Periodontal treatment step 2 Flashcards
what should be done after step 1 of treatment in the next appointment? what does this involve?
re-evaluation
* check pt is engaging with carrying out good oral hygiene and modifying risk factors
* identify successes and failures in step 1
encourage positive changes and modify suboptimal outcomes
how would you know if a patient was engaged?
- <=30% plaque score
- <=35% bleeding score
- >=50% improvement in plaque and bleeding scores
- patient has met target outlined in self-care plan agreed with clinician
how would you know if a patient was not engaged?
- >30% plaque scores
- >35% bleeding scores
- <50% inprovement in plaque and bleeding scores
- patient states preference to a palliative approach to periodontal care
what would you do if the patient is non-engaged?
- repeat step 1
- find out why
- remotivate and reinforce preventative advice
- supra and subgingival PMPR of clinical crown
what would you do if the patient is engaged?
move them on to step 2
what is involved in step 2 of periodontal treatment?
- reinforce OH, risk factor control and behaviour change
- subgingival instrumentation
how would you reinforce OH, risk factor control and behaviour change?
- check pts plaque and bleeding scores (modified bleeding chart)
- show pt both charts and inform pt of changes
- highlight areas of further improvement - any problems, pt demonstrate how they are cleaning these areas, suggest improvements
- if risk factor control required, any changes been made or considered, reiterate benefits
what is full mouth debridement?
all sites with pockets greater than 3mm are instrumented either at one visit or two visits within 24 hours
what is full mouth disinfection?
all sites with pockets greater than 3mm are instrumented either at one or two visits within 24 hours and pockets are irrigated with 0.2% chlorhexidine and pt uses CHX spray and mouthwash for 1-2 weeks
what is full mouth disinfection with systemic antibiotics?
all sites with pockets greater than 3mm are instrumented either at one or two visits within 24 hours and pockets are irrigated with 0.2% chlorhexidine and pt uses CHX spray and mouthwash for 1-2 weeks and pt takes antbiotics for 7 days
how would you prepare for subgingival instrumentation in step 2 of periodontal treatment?
- identify if pt has BPE scores of 3 or 4
- check if the pt has radiographs to help visualise root anatomy and shape of pocket
- decide which sites you plan to complete at visit
- inform pt what you plan to do
what are the effects of supra and subgingival PMPR on the microflora?
- significantly reduces the levels and prevelance of pathogenic species (e.g. P.gingivalis)
- complete elimination of pathogenic species is unrealistic
what are the effects of supra and subgingival PMPR on the hard and soft tissues?
- decrease in gingival inflammation
- shrinkage of gingival tissues leads to recession
- increase in collagen fibres in the connective tissue beneath the pocket and formation of long junctional epithelial attachment
- results in decrease in pocket depth and increase in attachment level
- very little change in bone height at sites with horizontal bone loss
- vertical defects display some infil and gain in bone height
what is the effect of supragingival plaque control alone?
- decreased gingival inflammation
- limited effect on probing depth
- no change in attachment levels
- no alteration in subgingival microflora in deep pockets greater than 6mm
what is the effect of subgingival PMPR and supragingival plaque control?
- decreased gingival inflammation
- reduction in probing depth
- gain in probing attachment level
- changes in subgingival microflora
what is the effect of subgingival PMPR alone?
- initial reduction in inflammation and pocket depth
- pockets are re-colonised by bacteria from supragingival plaque
- disease recurs
what should you do after step 2 of periodontal treatment?
re-evaluate after 3 months
after re-evaluation after step 2, what should you do if the patient is unstable?
move on to step 3
after re-evaluation after step 2, what should you do if the patient is stable?
move on to step 4
what does step 3 of periodontal treatment include?
managing non-responding sites
* reinforce OH, risk factor control, behaviour change
* subgingival PMPR in moderate (4-5mm) residual pockets
* consider alternative causes for deep residual pockets (>6mm)
* consider referral for pocket management or regenerative surgery
what should you do once pockets are stable after step 3 of periodontal treatment?
move on to step 4
what does step 4 of periodontal treatment include?
maintenance
* supportive periodontal care strongly encouraged
* reinforce OH, risk factor control, behaviour change
* regualr targeted PMPR as required to limit tooth loss
* consider toothpaste and mouthwash to control gingival inflammation
* individually tailored intervals from 3-12 months
what does stage 4 of periodontal treatment aim to do?
- prevent recurrence of disease
- stabilise periodontal condition
- maintain optimum periodontal health
what should you do when a patient has consistent poor OH and refuses to engage?
if there is no reason to think that the OH will significantly improve, discharge the pt to their GDP for supportive care
what may treatment fail?
- inadequate plaque control - lack of compliance, lack of dexterity, inaequate explanation
- residual subgingival deposits - deep pockets, furcations, concavities, root grooves, inexperienced operator
- systemic risk factors - smoking and uncontrolled diabetes
