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BDS3 Perio > supportive periodontal care > Flashcards

supportive periodontal care Flashcards

1
Q

who needs supportive periodontal care

A

patients who have had periodontal treatment

always a perio pt - need to be treated differently to non perio

often referred back to GDP

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2
Q

where is supportive perio care carried out

A

pt referred back to GDP

  • “The patient would benefit from regular supportive periodontal care ideally at three month intervals. The three monthly supportive visits should include removal of supra and any sub-gingival plaque and calculus using local anaesthetic if necessary. Oral hygiene instruction should be provided as required. The periodontal pocket probing depths should be reviewed at 12 month intervals to allow early detection and treatment of any disease recurrence or progression.”
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3
Q

why bother with supportive periodontal care

A

Patients who are not maintained in a supervised recall program subsequent to active treatment show obvious signs of recurrent periodontitis (e.g., increased pocket depth, bone loss, or tooth loss).

The more often patients present for recommended supportive periodontal treatment (SPT), the less likely they are to lose teeth.

  • Treated patients who do not return for regular recall are at 5.6 times greater risk for tooth loss than compliant patients – need to engage the pt
  • Patients with inadequate SPT after successful regenerative therapy have a fiftyfold increase in risk of probing attachment loss compared with those who have regular recall visits.
  • successful supportive= les likely to be lost*
  • more complex tx more important it is to maintain it
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4
Q

when is supportive periodontal care

A

determined by risk assessment for each individual pt

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5
Q

risk of disease progression in pt influenced by (6)

A
  • BOP
  • PD
  • Tooth loss
  • Systemic conditions - diabetes
  • Bone loss/age - ABC grading
  • Environment - smoking

How many tick and to what extent

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6
Q

generally supportive care intervals for mod-adv perio pt

A

every 3 months

maybe more or less frequent depending on stability

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7
Q

3 parts to suppportive periodontal care

A

Part I - examination

Part II - treatment

Part III - report, cleanup and scheduling

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8
Q

Part I supportive perio care

A

examination

  • Medical history changes
  • Oral pathologic examination
  • Oral hygiene status (plaque chart)
  • Gingival changes e.g. inflammation, recession, BOP
  • Pocket depth changes - periodontal and peri-implant
  • Mobility changes
  • Occlusal changes e.g. drifting
  • Dental caries
  • Restorative, prosthetic, and implant status
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9
Q

part II supprotive perio care

A

treatment

  • Oral hygiene reinforcement
  • Supra gingival scaling
  • Root surface debridement
  • Polishing - easier to keep clean
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10
Q

part III supportive perio care

A

report, cleanup and scheduling

  • Write report in chart.
    • Comment what you found at that app so can look at sequential and compare
      • May need X-rays of sites
  • Discuss report with patient.
  • Schedule next recall visit.
  • Schedule further periodontal treatment.
  • Schedule or refer for restorative or prosthetic treatment.
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11
Q

primary aim of SPD examination

A

primarily looks for changes that have occurred since the last evaluation

  • Has plaque score changed? Worse – why?
  • Not in isolation – reflect on what they have been like
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12
Q

part II treatment

care

A

Required scaling and root surface debridement are performed, (based on pocket chart/plaque chart - 4mm/BOP).

  • Care must be taken not to instrument normal sites with shallow sulci (1 to 3 mm deep – that do NOT have any calculus)
    • repeated subgingival scaling and root planing in initially normal periodontal sites result in significant loss of attachment - LEAVE ALONE

remove plaque and calculus is greater than 4

  • will get worse if leave
  • Need to remove plaque at regular basis to help imp

.

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13
Q

what to do if recurrence of periodontal disease occurs

A

reasons for recurrence established

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14
Q

causes for recurrence of periodontal disease (6)

A
  • inadequate plaque control - pt
  • failure to comply with SPT schedules - pt
  • Inadequate/ insufficient tx - failed to remove all the potential factors favouring plaque accumulation.
  • Incomplete calculus removal in areas of difficult access.
  • Inadequate restorations placed after the periodontal treatment was completed.
  • Presence of some systemic diseases that may affect host resistance to previously acceptable levels of plaque ask
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15
Q

dentist role in

  • inadequate plaque control - pt
  • failure to comply with SPT schedules - pt

causing recurrence of perio

A

compliance issue

dentist’s responsibility to teach, motivate, and control the patient’s oral hygiene technique, and the patient’s failure is the dentist’s failure.

