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.
When should interdental brushes be used and how?
- If there is any attachment loss interdental brushes should be used
- Available in a range of different sizes to suit size of interdental space
- Interdental brushes should be a snug fit without the wire rubbing against tooth and patient should perform 8- 10 back and forth strokes in each space – ask patient to practice and observe
What action is most effective, chemical or mechanical?
mechanical
What is the most effective device to remove interdental plaque?
interdental brushes
What can alcohol in mouthwashes cause?
dry mouth
cancer
What is the most effective mouthwash and how does it work?
Chlorhexidine
* possesses the property of adsorption to oral surfaces , notably enamel
* Long substantivity
* Fairly broad antimicrobial spectrum
What is a disadvantage of chlorhexidine?
interferes with taste and discolours teeth
When should mouthwash be prescribed according to SDCEP guidelines?
Only prescribe an anti-plaque mouthwash, such as 0.2% chlorhexidine gluconate, for patients where pain limits mechanical plaque removal
What is TIPPS?
talk
instruct
practise
plan
support
What is possible time commitment for patients with PD disease?
Patients with periodontitis may require up to 20 minutes once or ideally twice a day with oral hygiene procedures
What is PMPR used in conjuction with?
- In combination with oral hygiene instructions and risk factor control
What is PMPR?
- Removal of both supra gingival and subgingival plaque and calculus deposits
- Supragingival calculus is easily identifiable when present in large deposits
- Sometimes superficial deposits of subgingival calculus can also be seen
Powered and hand instruments can be used
What should happen after PMPR at following visit?
substantial resolution of
inflammation should be apparent if the patient has good plaque control
What is time scale after PMPR for recall interval?
1 week - 3 months
What is included in step one of the S3 guidelines?
Educate patient
Controlling risk factors
OHI
Supra and subgingival PMPR of clinical crown
Removing plaque retentive factors
