Step 2 Flashcards
Why do we re-evaluate after step 1
Re-evaluating after step 1 is an opportunity to identify successes and failures in step 1 treatment and to encourage further positive changes, seek reasons for failures, and possibilities to modify any suboptimal outcomes from step 1.
Success of periodontal treatment is dependent patients engaging with
Carrying out good oral hygiene
Modifying risk factors (if possible)
What is an engaging patient
Favourable improvement in OH indicated by >= 50% improvement in plaque and marginal bleeding scores
OR
Plaque levels less than 20% and bleeding levels less than 30%
OR
Patient has met targets outlined in their personal self-care plan as determined by their healthcare practitioner
What results would a non-engaging patient have
Insufficient improvement in OH indicated by less than 50% improvement in plaque and marginal bleeding scores
OR
Plaque levels greater than 20% and bleeding greater than 30%
OR
Patient states preference to a pallative approach to periodontal care
What palliative periodontal care can be given to non-engaging patients
If the patient remains non-engaging, they may enter a cycle of palliative periodontal care (PCP), which involves regular removal of calculus and re-motivation. Although less effective than full treatment, PCP could prolong tooth retention in non-engaging patients
When repeating step 1 what should be done
- find out WHY!
- remotivate and reinforce preventive advice
- Advise subgingival instrumentation will not give optimal results if plaque control is suboptimal
- Supra and subgingival PMPR of clinical crown to facilitate good oral hygiene
What does step 2 involve
Subgingival instrumentation (root surface debridement/PMPR on root)
1. Reinforce OH, risk factor control, behaviour change
2. Subgingival instrumentation, hand or powered (sonic/ultrasonic)
3. Use of adjunctive systemic antimicrobials determined by practitioner accredited for level 2 and 3 care
What isthe terminology to replace scaling
Subgingival PMPR
What does subgingival PMPR refer to
the removal of contaminated material, leaving the root surface smooth
How doyou prepare for sibgingival instrumentation
If BPE4 – you will have a 6PPC – this will guide where you need to carry out the subgingival instrumentation
If BPE3 – you may NOT have a pocket chart so you should look for the sextants that score 3 and identify which surfaces of which teeth have the 5-5mm pockets.
Check if the patient has radiographs - you should have these visible as this helps visualize the tooth/root anatomy, and can help visualize the shape of the pocket.
Decide which sites you plan to complete at this visit.
Inform the patient what you plan to do.
What is full mouth debridement
All the sites with pockets >3mm are instrumented - either at one visit or two visits within 24 hours
What is full mouth disinfection
All the sites with pockets >3mm are instrumented - either at one visit or two visits within 24 hours. The pockets are irrigated with 0.2% Chlorhexidine (CHX) and the patient uses CHX spray and mouthwash for 1-2 weeks
What is the pros and cons for either full mouth or quadrant approach
Both methods are equally effective
Limited additional benefit of a single visit or within 24 hours
The original full mouth protocol is intense and may not be realistic in practice
S3 guidelines suggest that subgingival periodontal instrumentation can be performed with either quadrant-wise or full mouth delivery within 24 hr.
The full mouth approach causes an acute systemic inflammatory response – The S3 guidelines advise that clinicians should consider the general health of their patients when planning full mouth treatment
When is perio treatment with antibiotics carried out
Usually only in specialist care and is not recommended
What effects does supragingival and subgingival PMPR have on the microflora in the mouth
Significantly reduces the levels and prevalence of pathogenic species –
e.g P. gingivalis, T. denticola – can reverse dysbiosis
Complete elimination of these species is unrealistic
How does supra and sub PMPR affect hard and soft tissues
Decrease in gingival inflammation
Shrinkage of the gingival tissues leads to recession
Increase in collagen fibers in the connective tissue beneath the pocket and formation of long junctional epithelial attachment
This results in decrease in pocket depth and increase in attachment level
Very little change in bone height at sites with horizontal bone loss
Vertical defects display some infill and gain in bone height
