Prognosis

Question 1

1. What factors affect prognosis?

Answer 1

a. Patient related
i. Systemic disease
ii. Age
iii. Habits
iv. Oral hygiene
v. Compliance

Question 2

b. Tooth related

Answer 2

i. Attachment loss
ii. Furcation involvement
iii. Mobility
iv. Trauma from occlusion
v. Pocket depth
vi. Fremitus
vii. Anatomical considerations
viii. Restorability
ix. Bleeding on probing

Question 3

Treatment Planning

Answer 3

1. Describe the sequence of tx plan for periodontal pt
2. How do you treat chronic periodontitis? Aggressive periodontitis/NUP?

Question 4

a. Treatment of Necrotizing Gingivitis

Answer 4

i. Non-surgical
1. Improve oral hygiene and debridement
2. 0.12% chlorhexidine pre/post-treatment rinse
ii. Antibiotics
1. Metronidazole 250mg, 3x daily for 7 days (1st choice) (talked about this earlier in studyguide)
2. OR Amoxicillin 500mg, 3x daily for 7 days
3. Targets Gram Negative bacteria
iii. Heals up fairly quickly with improvement seen even after 1-2 days
1. There will still be ‘scarring’ of the interdental papilla

Question 5

b. Treatment of NP

Answer 5

i. Non-surgical
1. 0.12% chlorhexidine pre/post-treatment rinse
2. Debridement with hand instruments
ii. Antibiotics
1. Metronidazole 250mg, 4x daily for 7-10 days
2. Antifungal therapy if indicated
iii. Surgical correction may be indicated

Question 6

WTF is SRP

Answer 6

a. Scaling and root planning. Need to go onto root surface to remove endotoxin. Infection is present due to the bone loss.

Question 7

4. Difference between SRP, prophy, perio maintenance and scaling in the presence of inflammation

Answer 7

a. “do you go supra and sub g in a prophy?” YES. The difference between a prophy and scaling in the presence is there is generalized inflammation, redness, and bleeding sites for scaling in the presence. For SRP, you go to the root surface to remove the ENDOTOXIN.

Question 8

5. What do you do at re-evaluation? What are you looking for?

Answer 8

a. Check probing depths, plaque debridement on all sites, note plaque and bleeding scores, see if pt’s OH has improved, see if inflammation has improved, progression of attachement loss, etc. Criteria for success: pockets that are NOT equal too or greater than 5mm and no sites with more than 4mm with BOP. It is at this time we decide where the pt needs to be referred for treatment.

Question 9

6. How much healing do you expect from SRP?

Answer 9

a. Formation of long junctional epithelium. Appears 1-2 weeks after SRP. We expect gradual reductions in inflammatory cell populations, GCF flow, and repair of connective tissue. Root hypersensitivity and recession of the gingival margins is frequently seen during healing. Must warn pts of this potential.

Question 10

7. When would you use local delivery antibiotics?

Answer 10

a. Specific cases?
b. Is local better than systemic? When do you use systemic and when local?

Question 11

8. When and why do you refer for periodontal surgery?

Answer 11

a. After 4-6 week re eval of SRP if the patient has a loss of attachment of 5mm or greater
b. Periodontists are usually successful with 5mm-8mm pockets
c. Limited success with 9mm + pockets
d. Early referral is critical to provide best result

Question 12

9. What is the rate of infection after periodontal surgery?

Answer 12

Fuck if I know!

Question 13

10. When is premedication necessary?

Answer 13

a. Dose/type/adverse reaction/alternatives

Question 14

11. Patient management

Answer 14

a. Heart murmur/diabetes/allergy/hypertension/immunocompromised/bleeding disorder/joint prosthesis/myocardial infarction/CHF/kidney disease/pain/infection/inflammation