periodontal tx in GDP Flashcards
WHO non-communicable disease stance on periodontal disease
3.5 Billion people affected by oral disease.
1 billion of the population affected by severe periodontal disease.
Starts in adolescence and peaks around 55 years
Poor oral hygiene is a major behavioural risk factor for periodontal disease, together with common NCD risk factors such as tobacco use.
Severe periodontal disease is closely interlinked with major NCDs especially diabetes.
assess periodontal disease in practice
BPE - screening tool
signs of interdental recession - special investigations needed (radiographs)
* if need 6PPC, best to do before so can determine which radiographs are needed
bleeding and plaque accumulation alone =
inflammation
record what you see in notes and inform pt
risk factors assessment
- Ensure full history has been taken – looking for risk factors.
- Presenting complaint- any bleeding, mobility or sensitivity?
- Past dental history- any tooth loss due to previous periodontal disease?
- Past family history – any family members with periodontal disease?
- Full medical history- look for risk factors: diabetes, smoking, medication that may cause gingival overgrowth
periodontal emergencies
Periodontal abscess.
Necrotising periodontal diseases.
communicating perio dx to pt
inform them in terms they will understand and give them information to read at home
OHI
gingivitis
pt explanation
term used to describe red, swolledn and inflammed gums
caused by plaque - white, sticky material that forms on everybody’s teeth
if plaque not removed effectively or frequently enough then it can cause gum disease
with good tooth cleaning and help from professional gingivitis is reversible
but in some people who are more susceptible or if left untreated can lead to irreversible bone loss -> peridontitis
periodontitis
pt explanation
this involves the destruction of bone which is irreversible
gums seem to shrink and the teeth may appear longer and are more loose
this can have no symptoms until at an advanced stage
what to discuss with perio pt
tx available and how long it will take
risk factors and their impact on tx outcome
remind them that each pt will respond differently to tx
cost of tx
possible outcomes of tx and limitations
if referring - explain why
record all in notes
tx options for perio pt
STEP1
OHI - TIPPS
MPBS
disclosing tablets
ensure oral hygiene is improved prior to subgingival scaling
STEP2
provide subginigval PMPR to remove plaque/biofilm and other plaque retentive factors
advice on side effects of tx - sensitivity, recession, aesthetics, mobility
REASSESS
ask pt how they feel tx going - any qs
assess MPBS
at 8 weeks - review 6PPC
if pockets 4mm+ or still bleeding –> sign active disease
STEP3/4
if good response = supportive perio care with annual 6PPC review
if some perisitent pockets of 4mm or more and bleeding = retx or refer
if poor response due to plaque levels = discuss with pt, reinforce OHI, reassess 3monthly on pallative perio care
ask pt what they want and document in notes
check medhical hx and risk factors (at each visit)
STEP1
OHI - TIPPS
MPBS
disclosing tablets
supragingival scaling
ensure oral hygiene is improved prior to subgingival scaling
STEP2
provide subginigval PMPR to remove plaque/biofilm and other plaque retentive factors
advice on side effects of tx - sensitivity, recession, aesthetics, mobility
when to reassess
ask pt how they feel tx going - any qs
assess MPBS
at 8 weeks - review 6PPC
* if pockets 4mm+ or still bleeding –> sign active disease
STEP3/4
if good response = supportive perio care with annual 6PPC review (STEP4)
if some perisitent pockets of 4mm or more and bleeding = retx or refer (STEP3)
if poor response due to plaque levels = discuss with pt, reinforce OHI, reassess 3monthly on pallative perio care
ask pt what they want and document in notes
enaging pts
BSP S3 guidelines
> /=50% improvement in MPBS
or plaque levels =/<20% and bleeding levels =/<30%
