Step 1

Question 1

Which patients receive step one periodontal care

Answer 1

Periodontal Health​

Gingivitis​

Periodontitis

Question 2

What is the first step in the step 1 of treatment

Answer 2

Explain disease, risk factors and treatment alternatives, risk and benefits including no treatment

Question 3

How can the clinician explain perdontal disease and the patients role in management

Answer 3

Picture and diagrams
Radiographs
Disclosing tablets
Show sites of inflamation/bleeding
See and modify brushing techniques
Check the patient understands

Question 4

What is the procedure with risk factors

Answer 4

Identify the patients risk factors and whether or not they are modifiable
Encourage modifications where possible and explain risks if no changes made

Question 5

What should be explained to the patient before beginning treatment

Answer 5

Explain to the patient their current plaque score
Highlight WHY cleaning the teeth thoroughly is important​

Highlight that cleaning teeth is difficult – and everybody is different in what they need to do​
Highlight their target plaque score, and explain that you can keep them updated as to how their plaque and bleeding scores improve with treatment.
Explain how many visits are likely to be needed, when the patient will be reviewed, when they will know whether the treatment has worked
Explain what outcomes the patient might expect
Explain what will happen at each visit – especially at the next visit.

Question 6

What are the benefits of perio treatment

Answer 6

Keep teeth longer
Reduce bleeding of gums
Fresh mouth
Reduce risk of developing medical conditions (diabeties)

Question 7

What risks are there to perio treatment

Answer 7

Short term discomfort
Sensitivity
Gum recession
Gaps between teeth
Increase in tooth mobility (temporary)

Question 8

What is the first physical treatment in step 1

Answer 8

Removing plaque retentive factors

Question 9

What are plaque retentive factors

Answer 9

Overhangs
Calculus

Question 10

How are risk factors reduced

Answer 10

Smoking - smoking cessation
Diabeties - liase with GP get under control

Question 11

What is arguably the most important factor in prevention and treatment of periodontal disease according to stenman et al. 2012

Answer 11

Individually tailored OHI

Question 12

How can OHI be individually tailored

Answer 12

Ask patient to bring current oral hygiene aids​

Ask how often they are being used and replaced in a non-judgmental way​

Discuss:​
-toothbrushes​
-dental floss and tape
-interdental sticks​
-interdental brushes​
-single tufted brush​

ask patient to demonstrate and modify technique accordingly and practice using a face mirror ​

Use disclosing tablets/liquid to identify areas patient is missing and coach them to better plaque control ​

Carry out modified plaque and bleeding scores​

Question 13

When are single tufted toothbrushes useful

Answer 13

To clean maligned teeth​

To clean distal surfaces of last molar tooth​

Teeth affected by localised gingival recession​

Question 14

What is the most effective mouthwash

Answer 14

Chlorohexidine

Question 15

Why is Chlorohexidine good

Answer 15

possesses the property of adsorption to oral surfaces , notably enamel​

Long substantivity​

Fairly broad antimicrobial spectrum ​

Interferes with taste, discolours teeth

Question 16

What does TIPPS stand for

Answer 16

Talk
Instruct
Practise
Plan
Support

Question 17

Why is a plan so important in treating patients with perio

Answer 17

Patients with periodontitis may require up to 20 minutes once or ideally twice a day with oral hygiene procedures ​

To achieve high levels of plaque control to achieve periodontal stability​

Patients need to understand the time commitment needed on a daily basis to achieve this as well as planning how they will allocate this protected time

Question 18

After removing plaque retentive factors giving tailored OHI and making a plan with the patient what is carried out

Answer 18

Supra and subgingival Professional Mechanical Plaque removal (PMPR) of clinical crown

Question 19

How long after carrying out step 1 should the patient take before the next appointment

Answer 19

Depends on the patient​

Can be a short as 1 week (for example in the student clinics to help complete treatment inside the term)​

Can be as long as 3 months (for example to allow more time for resolution of gingival inflammation​

Can be anywhere in between (for example to provide more detailed OHI if one visit is ‘overload’, or for high risk patients, or if patient prefers to be seen sooner)​

Question 20

What are the S3 guidelines for step 1 treatment

Answer 20

Educate patient
Control risk factors
OHI
Remove plaque retentive factors
Supra and subgingivalPMPR of clinical crown