periodontal treatment Flashcards
what are the 5 phases of treatment planning?
1- pain relief and initial exam
2- cause-related therapy
3- re-evaluation
4- definitive tx plan
5- maintainance
what is involved in phase 1?
- always begin with relief of acute pain
- full exam including history, clinical exam, special investigations, diagnosis
- formation of tx plan and gaurded prognosis
what is involved with phase 2? INDIVIDUALISED
identify and control risk factors and begin active tx
hygiene phase therapy- OHI and smoking cessation
NSPT- instrumentation related- removal of plaque retentive factors, supra/sub ging PMPR, tx of furcations
what is phase 3?
re-evaluation in 10-12 weeks:
- look at the tissues response to tx
- look at pt cooperation and motivation
- assess their periodontal status i.e stable, partly responsive or non-responsive, and decide whether they should move to phase 4, phase 5 or palliative care.
what is phase 4?
definitive treatment - if patients are non responsive or partly responsive and have good OH- 1st line of treatment would be repeated treatment. If more complex e.g FI or complex root morphology or complex med hx- pts may be referred for chemical adjuncts and periodontal surgery.
what is phase 5- maintenance phase?
if patients achieve stability- they are still a periodontitis patient.
- they can move onto maintaince recall system where they will get PMPR as and when required.
- initially may require more frequent appts to demonstrate stability over time and ensure good OH.
- this is an individualised recall system based on things such as susceptibility, risk factors, pocket depths, initial tx required to reach stability.
- if they become unstable which could be due to poorer OH or taking up smoking- can be moved back to phase 4 for further treatment.
what is palliative care?
- when patients are unable to achieve stability
- patients will be given simple scale and polish every 2-3 months
- aim is to keep patient comfortable with a functioning dentition
- must be informed of palliative care
- if OH improves and potential to achieve stability can be moved off of palliative care.
- must be informed that teeth of poor prognosis or causing any issues will likely be xla.
what are some reasons that palliative care may be the only option?
those who cant and those who wont
- poor OH
- poor compliance
- poor manual dexterity
- immunocompromised
- complex medical history
what are the types of uss?
magentostrictive and piezoelectric
how does magentostrictive uss work?
electrical current is passed through a coil of wire within the handpeice which causes rapid expansion and contraction of metal stacks within the handpeice causing vibrations
- can use all sides
- tip vibrates in back and forth pattern
how does peizoelectric uss work?
electrical energy is used to acitivate crystals within the handpiece which cause vibrations
- can you 2 sides
- tip vibrates in eliptical pattern
what are the modes of action of USS?
mechanical- movement of the vibratory working tip breaks deposits from the tooth surface and disrupts the biofilm
cavitational- vibrations of working tip cause the implosion of bubbles which cause shock waves which break deposits from the tooth surface and disrupt the biofilm- implosion of bubbles also leads to release of oxygen which kills GNAB
accoustic mode of action- flushes debris from the pocket
indications of USS
- supragingival pmpr
- subgingival pmpr
- stain removal
- removal of amalgam ledge
- cavitational effect only for things such as ng
- pre/post RSD
- FI/narrow pockets
contraindications of USS
- implants
- dentine hypersensitivity
- anxiety
- ceramic crowns
- contagious respiratory disease
- demineralised areas
what is the main aim of RSD?
render the root surface biologically compatible with healing
