Periodontal treatment step 1 Flashcards
ILO 1.6d: have knowledge of how to develop a treatment plan for patients with gingivitis and early periodontitis
what patients should recieve step 1 of periodontal treatment?
- periodontal health
- gingivitis
- periodontitis
what is involved in periodontal step 1 in the BSP guidelines?
- explain the disease, risk factors and treatment alternatives
- explain importance of OHI
- reduce risk factors, remove plaque retentive factors
- provide individually tailored OH advice incl. PMPR
- select a recall period
how would you explain the disease? what could you use to help?
make the explanation relevant to the individual
* pictures and diagrams
* radiographs
* disclose plaque
* show sites of disease with mirror
* see and modify toothbrush technique
* check the patient understands
what are risk factors associated with gum disease?
- diabetes
- smoking
- stress
- diet low in some types of nutrients
- obesity
- certain medications
- family history of losing teeth early
- lack of exercise
what should you do if a modifiable risk factor is identified?
- patient should be informed about the effect of the risk factor
- and benefits of eliminating the risk factor
- explain the risk factors - if modifiable, has pt considered modifications
how should you explain treatment options?
- explain to pt. their current plaque score
- explain why OHI is important
- highlight their target plaque score
- explain how many visits are likely needed
- explain the outcomes the pt may expect
- explain what will happen at each visit
what are the benefits of treatment?
- keep teeth for longer
- gums not bleeding or being sore
- fresher feeling mouth
- reduced risk of developing medical conditions (heart disease, diabetes)
what are the risks/side effects of treatment?
- short term discomfort after treatment once numbness wears off
- sensitivity to hot/cold and sweet foods or drinks
- gum recession and lengthening of teeth
- increased risk to root decay
- noticing gaps between teeth
- temporary increase in the mobility of teeth - should improve after a few weeks
what are examples of plaque retentive factors?
- overhangs on restorations
- calculus
- crown or bridgework
- ill-fitting partial dentures
- mal-positioned teeth
how could you reduce risk factors?
- diabetes control - contact doctor
- smoking - brief intervention, smoking cessation referral
how would you provide individually tailored OHI advice?
- ask pt to bring current OH aids
- ask how often they are used and replaced
- discuss toothbrushes, dental floss/tape, interdental brushes/sticks, single tufted brushes
- ask pt to demonstrate toothbrushing technique and modify using face mirror
- use disclosing tablets to identify areas pt is missing
- carry out modified plaque and bleeding scores
what advice can you give about toothbrushing?
- teach the modified Bass technique
- angle toothbrush at 45 degrees
- brush with short back and forth motions
- use a medium soft brush
- small or medium head of brush
- wait 30 mins - 1 hour after eating
what are single tufted brushed used for?
- cleaning malaligned teeth
- clean distal surfaces of last molar teeth
- clean teeth affected by localised gingival recession
when would you prescribe chlorhexidine 0.2% mouthwash to a patient?
when pain limits mechanical plaque removal
why is chlorhexidine an effective mouthwash? what are some of the disadvantages with chlorhexidine?
- adsorbs to oral surfaces, especially enamel
- long substantivity
- fairly broad antimicrobial spectrum
- reduces gingival bleeding
however, can interfere with taste and discolour teeth
what could mouthwash with alcohol cause?
- dry mouth
- oral cancer
what are the steps to changing a patient’s behaviour to OH?
- explain and coach good OHI
- obtain consent to demonstrate plaque removal in pts mouth and tailor individually
- ask patient to clean their teeth and modify technique if necessary
- make a plan with the pt, set goals and help them self-monitor - ensure the pt understands the time commitment needed on a daily basis (20 mins) to achieve high levels of plaque control
what other treatment should be given in combination with oral hygiene and risk factor control? what does it do?
supra and subgingival PMPR
* supragingival intrumentation facilitates patient’s plaque control
* at following visit, substantial resolution of inflammation should be apparent if pt has good plaque control
