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Clinical Knowledge 2 > Supportive Periodontal Care > Flashcards

Supportive Periodontal Care Flashcards

1
Q

What are the aims of supportive periodontal therapy?

A
  • prevent or minimise disease recurrence or progression
  • prevent or reduce incidence of tooth loos
  • increase likelihood of detecting and treating other oral conditions
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2
Q

In the Loe et al. 1986 study, what factors constitute as rapid progression of periodontitis ?

A
  • 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
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3
Q

In the Loe et al. 1986 study, what factors constitute as moderate progression of periodontitis ?

A
  • 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
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4
Q

In the Loe et al. 1986 study, what factors constitute no progression of periodontitis?

A
  • no progression beyong gingivitis
  • loss of attachment was 1mm at 35 with no tooth loss in study
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5
Q

What was the conclusion of the study conducted by Loe et al in 1986?

A
  • 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
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6
Q

Briefly outline the treatment plan for supportive periodontal treatment

A

assessment –> diagnosis –> treatment –> review –> maintenance

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7
Q

Where does supportive periodontal therapy fall in the treatment plan for periodontal treatment?

A

falls into the maintenance stage/phase of the treatment plan

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8
Q

The maintenance phase of the periodontal treatment plan is now commonly referred to as ..

A

supportive therapy- phase is vital to ensure stability

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9
Q

The supportive phase of periodontal therapy is achieved by implementing …

A
  • regular clincal assessment
  • re-treatment of certain sites
  • patient motivatoon
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10
Q

What does the supportive phase of periodontal treatment look like for patients who are most likely going to lose teeth?

A
  • 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
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11
Q

What are the factors that contribute to effective supportive periodontal treatment?

A
  • good oral hygiene
  • healthy looking gingivae
  • shallow pockets
  • stable attachment levels
  • intact dentition - no tooth loss or increased mobility
  • removal of deposits
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12
Q

What are the factors that contribute to ineffective supportive periodontal therapy?

A
  • marked gingivitis
  • deepening pocket depths
  • loss of attachment
  • tooth loss
  • evidence of ineffective debridement
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13
Q

What are the stages of supportive therapy?

A
  • 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
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13
Q

What are the stages of supportive therapy?

A
  • 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
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14
Q

What are the components of an effective history review?

A

MH:
* new conditions
* worsening conditions
* change in smoking status

DH:
* issues since last appt- pain, swelling

SH:
* lifestyle changes- stress
* reasons for lapses- bereavment

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15
Q

What should be reviewed in the in the patients oral hygiene regime ?

A
  • TB habits- ETB, MTB, how often
  • ID cleaning- what aids?
  • other aids- mouth washing
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16
Q

What must be included in your clinical assessment in your periodontal review?

A
  • PPD
  • bleeding scores
  • plaque scores
  • recession
  • suppuration
  • mobility
  • furcation involvment
  • CAL
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17
Q

The frequency of radiographs for periodontal assessments is often determined by…

A

clinical judgement

18
Q

What are a potential justifications for radiation exposure in a periodontal review?

A
  • deepening pockets
  • increased attachment loss, mobility furcation involvement
  • suppuration or abscess
19
Q

A diagnosis of periodontal disease is for life. True or false

A

true

20
Q

When discussing your findings following the clinical assessment of the periodontal review, what should you include?

A
  • 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)
21
Q

Non-responding sites in periodontal disease may be present due to…

A
  • incorrect diagnosis
  • inadequate plaque control
  • inadequate sub-ginvival debridement
  • smoking
  • other - systemic, bacterial
22
Q

Give some potential reasons for non compliance in periodontitis patients

A
  • time
  • cost
  • social issues
  • treatment complexity
  • personal view of disease
  • treatment dissatisfaction e.g. taking too long
  • breakdown in professional relationship
23
Q

What constitutes stable periodontal disease?

A

<10% BoP
PPD </= 4mm
no BoP at 4 mm sites

24
Q

What constitutes periodontal disease that is currently in remission?

A

> 10% BoP
PPD </= 4mm
No BoP at 4mm sites

25
Q

What constitutes unstable periodontal disease?

A
  • PPD >/= 5mm
  • PPD =/> 4mm with BoP
26
Q

No bleeding of often a sign of _______ in periodontal disease except in _______.

A

stability
except in smokers

27
Q

According to the S3 guidance, what stage should every one receive (regardless of their disease scale) ?

A

step 1

28
Q

What does step 1 of the BSP S3 guidance entail for the treatment of periodontal disease?

A
  • 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
29
Q

When should you move on to step 2 of the BSP S3 guidance?

A

engaging patient

30
Q

In the case of an engaging patient, with no improvement after step 1 guidance, what action can you take?

A

consider referral

31
Q

What does step 2 of the BSP S3 guidance entail for the treatment of periodontal disease?

A
  • reinforce OHI, risk factors, behavioural change
  • subgingival instrumentation using hand or USS; can be done in combination
  • use adjunctive systemic anti-microbials
32
Q

When should you re-evaluate the patient after completing step 2 guidance?

A

3 months

33
Q

Following 3 month evaluation, if the patient is unstable, what should you do?

A

move them to step 3

34
Q

What does step 3 S3 guidance involve?

A
  • 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
35
Q

Following 3 month evaluation, if the patient is stable, what should you do?

A

move them to step 4

36
Q

What does step 4 S3 guidance involve?

A
  • 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
37
Q

What is paramount to the success/stability of periodontal disease?

A

ID cleaning

38
Q

What advice must you reinforce at each appointment to a patient with periodontal disease?

A

ID cleaning is paramount to success and stability

39
Q

When are frequent recalls for periodontal disease indicated?

A
  • unstable disease
  • grade C disease
  • poor plaque control
  • deep pockets
  • poor response to treatment
  • guarged progniss
  • risk factors- smoking, MH, stress
  • special care patients
40
Q

Why are recall periods ideally placed around 3-4 months?

A
  • 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
41
Q

Recall periods should be tailored to the patient however, they should be be kept …

A

between 3 and 12 months

42
Q

What is the importance of supportive periodontal therapy?

A
  • 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

Clinical Knowledge 2 (40 decks)

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