Preventive Procedures - Outcome 3

Question 1

Complete Review of Medical and Dental History

Answer 1

It’s crucial to thoroughly review and update both the medical and dental history of a patient at every visit. This ensures that any new findings or changes are noted and considered.

Question 2

Medical History and Dental Probing

Answer 2

Before performing any oral examination involving periodontal probing, it is essential to review the patient’s medical history. This is because probing involves manipulating the soft tissues around the teeth, and it may not be safe until it is determined if antibiotic premedication is necessary.

Question 3

Premedication Considerations

Answer 3

Transient Bacteremia: During dental probing, temporary bacteria in the bloodstream can occur. For patients with certain heart conditions, joint replacements, or weakened immune systems, this can be risky.

Consultation: It may be necessary to consult with the supervising dentist and dental hygienist to assess the risk and decide if premedication is required.

Question 4

Importance of Medical History

Answer 4

Pre-medication Needs: Alert the dental team if a patient requires antibiotics before treatment.

Treatment Complications: Identifies any medical conditions or medications that might complicate or affect dental treatment.

Medical Emergencies: Helps in planning for potential medical emergencies.

Special Needs: Highlights any special treatment requirements.

Question 5

Systemic Diseases and Periodontal Health

Answer 5

The medical history helps evaluate if any systemic diseases could impact periodontal health. Conversely, periodontal disease can sometimes indicate underlying systemic conditions.

Question 6

Can Dental Assistants perform dental probing?

Answer 6

In Alberta, dental probing is a restricted activity for dental assistants under the Health Professions Act. Only dental assistants who have completed their PDM module and work under the supervision of an authorized dentist, dental hygienist, or denturist can perform probing

Question 7

Periodontal Attachment System

Answer 7

This system is a group of structures (the periodontium) that work together to attach the teeth to the skull. These structures include:

Epithelial Attachment (Junctional Epithelium)
Periodontal Ligament Fibers
Gingiva
Sulcus
Cementum
Alveolar Bone

Question 8

Healthy Periodontium

Answer 8

In a healthy periodontium, the tooth is surrounded by the gingival sulcus. The junctional epithelium (JE) attaches to the tooth near the cemento-enamel junction (CEJ) and forms the base of the sulcus. The depth of a healthy sulcus ranges from 1–3 mm.

Question 9

Periodontal Pocket

Answer 9

A periodontal pocket occurs when the gingival sulcus deepens due to periodontal disease. In this case, the junctional epithelium attaches to the tooth root below the CEJ, resulting from the destruction of the alveolar bone and periodontal ligament fibers that support the tooth.

Question 10

Measuring Pockets

Answer 10

A pocket is essentially a diseased sulcus. To assess and measure sulcus and pocket depths, a calibrated periodontal probe is used. The measurement is taken from the base of the pocket (or diseased sulcus) to the gingival margin.

Question 11

Complete Measurement

Answer 11

Since the pocket or sulcus extends around the entire circumference of the tooth, measurements must be taken all around the tooth. Probing depths can vary between different areas of the same tooth

Question 12

What are Dental Probes?

Answer 12

Dental probes are thin, slender instruments with a calibrated tip that allows for precise measurement. They often have a series of markings or bands along their length to measure the depth of the gum pockets around the teeth.

Question 13

Why are Dental Probes used?

Answer 13

Measuring Pocket Depths:
-Purpose: To measure the depth of the space (sulcus or pocket) between the gum and the tooth.
-Importance: Helps determine if there is gum disease, as deeper pockets can indicate periodontal issues.

Assessing Gum Health:
-Purpose: To evaluate the health of the gums and detect signs of inflammation or infection.
-Importance: Early detection of gum disease can prevent further damage and tooth loss.

Identifying Periodontal Disease:
-Purpose: To help diagnose periodontal disease by measuring changes in gum tissue and bone levels.
-Importance: Accurate diagnosis allows for appropriate treatment planning.

Monitoring Treatment Progress:
-Purpose: To track the effectiveness of periodontal treatments and observe improvements or worsening conditions.
-Importance: Ensures that treatments are working and adjusts care plans as needed.

Detecting Gum Recession:
-Purpose: To measure the amount of gum recession from the tooth’s surface.
-Importance: Helps in understanding the extent of gum damage and planning corrective treatments.

