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1. periodontal disease finals > Periodontal disease- tx planning and therapy > Flashcards

Periodontal disease- tx planning and therapy Flashcards

1
Q

what types of scalers are there?

A

USS and Sonic scaler- both operate at high frequencies and use water to cool heated tip

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2
Q

what is the sonic scaler?

A
  • operates at 5-10kHz
  • CONNECTS TO AIR TURBINE (same as high speed handpiece)
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3
Q

what is the USS?

A
  • operates at 20kHz
  • high frequency
  • POWERED BY ELECTRICAL CURRENT
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4
Q

what are the types of USS?

A
  • magnetostrictive
  • piezoelectric
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5
Q

how does magentostrictive USS work?

A

ELECTRICAL ENERGY FLOWS THROUGH COIL OF WIRE IN HANDPIECE WHICH CAUSES RAPID EXPANSION AND CONTRACTIONS OF METAL STACKS WHICH causes vibrations
- use all sides of tip

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6
Q

how does piezoelectric USS work?

A

electrical energy is used to activate crystals within the handpiece which cause vibrations
- use 2 sides of tip

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7
Q

what are the modes of action for USS?

A

mechanical- movement of vibratory tip breaks deposits from the tooth surface

cavitational- vibratory tip causes minute air bubbles within water implode causing shock waves which break deposits from surface and bubbles release O2 which kills anaerobic bacteria

acoustic- water from vibratory tip flushes pocket and debris from the tooth surface and disrupts biofilm

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8
Q

what are the indications of using an USS?

A
  • supra scale
  • sub scale
  • RSD
  • cavitational effect only (NUG)
  • remove staining
  • REMOVE AMALGAM LEDGES
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9
Q

what are the contraindications of using USS?

A
  • dentine hypersensitivity- exposed dentine recession
  • anxious patients
  • IMPLANTS - CAN DAMAGE TITANIUM IMPLANT
  • pacemaker- high frequency may interfere with pacemaker
  • PORCELAIN CROWNS
  • DECALCIFICATION- CAN CAPITATE LESIONS- IRREVERSIBLE damage
  • patients with contagious diseases e.g tb
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10
Q

what are the properties of calculus?

A
  • sterile
  • crystalline structure
  • inert
  • unmineralised layer of plaque on top
  • porous- can withhold bacterial endotoxins
  • supra and sub
  • impedes normal OH
  • must be removed by professional
  • prone to staining- diet or smoking
  • rough surface
  • local risk factor for periodontitis
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11
Q

advantages of USS

A
  • fine tip- can be used in furcations
  • efficient
  • use supra and sub
  • USED IN NARROW POCKETS
  • cavitational effect
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12
Q

disadvantages of USS

A
  • CONTRAINDICATIONS
  • MAY NOT TOLERATE WATER/SUCTION
  • CAN DAMAGE TOOTH IF NOT USED CORRECTLY
  • EXPENSIVE
  • CREATES AEROSOL (INFECTION)
  • CAN DE-CEMENT OR DE-BOND RESTORATIONS
  • WITHOUT COOLANT CAN CAUSE THERMAL DAMAGE
  • NURSE REQUIRED
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13
Q

where is calculus most common?

A

near salivary gland openings
- sublingual gland- lower anteriors lingual
- upper molars- parotid gland opening

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14
Q

what is the difference between supra and sub gingival calculus?

A

supra- hard but brittle, yellow/brown, detected by BPE probe and 3in 1- direct vision

sub- very hard- attached to root surface, hard to detect use bpe probe and 3 in 1 if loose pocket- green black colour- indirect vision

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15
Q

why is it necessary to remove calculus?

A

does not cause disease but is a risk factor for periodontal disease as it is:

  • rough plaque retentive factor
  • SURPRAGINGIVAL IMPEDES OH
  • can absorb bacterial endotoxins as porous
  • needed to render root surface biologically compatible with healing and allows new epithelial attachment to previously pathogenically altered root surface and formation of LJE.
  • UNDERESTIMATED PPD’S- MASK DISEASE
  • sub gingival calculus has layer of unmineralised plaque on surface
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16
Q

define a true pocket

A
  • LOA- JE migrates apically
  • ulceration at base of pocket
  • DISEASED ROOT SURFACE- CALCULUS WITH LAYER OF SUB GINGIVAL PLAQUE
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17
Q

what is the aim of RSD?

A

render root surface biologically compatible with healing to allow new epithelial attachment and formation of LJE to previously pathologically altered root surface. By

  • reduce overall no of microorganisms
  • reducing proportion of GNAB
  • leaving residual gram + aerobic bacteria
  • remove subgingival calculus
  • remove sub gingival plaque
  • REMOVE BACTERIAL ENDOTOXINS
  • remove necrotic surface cementum
  • disrupt pathogenic bacteria in sub gingival biofilm
  • reduction in plaque thickness- changes environment- more 02 available
18
Q

why use LA for RSD?

A

soft tissues and root dentine is highly innervated- can cause pain

19
Q

what must you warn patients of before beginning treatment?

A
  • post op sensitivity
  • gingival shrinkage - periodontal tissues rarely regenerate and if they do it is minor
20
Q

what is full mouth disinfection? and why is it carried out

A

to remove as much bacteria as possible within 24-48hrs to minimise risk of re-infection by adjacent teeth

  • f/m RSD
  • OHI
  • chemical adjunct- chlorahmexidine or antibiotic though little evidence of effectiveness
  • only done on small number of those who have not responded to initial treatment.
21
Q

what evidence is there for RSD on shallow pockets?

A
  • little improvement
  • may lose further attachment due to trauma
22
Q

what evidence is there for pockets 4-6mm and >6mm?

