Reading a perio chart and perio questions

Question 1

What is your diagnosis?

Answer 1

Using the loss of attachement instead of radiograph
* Generalised periodontitis
* Stage 4
* Grade C
* Currently unstable
* Somker as risk factors

Question 2

Which tooth caries the poorest diagnosis?

Answer 2

16

Question 3

Why 16 caries the worst diagnosis?

Answer 3

• Furcation grade 3 - harder to keep clean
• 12mm loss of attachment - harder to clean deep pockets and bacteria can ingress more
• Grade 3 mobility - increased bone loss

Question 4

In regards to prognosis , why is the green line drawing section on the chart potentially misleading?

Answer 4

The teeth drawn on the chart are standardised which mean that the green line drawn on the chart representing the attachement loss is not exactly the same as it is seen in the patient mouth due to difference of anatomical morphology

Question 5

A perio patient with 6PPC available and radiographs, what 2 more special investigations would you want to get?

Answer 5

• Diet diary
• Plaque and bleeding index

Question 6

A perio patient with 6PPC available and radiographs, what other information would you want to get from the patient history?

Answer 6

• Medical history - conditions and medications
• Smoking history
• Family history - did her patients lose teeth at a young age due to periodontal disease?
• Patient motivation for treatment and performing oral hygiene

Question 7

4 reasons why non-surgical therapy may fail to eliminate bacteria from periodontal pockets?

Answer 7

• Pockets may be blocked
• Instruments may not reach depth of the pockets due to the size of the pocket
• Poor patient compliance with oral hygiene
• Poor clinician skills in performing instrumentation

Question 8

List three potential problems that limit the usefulness of oral antibiotics in the treatment of periodontitis?

Answer 8

• antibiotics may unable to penetrate the biofilm
• antibiotics may not reach the sites of infection
• chance of antibiotic resistance

Question 9

You are seeing a patient with a lateral periodontal abscess in tooth 22, they have accompanying systemic symptoms but wishes to keep the tooth , describe your management

Answer 9

• Reassure patient and gain consent
• Incise and drain abscess or drain through pocket (use LA)
• Supra and subgingival PMPR short of the base of the pocket
• Start Perio step 1 according to BSP guidelines - OHI , Manage risk factors
• Prescribe antibiotics for the patient ( amoxicillin 500mg , 3times daily for 5 days
• Give post op instructions and analgesics for pain relief
• Record in the notes