Question 14

Probe Depth

Answer 14

A probe depth measures how deep a gingival sulcus or periodontal pocket is. To find this, use a calibrated periodontal probe to measure the distance from the gingival margin (where the gum meets the tooth) to the base of the sulcus or pocket.

Question 15

Measurement sites for Probe Depth

Answer 15

Six Sites per Tooth: Measure probing depths at six specific sites around each tooth

Mesio-facial: The front part of the tooth closest to the middle of the mouth.
Mid-facial: The middle part of the tooth facing the cheek.
Disto-facial: The back part of the tooth facing the cheek.
Mesio-lingual: The front part of the tooth closest to the tongue.
Mid-lingual: The middle part of the tooth facing the tongue.
Disto-lingual: The back part of the tooth facing the tongue.

Question 16

One Reading per site - for probe depth

Answer 16

Record only one depth measurement per site. If there are variations in depth within a site, use the deepest measurement.

Question 17

Full Millimeter Measurements

Answer 17

Record measurements to the nearest full millimeter. For instance, if you measure 3.5 mm, record it as 4 mm.

Question 18

How to read the probe

Answer 18

Measure from the gingival margin to the base of the pocket. Count the millimeters visible on the probe above the gingival margin. Subtract this number from the total millimeters marked on the probe.
If the gingival margin is between two probe markings, use the higher mark for your reading.

Question 19

Documentation of Probe Depth

Answer 19

The measurements are recorded on a periodontal chart, which becomes a permanent and legal part of the patient’s record.

Question 20

What is a Dental Implant?

Answer 20

A dental implant is an artificial device surgically placed into the jawbone to:

Replace a missing tooth, or
Support a prosthetic denture.
As a dental assistant, it’s important to have specialized knowledge and skills for probing dental implants.

Question 21

Basic Implant Anatomy

Answer 21

Implant Fixture: The part of the implant inserted into the bone.

Abutment Post: A titanium post that sticks out of the gum and supports the prosthetic device (like a crown, bridge, or denture).

Question 22

Material and Probing - for dental implants

Answer 22

Titanium: Used because it’s biocompatible and doesn’t conduct heat or electricity well. However, it scratches easily.

Probing Tools: Traditional metal probes can damage titanium implants, so plastic probes are preferred for safety.

Question 23

Why Probe Dental Implants?

Answer 23

Plaque and Tissues: Just like around natural teeth, plaque can build up around implants. The surrounding tissues react to plaque toxins similarly to natural teeth, potentially leading to pocket formation

Question 24

Debate on Probing Implants

Answer 24

Probing Risks: Some believe that probing can damage the implant site or introduce bacteria into the bone
Safety of Probing: Others argue that probing is safe and doesn’t harm the implant’s integrity

Question 25

Best Practices for Dental Probing Implants

Answer 25

Consultation: Always discuss implant probing with the supervising dentist or dental hygienist before proceeding.
Establish Baseline: Measure and record initial probing depths after implant placement to track changes over time
Healthy Depths: Probing depths of 2-4 mm are generally considered healthy. Increases may indicate peri-implant disease
Use Light Force: Avoid heavy probing to prevent damage and infection
Avoid Cross-Contamination: Use a new plastic probe or dip the probe in a 0.12% chlorhexidine solution for each implant to prevent pathogen transfer

Question 26

Overview of Periodontal Screening and Recording (PSR)

Answer 26

In 1995, the Canadian Dental Association and the Canadian Academy of Periodontology, with corporate support from Procter & Gamble Inc., introduced Periodontal Screening and Recording (PSR) to Canadian dentistry. This system offers a straightforward and efficient method for assessing periodontal health and determining if a more detailed examination is necessary.

Question 27

Purpose of PSR

Answer 27

Assess Periodontal Health: PSR helps determine the periodontal health status of patients.

Determine Further Evaluation: This indicates whether a more comprehensive periodontal examination is needed.

Question 28

Benefits of PSR

Answer 28

Time Efficiency: Saves time by replacing a full-mouth periodontal exam with fewer measurements in patients with good periodontal health. Instead of 192 potential measurements, only six scores are recorded.

Simplified Examination: Useful for dental practitioners who face time constraints. Dental assistants can conduct the PSR and report to the dentist if further assessment is needed.

Patient Education: Acts as an educational tool to increase patient awareness and motivation for periodontal care.

Question 29

Limitations of PSR

Answer 29

Age Restriction: Primarily designed for adults aged 18 and older, with limited application for children and adolescents.
Not a Replacement: PSR is a screening tool, not a substitute for a comprehensive periodontal examination. It indicates when further examination is required.

