Supportive Periodontal Care Flashcards
What are the aims of supportive periodontal therapy?
- prevent or minimise disease recurrence or progression
- prevent or reduce incidence of tooth loos
- increase likelihood of detecting and treating other oral conditions
In the Loe et al. 1986 study, what factors constitute as rapid progression of periodontitis ?
- loss of attachment 9mm at 35 years old
- loss of attachment 13mm at 45 years old
- tooth loss starts at 20 with all teeth lost at 45
In the Loe et al. 1986 study, what factors constitute as moderate progression of periodontitis ?
- loss of attachment of 4mm at 35 years old
- loss of attachment of 7mm at 45 years old
- tooth loss starts at 30 with 7 teeth lost at 45
In the Loe et al. 1986 study, what factors constitute no progression of periodontitis?
- no progression beyong gingivitis
- loss of attachment was 1mm at 35 with no tooth loss in study
What was the conclusion of the study conducted by Loe et al in 1986?
- small group showed no progression of disease beyond gingivitis suggesting a possible genetic component influencing susceptibility
- for most people, disease will progress if left untreated resulting in tooth loss
Briefly outline the treatment plan for supportive periodontal treatment
assessment –> diagnosis –> treatment –> review –> maintenance
Where does supportive periodontal therapy fall in the treatment plan for periodontal treatment?
falls into the maintenance stage/phase of the treatment plan
The maintenance phase of the periodontal treatment plan is now commonly referred to as ..
supportive therapy- phase is vital to ensure stability
The supportive phase of periodontal therapy is achieved by implementing …
- regular clincal assessment
- re-treatment of certain sites
- patient motivatoon
What does the supportive phase of periodontal treatment look like for patients who are most likely going to lose teeth?
- regular clinical assessment
- retreatment at certain sites
- motivation
- modify factors affecting succes e.g. smoking
- discuss progression
- manage symptoms
- if patient is compliant look for other possible reasons why disease is progressing/no respisne to treatment
What are the factors that contribute to effective supportive periodontal treatment?
- good oral hygiene
- healthy looking gingivae
- shallow pockets
- stable attachment levels
- intact dentition - no tooth loss or increased mobility
- removal of deposits
What are the factors that contribute to ineffective supportive periodontal therapy?
- marked gingivitis
- deepening pocket depths
- loss of attachment
- tooth loss
- evidence of ineffective debridement
What are the stages of supportive therapy?
- review history- MH, DH, SH
- review oral hygien regim
- clinical assessment and periodontal review
- radiograph assessment
- diagnosis
- discuss findings
- tratment
- reinforce advice
- arrange recall/review
What are the stages of supportive therapy?
- review history- MH, DH, SH
- review oral hygien regim
- clinical assessment and periodontal review
- radiograph assessment
- diagnosis
- discuss findings
- tratment
- reinforce advice
- arrange recall/review
What are the components of an effective history review?
MH:
* new conditions
* worsening conditions
* change in smoking status
DH:
* issues since last appt- pain, swelling
SH:
* lifestyle changes- stress
* reasons for lapses- bereavment
What should be reviewed in the in the patients oral hygiene regime ?
- TB habits- ETB, MTB, how often
- ID cleaning- what aids?
- other aids- mouth washing
What must be included in your clinical assessment in your periodontal review?
- PPD
- bleeding scores
- plaque scores
- recession
- suppuration
- mobility
- furcation involvment
- CAL
The frequency of radiographs for periodontal assessments is often determined by…
clinical judgement
What are a potential justifications for radiation exposure in a periodontal review?
- deepening pockets
- increased attachment loss, mobility furcation involvement
- suppuration or abscess
A diagnosis of periodontal disease is for life. True or false
true
When discussing your findings following the clinical assessment of the periodontal review, what should you include?
- current condition
- any non responsive sites
- reasons why non responsive sites are present (if known)
- any sites being missed for plaque control
- recommended options (risks and benefits)
Non-responding sites in periodontal disease may be present due to…
- incorrect diagnosis
- inadequate plaque control
- inadequate sub-ginvival debridement
- smoking
- other - systemic, bacterial
Give some potential reasons for non compliance in periodontitis patients
- time
- cost
- social issues
- treatment complexity
- personal view of disease
- treatment dissatisfaction e.g. taking too long
- breakdown in professional relationship
What constitutes stable periodontal disease?
<10% BoP
PPD </= 4mm
no BoP at 4 mm sites
What constitutes periodontal disease that is currently in remission?
> 10% BoP
PPD </= 4mm
No BoP at 4mm sites
What constitutes unstable periodontal disease?
- PPD >/= 5mm
- PPD =/> 4mm with BoP
No bleeding of often a sign of _______ in periodontal disease except in _______.
stability
except in smokers
According to the S3 guidance, what stage should every one receive (regardless of their disease scale) ?
step 1
What does step 1 of the BSP S3 guidance entail for the treatment of periodontal disease?
- explain diseae, risk facctors, risk and benefits of treatment
- OHI- encourage and support behaviour
- reduce risks e.g. plaque retentive factors, smoking cessation, diabetes control
- provide tailored OH advice, ID cleaning, adjunctive efficacious toothpaste, mouthwash, PMPr
- select recall period
When should you move on to step 2 of the BSP S3 guidance?
engaging patient
In the case of an engaging patient, with no improvement after step 1 guidance, what action can you take?
consider referral
What does step 2 of the BSP S3 guidance entail for the treatment of periodontal disease?
- reinforce OHI, risk factors, behavioural change
- subgingival instrumentation using hand or USS; can be done in combination
- use adjunctive systemic anti-microbials
When should you re-evaluate the patient after completing step 2 guidance?
3 months
Following 3 month evaluation, if the patient is unstable, what should you do?
move them to step 3
What does step 3 S3 guidance involve?
- reinforce OHI, risk factors and behaviour change
- for moderate residual pockets (4-5mm) re perform subgingival instrumentation
- for deep >6mm pockets consider alternative causes
- consider referal to pocket management or regenerative therapy
- if referal not possible re-perform sub-gingival instrumentation
Following 3 month evaluation, if the patient is stable, what should you do?
move them to step 4
What does step 4 S3 guidance involve?
- supportive periodontal therapy strongly advised
- reinforce OH, risk factor control, behaviour change
- regular targeted PMPR to limit tooth losss
- consider evidence based adjunctive toothpaste and/or mouthwash to control gingival inflammation
What is paramount to the success/stability of periodontal disease?
ID cleaning
What advice must you reinforce at each appointment to a patient with periodontal disease?
ID cleaning is paramount to success and stability
When are frequent recalls for periodontal disease indicated?
- unstable disease
- grade C disease
- poor plaque control
- deep pockets
- poor response to treatment
- guarged progniss
- risk factors- smoking, MH, stress
- special care patients
Why are recall periods ideally placed around 3-4 months?
- evidence shows that microbial plaque tends to grow back to pre-cleaning levels 3-4 months post debridement levels
- healing phase is also 3 months for long JE- avoid probing in this period
- surrounding gingival and connective tissue take 6-9 months to heal
Recall periods should be tailored to the patient however, they should be be kept …
between 3 and 12 months
What is the importance of supportive periodontal therapy?
- helps review clinical condition to maintain stability
- assess changes that may affect stability
- identify problems early and manage appropriately
- keep patient infomed about disease status
- avoid- medico-legal issues if you do right by patient and document; also helps if patient complaint arises
