Prevention in Periodontics Flashcards
What is the prevalence of periodontitis?
11.2%
What are the basics of prevention in periodontitis?
Prevention of gingivitis, early detection of periodontitis using BPE, managing risk factors that increase risk of developing periodontitis/complicate its successful care, and supportive periodontal therapy
What will diagnosis of periodontitis dictate?
Patient risks and needs
What can gingivitis progress to?
Periodontitis (stable, non-stable, in remission)
What is required with professional mechanical plaque removal?
Education and behaviour modification
What is the first step in treatment of periodontitis?
Patient motivation, supragingival plaque control, and risk factor control
What is the second step in treatment of periodontitis?
Cause related therapy, control subgingival biofilm, and calculus
What is the third step in treatment of periodontitis?
Treatment of areas non-responding to second step (surgery)
What is the fourth step in treatment of periodontitis?
Supportive periodontal care: maintain periodontal stability
What are the existing motives for motivation?
Desire to be clean, to conform to social norms, be socially acceptable, avoid tooth loss, and avoid dentures
What does TIPPS stand for?
TALK, INSTRUCT, PRACTICE, PLAN, SUPPORT
What is TALK?
TALK with patient about causes of periodontal disease and discuss any barriers to effective plaque removal
What is INSTRUCT?
INSTRUCT patient on best ways to perform effective plaque removal
What is PRACTICE?
PRACTICE cleaning his/her teeth and to use interdental cleaning aids whilst in dental surgery
What is PLAN?
PLAN which specifies how patient will incorporate oral hygiene into daily life
What is SUPPORT?
SUPPORT patient by following up at subsequent visits
What are the recommendations from The Good Practitioners Guide to Periodontology?
Use open questions, listen and give information in small doses, use reflective listening, use a guiding approach, maintain an adult to adult conversation, sit patient upright, and consider information leaflets
What is the grade of patient motivation?
Grade A
What is the grade of motivational interviewing and cognitive behavioural therapy?
No evidence for
What is the optimal plaque score?
Below 15%
What is the optimal bleeding score?
Below 10%
What is the optional probing depth?
Less than 4mm
What is the grade of OHI?
Grade A
What is recommended as a primary means of reducing plaque and gingivitis?
Manual/power tooth brushing
What should be professionally taught to patients?
Inter-dental cleaning, preferably with interdental brushes
What is the average plaque reduction with a manual toothbrush?
42%
What is the average plaque reduction with an electric toothbrush?
46%
What are the recommendations from 11th European Workshop (2015)?
Brush twice a day for 2 minutes
Who is 2 minutes of brushing likely to be insufficient for?
Periodontitis patients
How often should patients use interdental cleaning?
Once every 24 hours
What are the different types of interdental cleaning?
Flossing, interdental brushes, woodsticks, and oral irrigators
What are the most effective devices to remove interdental plaque?
Inter-dental brushes
What is needed to make flossing effort worthwhile?
Proper instruction, sufficient motivation of patient, and a high level of dexterity
What are the benefits of single tufted brushes?
BoP eliminated, PPD reduced by mean of 1.8mm, and periopathogens reduced 14% to 0.8%
What are the other constituents of mouthwashes?
Solubilisers, flavourings, preservatives, alcohol, water, colourings, SLS, foaming agents etc.
What are co-adjunctive chemicals?
Mouthwashes
What are the 3 main categories of mouthwash?
Those for use against halitosis (cosmetic), those advocated to reduce plaque bacteria (and hence adjuncts against periodontal diseases) (chemo-therapeutic), and those advocated for prevention and repair of dental caries (chemo-therapeutic)
What mouthwashes are advocated to reduce plaque bacteria?
M/Ws containing chlorhexidine gluconate (e.g., Corsodyl), essential oils (e.g., Listerine), and cetylpyridinium chloride/CPC (a quaternary ammonium compound) (e.g., Eludril, Plax)
What mouthwashes are advocated for prevention and repair of dental caries?
M/Ws containing fluoride
What do some mouthwashes have?
Both anti-plaque and remineralisation active ingredients
What is chlorhexidine generally regearded as?
An ‘antiseptic’ rather than an antimicrobial
What are the properties of chlorhexidine?
Bacteriostatic (inhibits growth) and bactericidal properties (kills bacteria)
What type of molecule is chlorhexidine?
A positively charged molecule that binds to negatively charged sites on cell wall
What does chlorhexidine do to the bacterial cell wall?
It destabilizes cell wall and interferes with osmosis, ultimately leading to lysis
What is the mode of action of chlorhexidine in topical applications?
Shown to have unique ability to bind to proteins present in human tissues such as skin and mucous membranes with limited systemic/bodily absorption
What is the substantivity of chlorhexidine?
Released slowly leading to prolonged activity
What does chlorhexidine have cidal actions againt?
Fungi (Candida) so has uses in treatment and prevention of denture induced candidosis
What is the concentration of chlorhexidine original?
0.2%
What is the concentration of chlorhexidine daily?
0.06%
How long should you use chlorhexidine original for?
2 weeks
What are the adverse effects of chlorhexidine?
Taste disturbance/alteration, effects on oral mucosa including soreness, irritation, mild desquamation and mucosal ulceration/erosions and a general burning sensation/a burning tongue/both
What are the four essential oils?
Eucalyptol, thymol, methyl salicylate and menthol
What are essential oils?
Antibacterial antiplaque agents, and have ability to penetrate biofilm
What are some of the proposed methods of action of essential oils?
Disruption of cell membranes, perturbation of proton pumps, and coagulation of cell content
What does the Listerine range also contain?
Fluoride (anywhere from 100 to 450 ppm)
What do essential oil containing mouthwashes kill?
A broad spectrum of planktonic bacteria and penetrate biofilm, allowing action upon sessile (within matrix) bacteria
What is the optimum concentration of NaF in fluoride containing mouthwashes?
0.05% (or approx. 225ppm)
How is triclosan thought to primarily function?
By inhibiting fatty acid synthesis (in bacterial rather than human cells)
What is triclosan bacteriostatic in?
Concentrations used in toothpaste formulations
What is triclosan biocidal in?
Higher concentrations
What is the definition of biocidal?
Destructive to life
Why has triclosan been phased out?
Not environmentally friendly
What are the risk factors of periodontitis?
Genetics, stress, smoking, drugs, diabetes, and pregnancy
How should smoking cessation be given?
ASK, ADVISE, ACT
What is ASK?
Are you a smoker?
What is ADVISE?
On benefits of stopping and best methods
What is ACT?
Motivate and refer
