S5 Prevention in periodontics Flashcards
What are the main messages of Delivering Better Oral Health, PHE (2014)?
- Prevention of gingivitis
- Prevention alone is not sufficient for periodontitis or peri-implantitis
- Early detection of periodontitis using the BPE
- Managing risk factors that increase the risk of perio or complicate its successful care
- Supportive perio therapy for patients treated for periodontitis
What are the 4 steps of treatment for periodontitis according to the EFP S3 level clinical guidance?
1) Patient motivation, supragingival plaque control and risk factor control
2) Cause related therapy (non-surgical management), and RSD to control subgingival biofilm and calculus
3) Treatment of areas not responding to step 2 (surgical management)
4) Supportive periodontal care, maintaining periodontal stability
How can we motivate patients?
We cannot initiate motivation, but we can enhance the appeal of existing motivations such as:
- Desire to be clean
- To conform to social norms
- To be socially acceptable
- Avoid tooth loss
- Avoid dentures
How do the SDCEP recommend changing a patient’s oral hygiene behaviours?
TIPPS:
- Talk to pt about causes of periodontal disease and discuss barriers to plaque removal
- Instruct pt on best ways to perform effective plaque removal
- Practice cleaning teeth using interdental aids in surgery
- Plan next steps for pt, how will they incorporate new oral hygiene advice into their daily life
- Support the pt by following up at subsequent visits
What level of recommendation are patient motivation and OHI in the EFP S3 guidance?
Patient motivation and OHI are both grade A recommendations
What are optimal plaque and bleeding scores according to the BSP?
- 20% plaque score
- 10% bleeding score
Aka most favourable outcomes.
What are the current recommendations regarding toothbrushing?
- Manual toothbrushes, on average, reduce plaque by 42%
- Electric toothbrushes, on average, reduce plaque by 46%
- Electric toothbrushes have a greater plaque reduction short term and long term, and greater reduction in gingival inflammation, but the difference with manual brushes isn’t huge and the clinical importance of these findings remains unlcear
- Benefits outweigh risks (e.g. bleeding or bacteraemia)
- For periodontitis patients, 2 minutes is likely to be insufficient
What are the current recommendations regarding interdental cleaning?
- Interdental plaque removal is required once every 24 hours
- Evidence for flossing is weak, could be because most people struggle to floss effectively
- Evidence for bamboo interdental sticks is unclear
- Oral irrigators have weak evidence
- Interdental brushes have moderate evidence supporting their efficacy, pts will usually need to use at least 2 sizes to accomdate different sized spacing
How should interdental brushes be used?
- Need to use the biggest possible brush that will fit into the space
- Brush close to the gingival margin, not just back and forth
- ID brush can be used for furcations, not just interdental spaces
- Most pts will use at least 2 sizes of brushes
Interdental brushes should be the first choice for ID cleaning. Interproximal cleaning advice requires professional training irrespective of the tool of choice.
Should patients brush their periodontal pockets?
- Studies have found that using a single tufted brush over 14 days in properly trained patients, induced favourbale clinical and microbiological changes in deep perio pockets >6mm even in the absence of RSD
How can mouthwashes be categorised?
Categorise by purpose:
Name the types of mouthwashes advocated to reduce plaque bacteria.
- M/Ws containing chlorhexidine gluconate (Corsodyl)
- M/Ws containing essential oils (Listerine)
- M/Ws containing cetylpyridinium chloride (CPC), a quaternary ammonium compound, e.g. Eludril, Plax
What ingredient is found in mouthwashes advocated to prevent and repair caries?
Fluoride
What is Chlorehexidine? Describe its mode of action.
- Regarded as an antiseptic, not an antimicrobial
- Bacteriostatic (inhibits growth) and bactericidal properties (kills bacteria)
- Dose dependent
- Chx is positively charged, binds to negatively charged sites of cell wall, destabilises it and interferes with osmosis causing lysis of bacterial cell
- Chx also has some ability to inhibit adherence of microorganisms to a surface, preventing growth and development of biofilms
- Also has cidal actions against fungi, so used in treatment and prevention of denture induced candidosis
Chlorhexidine has good substantivity, what does this mean?
- Chx binds to the salivary pellicle
- Substantivity: Chx is slowly released from this surface leading to prolonged activity