Question 30

PSR Scoring System

Answer 30

PSR involves measuring probing depths at six sites per tooth, divided into six sextants:

Sites Measured:
Mesio-facial
Mid-facial
Disto-facial
Mesio-lingual
Mid-lingual
Disto-lingual

Question 31

Scoring and Intepretation

Answer 31

Code 0: The colored area of the probe is fully visible; no calculus or bleeding.
Code 1: The colored area is fully visible; bleeding after gentle probing.
Code 2: The colored area is fully visible; calculus or defective margins present.
Code 3: The colored area is partially visible; potential issues may be present.
Code 4: The colored area is not visible; probing depth exceeds 5.5 mm.
*Code : Added if abnormalities like furcation involvement, mobility, mucogingival problems, or significant recession are present.
Code X: Used if there are no teeth in the sextant.

Question 32

Sextant Division for PSR

Answer 32

The mouth is divided into six sextants, each evaluated and scored individually. The following PSR codes are used

Question 33

Procedure for Measuring and Recording

Answer 33

Probing Technique: Use a PSR probe with color-coded markings at 3.5, 5.5, 8.5, and 11.5 mm. The probe’s 0.5 mm ball tip helps detect calculus and irregularities while minimizing measurement errors.
Recording: Each sextant is scored with one code, and the results are documented on a PSR chart. If no teeth are present, mark with an X.

Question 34

Interpretation of Codes & Follow up

Answer 34

Stable Periodontal Health: If PSR scores indicate no significant concerns, the patient can continue regular care with the general dentist or dental hygienist.
High PSR Scores: Scores indicating potential periodontal problems (two sextants with a score of 3 or one with a score of 4) may require a comprehensive periodontal examination and treatment.
Re-evaluation: For patients undergoing conservative care, a follow-up reassessment is essential to evaluate progress and adjust the treatment plan as needed.

Question 35

Referral to Specialists

Answer 35

When necessary, patients may be referred to a periodontist for:

Prescription Surgery: Treatment based on general dentist or hygienist requests, with ongoing dialogue between practitioners.
Well-Controlled Case: Consultation to ensure periodontal control and decide on care responsibilities.
Moderately Well Controlled Case: Active treatment and stabilization, with subsequent collaboration on therapy schedules.
Difficult to Control Case: Management may be handed over to a periodontist, while the general dentist continues to address other dental concerns.

Question 36

Impact of PSR on Dental Practice

Answer 36

Efficient Monitoring: Simplifies recording and tracking of periodontal health.

Reduced Treatment Needs: Identifies patients with minimal periodontal issues, reducing the need for extensive treatment.

Educational Tool: Helps in educating patients about their periodontal health and motivating self-care.

Specialist Referral: Facilitates early identification of patients requiring specialist care.

By understanding and using the PSR system, dental professionals can enhance patient care and streamline periodontal evaluations.

Question 37

What is the leading cause of tooth loss in adults?

Answer 37

Periodontal diseases are the leading cause of tooth loss in adults

Question 38

Name the structures of the periodontium.

Answer 38

The structures of the periodontium are gingivae, epithelial attachment, sulcus, periodontal ligaments,
cementum, and alveolar bone.

Question 39

Name 2 types of calculus

Answer 39

The two types of calculus are supragingival and subgingival.

Question 40

What systemic diseases have a connection to periodontal disease?

Answer 40

Periodontal disease may have connections to cardiovascular disease (including coronary heart disease,
stroke, and heart attack), respiratory disease (including pneumonia), diabetes, and cancers.

Question 41

What are the four stages of periodontal disease?

Answer 41

The four stages includes gingivitis, early periodontitis, moderate periodontitis, and advanced periodontitis.

Question 42

What are the signs of gingivitis ?

Answer 42

The signs of gingivitis include redness and swelling of the gingiva, bleeding from brushing and flossing, and changes in gingival contour

Question 43

How is the severity of periodontal disease determined?

Answer 43

The severity of the disease is determined by the periodontist or dental hygienist using a staging based on its severity and a grading system used to assess the rate of progression and how to respond to treatment.

Question 44

What specialist cares for a patient with periodontitis?

Answer 44

The dentist and dental hygienist initially determines the stage gum disease, and the patient is referred
to a periodontist for advanced periodontal disease.