Periodontal treatment

Question 1

What is included in Step 1 for treatment of Periodontal disease?

Answer 1

• Education/ explanation
• OHI and its importance
• Risk factor control inc removal of plaque retentive factors, smoking cessation and diabetes control
• PMPR for all accessible plaque and calculus
• Arrange review

Question 2

Step 2 for treatment of periodontal disease?

Answer 2

• See if engaging or non engaging pt
• If non engaging return to step 1 and repeat
• If engaging
• Reinforce OHI , risk factor control and behaviour change
• Subgingival instrumentation
• Re-evaluate in 3 months
• Go to step 3 if unstable
• Go to step 4 if stable

Question 3

Step 3

Answer 3

• Manage non-responding sites
• Reinforce OHI, risk factor control and behaviour change
• Pockets of 4-5mm re perform subgingival instrumentation
• Deep pockets of >6mm consider for referral for pocket management or regenerative surgery
• If refer not poss then subgingival instrumentation then step 4

Question 4

Step 4

Answer 4

• Maintenance
• Supportive periodontal care strongly encouraged
• Reinforce OHI, risk factor control , behaviour change
• Regular targeted PMPR as required to limit tooth loss
• Consider evidence based mouthwash/ toothpaste to control gingival inflammation
• Individually tailored intervals from 3-12months

Question 5

What defines an engaging patient?

Answer 5

• Improvement of OHI by >=50% imporvement in plaque or bleeding scores
• OR Plaque levels <=20% and bleeding levels <=30%

Question 6

What is necrotising gingivitis?

Answer 6

• Severe form of gum disease that causes inflammation , bleeding and necrosis of gums
• Only gingival tissues affected
• Characterised by painful, bleeding gums , ulceration and necrosis of interdental papilla (punched out appearance)

Question 7

What is necrotising peridontitis?

Answer 7

• when the necrosis progresses into the periodontal ligament and the alveolar bone, leading to attachment loss.

Question 8

What is necrotising stomatitis?

Answer 8

• When the necrosis progresses to deeper tissues beyond the mucogingival line, including the lip or cheek mucosa, the tongue, etc.

Question 9

Risk factors of NPD?

Answer 9

• Stress
• Sleep deprivation
• Poor oral hygiene
• Smoking
• Immunosuppression like HIV or leukaemia
• Malnutrition

Question 10

Treatment of NPD/

Answer 10

• Superficial debridement to remove soft and mineralised deposits daily for 2-4 days
• Mechanical OH measures limited as brushing daily may impair healing of wounds and induce pain
• Chlorhexidine mouthwash 0.2% twice daily
• If systemic response occurs prescribe Metronidazole 400mg TID 3 days
• Once improved treat pre-existing condition that will most likely be chronic gingivitis or periodontitis
• Also emphasise, diet, smoking cessation, adequate sleep, reduce stress