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16
Q

SPD challenges

A

Less than 1/5 complete comply with their schedule for 8 years

Down to dental team to persuade pt

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17
Q

importance of getting pt compliance in SCD

A

perio pts at risk of perio disease for whole life

  • Pockets in furcation areas may not have been eliminated by initial treatment or surgery.
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18
Q

SCD requires

A

need well organised charting system to complare sequential probing depths - gives the most accurate indication of the rate of the loss of attachment

19
Q

measurements for perio activity

A

no ‘test’ currently

clinicians rely on the information provided by combining probing, bleeding on probing, and sequential attachment measurements

  • only way to measure stability is compare over time
20
Q

perio sites that are not resolved

A

4mm+

  • Need to keep close eye
  • Need subgingival clean
  • Otherwise guarantee to get worse
21
Q

goal plaque score

A

below 20%

pt respond well to them

22
Q

RSD and supra and sub gingival scaling in SPD

A

may need LA

consider it as ongoing treatment - active process

get plaque and calculus out of pockets

23
Q

how many appointments should SPC take per go

A

try to get it down to 1 appointment

have a clear idea of what you are trying to and get across at start so can be efficient

24
Q

full mouth periodontal charting

A

4 in one sextant

or 3 in more than one sextant

at baseline

(3 in only one sextant 6PPC for that sextant)

25
Q

SCD subgingival and RSD where

A

sites >or= 4mm where there is subgingival deposits present or BOP

sires <4mm which have subgingival deposits

26
Q

diagnosis for

A

Stage Periodontitis IV Grade C Generalised Periodontitis, unstable

27
Q

what does the dot on the diagram mean

A

healthy

less than 4mm site - don’t need Tx

28
Q

why is there still inflammation anteriorly

A

access issue - crowns

29
Q

Tx for

Stage Periodontitis IV Grade C Generalised Periodontitis, unstable

A

HPT

Open Flap Curettage 14, 13, 12, 11, 21, 22, 23 and 24

Review

30
Q

describe this photos post OFC

A

Persistent pockets round molars and premolars

X-ray

  • Advanced bone loss
  • Furcation bone loss
  • Extensive restoration

Are we going to be able to resolve?

  • Complete resoluation around molars - unrealistic
    • Mobile - less suitable for surgery
    • Poorer healing
31
Q

what recession type is this

A
  • Recession type 3
    • Negative gingiva architecture
    • No papilla - almost minus
    • No bone
    • Grafts don’t work
32
Q

what is a consequence of successful perio

A

Gingival recession with successful perio

  • Need to explain to pt before
    • Some attachment junctional epith and connective tissue And gingival recession
33
Q

how could this be aesthetically addressed

A

recession type 3

Options available for recession

  • New crowns - issue long - need to prep root - narrow prep, long contact points already - cause perio likely as uncleanable
    • Lead to more perio -> lose teeth
    • Can tidy up crowns so margin less obvious but if make more apical not best as risky
  • Gingival grafting - not for recession type 3
  • Pink coloured restorative material
    • Porcelain - same issues as crown lengthening (can lead to more perio)- can help not ideal aesthetics
    • Composite
  • Acrylic gingival veneer
    • Flange of upper denture like, Retained by undercuts in upper teeth
    • Pts quite like them
    • Warn as they are at risk of root caries - need careful monitor and meticulous OH
34
Q

how to make acrylic gingival veneer

A

Take upper impression

Make special tray

Horizotnal path of inseriotn

5-5 region

Block out - scult undercuts between teeth to point of max concavity

Dictate where acryclic go - red ribbon wax - need space for acrylic to go into

Liase with lab - tooth show, extension (larger more likely to break)

Check fit, check rub

Review and instruct on cleaning

Want them to take them out as much as possible - like shoes

35
Q

what can be added to acrylic gingival veneer to boost aesthetics

A

stippling - can improve appearance but pt may not like texture

36
Q

diagnosis

  • Generalized gingival inflammation, brisk BOP
  • Poor OH
  • Moderately restored dentition
  • Spacing upper and lower anterior
  • Generalised tooth mobility
  • Deep pockets 6-9
  • Generalized moderate to advanced horizontal bone loss
    • Advanced bone loss 14, 26, 31, 41
  • recession
  • Splaying and spacing of teeth
    • Due to occlusal instability likely
A
  • Stage IV, Grade C generalised periodontitis, unstable. Risk factors – variably controlled diabetes
37
Q

Tx plan for

  • Stage IV, Grade C generalised periodontitis, unstable. Risk factors – variably controlled diabetes
A
  • HPT, review
  • GDP re caries
38
Q

complication of diabetic and SPC

compliance issue

A

Diabetics have many appointments – low compliance sometimes – manage life

39
Q

what can be a good motivator for pt compliance for SPC

A

Can be good motivator if we have a solution for aesthetic

40
Q

options for lower anterior prosthetic replacement

A
  • PL co/cr
  • Bridge
  • Implants - not good for diabetics
  • resin bonded bride
41
Q

why would you build rest seats and guide planes into crowns

A

continguency

have option for CoCr in future

esp for perio pt as still potential for tooth loss

42
Q

bonded wire retainer used in SPC

A

to prevent drifting of mobile teeth

esp if there has been poor prognosis teeth extracted in arch

43
Q

what can be added to reduce spacing on upper anteriors

A

composite

44
Q

how long will perio tx last

A

perio pt is pt for life

active perio tx can vary in length until get pt in a stable state (PPD under 4mm)

SPC after that - can be carried out by GDP

BDS3 Perio (7 decks)

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