S3 BSP (2023) Guidelines on Management of Periodontal Disease Flashcards
Describe Step 1 treatment.
- Explain disease, risk factors, treatment options and risks vs. benefits of treating and not treating condition.
- Explain importance of OH and risk factor management.
- Give patient-specific oral hygiene advice including ID brushing, +/- adjunctive mouthwash/toothpaste.
- Carry out supra and sub gingival PMPR of clinical crown.
- Reduce risk factors i.e. smoking cessation, diabetes control, removal of plaque retentive factors.
- Agree recall period.
What is the step 1 recall period ?
3 months.
At step 1 3 month recall, patient engagement should be assessed using what special investigation ?
MPBS
At step 1 3 month recall, patient engagement should be assessed, define an engaging patient ?
<20% plaque and <30% BoP score OR
>50% reduction in both plaque and BoP score OR
Patient has met personal self-care plan targets set out at first appointment by clinician.
At step 1 recall, your patient is not engaging, how would you continue to treat this patient ?
Repeat step 1 treatment.
At step 1 recall, your patient is engaging, how would you continue to treat this patient ?
Move to step 2 treatment.
Describe step 2 treatment.
SUBGINGIVAL SCALING (RSD)
Reinforce OH, risk factor control and support behaviour change.
Can use ultrasonic or hand scaling +/- systemic antimicrobial adjuncts.
Set recall period.
What is the step 2 recall period ?
3 months.
At step 2 3 month recall, what do you assess ?
Periodontal condition stability.
How would you assess stability of periodontal condition at step 2 recall ?
Using BPE probe around all teeth (like taking a BPE).
Describe a stable (responding) periodontal condition (step 2 recall).
<10% BoP.
<4mm PPD.
No BoP at 4mm sites.
Describe a periodontal condition in remission (step 2 recall).
> 10% BoP.
<4mm PPD.
No BoP at 4mm sites.
Describe an unstable (non-responding) periodontal condition (step 2 recall).
=/>5mm PPD.
>4mm sites BoP.
Describe step 3 treatment.
Re-instrumentation of 4-5mm PPD.
>5mm PPD - consider referral for other treatment (if not possible re-instrument the entire mouth).
At step 2 3 month recall, your patient has stabilised their periodontal condition, how would you continue to treat this patient ?
Move to Step 4 treatment.
At step 2 3 month recall, your patient still has persisting pockets of =/> 5mm which are not responding to step 2 non-surgical treatment, how would you continue to treat this patient ?
Move to Step 3 treatment.
What methods might a tier 2 and tier 3 clinician in secondary care use to treat non-responding pockets =/> 5mm ?
Re-instrumentation of full mouth using systemic/local adjuncts.
Periodontal surgery - access flap, regenerative, resective surgery.
What patient holistic factors might cause sites to fail to respond to step 2 non-surgical instrumentation ?
Poor patient engagement.
Smokers.
Uncontrolled diabetes.
What patient specific oral factors might cause sites to fail to respond to step 2 non-surgical instrumentation ?
Deep vertical bone defects.
Mid-buccal or mid-palatal pockets.
1 sided vertical bony defects.
Endo-perio lesions.
Anatomical factors - enamel pearls, groove in roots, furcations.
What type of local adjuncts can be used as part of step 3 treatment by a specialist ?
Disinfectants (Periochip).
Antimicrobials (Dentinomycin).
Host immune modulation therapy (Periostat).
What systemic antimicrobial adjunct can be used as part of step 2/3 treatment by specialist ?
400mg 3x daily for 7 days Metronidazole.
Start immediately after full mouth sub-gingival scaling.
What is the aim of access flap periodontal surgery ?
Direct access to root surface for debridement by lifting periosteal flap and removal of bone.
What is the aim of resective periodontal surgery ?
Removal of overgrown soft tissue to make pockets more manageable for a patient to clean - gingivectomy.
What is the aim of regenerative periodontal surgery ?
Improve clinical attachment, reduce probing depths, ridge augmentation.
