Step One of Treatment Flashcards
What is clinical gingival health?
no probing attachment loss
≤ 10% bleeding on probing
≤ 3mm probing pocket
What should physiological bone levels range from?
Physiological bone levels range from 1.0 to 3.0 mm apical to ACJ
What is gingivitis in relation to clinical gingival health?
no probing attachment loss
> 10% bleeding on probing
≤ 3mm probing pocket depths (assuming no ‘false pockets;) BUT probing pocket depths MAY be deeper
(bone levels range from 1.0 to 3.0 mm apical to ACJ)
Gingival inflammation but NO Loss of attachment
What is periodontitis in relation to clinical gingival health?
- probing attachment loss
- MAY be > 10% bleeding on probing
- May be > 3mm probing pocket depths
- bone levels generally 3mm or more apical to ACJ)
- Loss of attachment
How do you explain gingival disease and management to a patient?
Use the patient’s radiographs to highlight the sites of worst bone loss, and the sites not / less affected.
Pictures and Diagrams
To illustrate how disease develops
Disclose plaque and show areas that the patient is missing
See and modify toothbrush technique using face mirror
Check patient understands any questions?
Point out sites of disease
How to explain to the patient their risk factors?
Highlight the patient’s individual risk factors
If these are modifiable find out if the patient has considered modifications and had any support for this (in a nonjudgement way!!)
What does the patient need to sign before treatment?
Oral Health Care Plan and Agreement Form
Consent in Periodontal Booklet
What are examples of plaque retentive factors that can be removed?
overhangs
calculus
bad denture design
What are risk factors that can be reduced and how?
smoking - can be referred via Trakcare
diabetes - liase with GP to investigate blood sugar levels
What is a controlled HbA1c value for diabetes?
<48mmol/mol
What does individual tailored OHI include?
- 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
Excellent plaque control is vital for a successful treatment outcome in the short and long term
What method of toothbrushing is recommended and how is it carried out?
Toothbrushing
* Manual –The Bass technique or some modification of it
* Bristles are directed into the gingival sulcus at 45- degree angle to the long axis of the teeth
* Brush is activated with short back and forth vibrating motions
* Warn against vigorous toothbrushing – may cause gingival abrasion , gingival recession, tooth abrasion
* Medium soft filament brush
* Small or medium head of toothbrush
* to wait 30 minutes to an hour after eating prior to brushing
Powered vs Manual Toothbrushes?
powered toothbrushes after a brushing exercise are, at least numerically, more efficacious than manual brushes in overall weighted mean plaque score reduction
What are single tufted brushes used for?
- To clean maligned teeth
- To clean distal surfaces of last molar tooth
- Teeth affected by localised gingival recession
How is interdental cleaning carried out?
- Floss/tape for intact papilla
- Interdental brushes – if there is space.
