RSD and Healing

Question 1

If calculus is essentially an inert mineralised deposit, why is it necessary to remove it?

Answer 1

• Acts as a plaque trap which promotes further build up of plaque biofilm. (calculus has a rough surface)
• removal of calculus makes it easier for patients to maintain adequate OH. Key for perio treatment and long term stability.

Question 2

What else should be done to prevent build up of calculus?

Answer 2

• OHI
• Smoking cessations
• Maintenance perio therapy

Question 3

What is RSD?

Answer 3

RSD is the removal/disruption of subgingival biofilm & Calculus deposits without the removal of cementum

Question 4

What is the Criteria for RSD?

Answer 4

True pockets 4mm or greater, BOP of sub gingival calculus and adequate OH

Although sometimes you will see reduced BOP in smokers but still carry out RSD.

Question 5

How long should you wait before probing after RSD?

Answer 5

10-12 weeks

Question 6

Why is there usually more recession following non-surgical perio treatment?

Answer 6

Reduction in inflammatory swelling following periodontal treatment results in more recession.

Should warn patients of this before treatment!!

Question 7

What 4 cells are involved in Periodontal pocket healing?

Question 8

What are the 3 reasons for reduced probing depth following successful periodontal treatment?

Answer 8

• Reduction in inflammatory swelling
• Improved tissue resistance
• Formation of Long Junctional Epithelium

Question 9

What are the causes of treatment failure?

Answer 9

• Inadequate plaque control
• Original diagnosis incorrect
• Inadequate debridement
• Patient is a poor responder
• Inadequate maintenance

Must address cause of failure before trying treatment again or likely to fail again.

Question 10

What is palliative care?

Answer 10

• Form of Supportive Periodontal therapy (SPT). Aims to keep the patient comfortable, functioning and slow the progression of the periodontal disease. (i.e. cannot be stabilised)
• It is important patient is involved in decision and consents to being on palliative care or dentist could be accused of supervised neglect.

Question 11

When should you refer to specialist?

Answer 11

• High susceptibility to periodontitis (stage3-4 grade C
• Complex medical history e.g. bleeding disorder or immunocompromised
• deep non-responding pocket depths with persistent bleeding/pus despite adequate OH and non surgical therapy
• Complex dental management
• Localised gingival recession
• Complex root/anaatomical factors
• Peri-implants (disease around implants)