Periodontal Treatment 3

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