A

4-6mm
- proven effective with average ppd decreasing by 1mm
- gain attachment of 0.5mm

> 6mm
- proven effective with average ppd decreasing by 2mm
- gain attachment of 1mm

23
Q

how do you carry out RSD?

A
  • reassess pockets for ppd and bop
  • administer LA
  • explore root surface with probe
  • carry out pre USS to remove bulk of sub gingival calculus
  • re-explore RS with probe
  • use hand instruments to remove residual calculus (small deposits remaining will still Redner RS biologically compatible with healing)
  • re-check with probe and repeat if necessary
  • flush debris and bacteria from pocket with post USS
  • POI
  • leave for 10-12 weeks
24
Q

what are the 5 phases of treatment planning?

A
  • initial clinical examination and pain relief
  • cause related non-surgical therapy
  • reassessment
  • definitive treatment
  • maintenance or supportive therapy
25
Q

explain phase 1 of treatment planning

A
  • relief of pain= priority
  • full initial exam including radiographs to form diagnosis and treatment plan.
  • includes P+B charts, 6ppcs, radiographs
26
Q

explain phase 2 of treatment planning

A

based on initial exam and radiographic evidence: do

  • clinical checks - this can include checking caries, overhangs, deficiencies, sensitivity testing ( if furcation involvement as accessory canals, PA pathology or extensive bone loss- hopeless prognosis)
  • discussion- discuss findings, diagnosis, tx options, risk factors with patient- gain consent
  • advice- give tailored OHI (TIPPS), diet advice, risk factors advice e.g smoking cessation, advice on modifiable risk factors.
  • begin treatment- this can include extractions of teeth with hopeless prognosis, PMPR supra, PMPR sub gingival and RSD to remove calculus , remove overhangs, poorly fitted dentures, restore carious teeth.
27
Q

what is phase 3 of treatment planning?

A

reassessment

  • P+B charts
  • 6ppcs
  • assess OH and pt cooperation
  • update diagnosis (periodontal stability)
  • assess whether patient is engaging or non-engaging
28
Q

what is an engaging pt?

A
  • > 50% improvement in plaque and bleeding scores
  • plaque levels <20% and bleeding levels <30%
29
Q

what is a non-engaging patient?

A
  • <50% improvement in plaque and bleeding scores
  • > 20% plaque levels and >30% bleeding levels
  • expresses that they would prefer palliative approach
30
Q

what is phase 5?

A
  • when patient is stable after treatment- successful tx
  • supportive therapy
  • tailored OHI and simple PMPR at stable sites if necessary
  • reinforce RF modification
31
Q

when should maintenance patient be recalled?

A

initially- more frequent to ensure stability is demonstrated over period of time and OH is very good

  • IS INDIVIDUALISED

Low susceptibility and low RF- 6m-1yr

high susceptibility and high RF- 3 months

-when not stable- active tx

32
Q

what are the signs of treatment failure?

A
  • pockets >5mm
  • pockets >4mm with BOP
  • discomfort
  • inflammation
  • further LOA
  • poor OH
33
Q

why may an individual not respond to treatment?

A

most common=poor OH

  • poor communication- improper technique advised, tepes not resized
  • misunderstanding- not practicing in chair as part of TIPPS
  • underlying systemic disease- uncontrolled or undiagnosed type 1 diabetes, CVD
  • immunocompromised
  • high susceptibility to periodontal disease i.e genetics
    inadequate debridement due to:
  • tenacious calculus
  • furcation involvement
  • instruments not sharpened
  • poor operator skills
  • deep, torturous pockets
  • incorrect diagnosis- may be endodontic problem
  • complex root morphology
  • smoker
  • taking medications that interfere with good OH due to gingival overgrowth- cyclosporine, amlodipine, phenytoin, amitriptyline
  • poor manual dexterity (palliative??)
  • teeth had poor prognosis (severe bone loss)
34
Q

what should be done if non responding initially?

A
  • address cause and pt cooperation
  • repeat tx
35
Q

what should be done if non responding and non engaging?

A
  • if RF not modified (can’t/won’t) and unable to achieve stability
  • palliative care
36
Q

what is palliative care?

A
  • must discuss with patient
  • simple PMPR every 3 months
  • if teeth become excessively mobile or abscessed most likely XLA- must be discussed prior to palliative care
  • slow disease and keep patient comfortable and maintaining function
  • can be moved to active treatment again if OH/RF good
37
Q

if patient has good OH, tx has been repeated and still poor response, what should be done?

A

phase 4- definitive tx
- referral to consultant
- chemical adjunct
- periodontal surgeries
- endodontic tx

38
Q

when should you refer?

A
  • complex root morphology
  • BOP and SUP despite good OH
  • complex med hx- bleeding disorders
  • high susceptibility

must have good OH and modified RF and have had at least 1 course of tx

39
Q

name the types pf periodontal surgery that may be carried out?

A
  • flap surgery- open flap of gingivae for thorough clean or if furcation involvement
  • gingival graft
  • bone graft
  • guided tissue regeneration
40
Q

what is guided tissue regeneration?

A

most effective formation of new attachment as epithelial cells regenerate faster than bone/pdl cells- guided tissue regeneration gives bone/pdl cells time to regenerate

  • surgically open flap of gingivae
  • thoroughly clean root surface RSD
  • place nonstick membrane to hold epithelium and CT back (gortex or teflon) to allow pdl/bone cells to regenerate
  • suture tissue
  • leave for 3-6 months
  • forms stable new attachment
41
Q

chemical adjuncts

A

1. periodontal disease finals (11 decks)

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