemia, T1DM, cyclic neutropenia). Refer for specialist review immediately.

Question 8

What are the management strategies for periodontitis?

Answer 8

1. Thorough debridement to remove supra and subgingival calculus and plaque (may need LA)
2. Polish, reshape or replace defective fillings.
3. Provide patients with advice on oral hygiene.
4. Collaborate with GP to modify any risk factors (e.g.: smoking, diabetes management)
5. Provide regular supportive periodontal care.

Question 9

Is antibiotic therapy required for periodontitis?

Answer 9

Rarely. You should only consider it if:

• Pt has a rapidly progressing form of it.
• Periodontitis hasn’t responded to dental treatment
• Pts are immunocompromised

Question 10

What is Necrotising Periodontal Disease?

Answer 10

An acute, painful condition characterized by gingival bleeding and necrosis or ulceration of the interdental papillae (often covered in a greyish pseudomembrane). Usually associated with halitosis, swollen glands, and fever.

Question 11

What are the 3 different types of Necrotising Periodontal Disease?

Answer 11

1. Necrotising Gingivitis (previously called ANUG): affects the interdental papillae and gingiva. Common in YA smokers.
2. Necrotising Periodontitis: affects the periodontium and results in bone loss.
3. Necrotising stomatitis: affects the periodontium, bone, and soft tissues of the oral cavity.

Question 12

Which of the NPD’s will require specialist referral and management?

Answer 12

Necrotising periodontitis and necrotising stomatitis

Question 13

How to manage Necrotising Gingivitis.

Answer 13

1. Gentle debridement of plaque and necrotic debris (LA will be necessary b/c Pt will be in pain)
2. Local irrigation with 0.2% CHX MW or 3% hydrogen peroxide solution.
3. Antibiotic therapy
4. Analgesics
5. Advice to stop smoking

Question 14

What antibiotic therapy do you prescribe for Necrotising Gingivitis?

Answer 14

Metronidazole 400mg (oral) taken 12-hourly for 3-5 days.

Question 15

When would you review a Necrotising Gingivitis patient?

Answer 15

48 to 72 hours after the first debridement. Perform a periodontal exam and provide OHI.

Question 16

When would you refer a Necrotising Gingivitis case?

Answer 16

If the infection hasn’t responded to treatment within 2 weeks, refer to a specialist for management.

Question 17

How do you treat a periodontal abscess?

Answer 17

1. Drain the abscess (with LA) through the periodontal pocket beneath the swelling.
   - Alternatively (less commonly) you could also drain by incising through an incision in the external surface of the gingival swelling.
2. Remove calculus and plaque deposits via thorough debridement.
3. Irrigate the area with water, saline solution or LA solution.

Question 18

What are Peri-Implant Diseases?

Answer 18

Diseases caused by plaque accumulation around an osseointegrated dental implant.

Question 19

What’s the difference between Peri-Implant Mucositis and Peri-Implantitis?

Answer 19

PIM involves the non-destructive and reversible inflammation of the soft tissues (similar to gingivitis).

PI involves the destruction of the bone support of the implant and can lead to loss of the implant.