Supportive Therapy

Question 1

what is supportive therapy

Answer 1

1. therapeutic measures to support patients OWN EFFORTS to control + prevent perio infection

the successful periodontal outcome comes down heavily to the contribution of patient and their regular removal of soft deposits!

2. maintenance to prevent relapse/ RECURRENCE after the perio therapy has been completed

Question 2

various studies examined the effectiveness of SPT(Axellson, Lindhe). summarise key conclusions
from these studies

Answer 2

without FREQUENT RECALLS, patients will tend to return to OLD OHI practises after a short period of time

through SPT we can REDUCE CARIES

compliance rate is low amongst perio patients

Question 3

a 26 year study on dentally aware Norwegian males was carried out to compare the ROLE of gingival inflammation on CAL. what were the findings

Answer 3

teeth with inflamed gingiva have more CAL

GI=2 had 70% more CAL than non inflamed sites

GI=2 had more tooth loss than GI=0

sub-gingival calculus formation increased the progression from gingivitis to periodontitis

Question 4

SPT is 1 hour. describe layout in this hour

Answer 4

1. 10/15 min= examine, re-evaluare, diagnosis
2. 5-7 min= motivation, re-instruct
3. 30-40 min= instrumentation
4. (may need second appointment for…) treatment of RE-infected sites such as RSD with LA, local antimicrobials, or small surgicals
5. 8 min= polishing, fluorides, determine future visit

Question 5

in spt, as part of the examination/ evaluation, what would you do

Answer 5

already have a baseline so would carry out indices…

• gingival indices, pocket depth, BOP, suppuration, furcation, mobility, recession, attachment levels

all marginal bleeding/ plaque free score= >80%
smoking should be reduced to 10 a day
PPD= <5mm
no BOP/ suppuration, furcation etc

Question 6

as part of OHI, you need to tell the patient that healing may result in …

Answer 6

change in gingival morphology

Question 7

what is the function of re-instrumentation (scaling etc) as part of SPT

Answer 7

to disrupt the plaque flora, it will then take time to establish complex and more pathogenic plaque

it allows residual/ newly formed calculus to be removed

Question 8

what may scaling not be good to do every time you see a patient
NB. should avoid repeated instrumentation if possible

Answer 8

only focus on sites which would benefit

repeated sub-gingival scaling may leave grooves and furrows on root surface and act as PRFS

Question 9

BOP score meaning of <10%, 25%, >25%

Answer 9

<10%= low risk of recurrence

25%= cut off point between patients with perio stability for 4 years and those with recurrent disease

> 25%= high risk of recurrence

Question 10

the absence of bleeding is a reliable predictor for which things

Answer 10

periodontal stability

30% predicture for future CAL

if site bleeds repeatedly= increased likelihood of progression

Question 11

risk assessment is important since each patient has different risk factors, each tooth and each site on the tooth does too. consider these

Answer 11

patient= different systemic risk factors and local factors (smoking, compliance, age, OH, % sites bleeding, partial dentures, prevalence of residual pockets)

tooth= position in arch, morphology, PRFs, furcation involvement
—–> molar with deep pockets and furcation is more at risk than anterior teeth

site on tooth= BOP, pockets etc

Question 12

what are the periodontal risk assessment models

Answer 12

pre -visor: based on 11 risk parameters:
age, smoking, diabetes, furcations, sub-gingival restorations, history of perio surgery, PD, BOP, root calculus, radiographic bone height, vertical bone loss

PRA: based on 6 factors:
%BOP, PD >or equal to 5mm, tooth loss, systemic/ genetic conditions, radiographic bone loss to age ratio, smoking

Question 13

when should SPT start

Answer 13

after active therapy (initial, corrective)
12 weeks (6-8 weeks if under time pressure)
patients own plaque control should be good

—-> bone re-models over many years

—->attachment levels are stable after 6 months

—-> can disrupt healing if scale sub-gingivally in the 1st 6 weeks

Question 14

frequency of recall/ SPT

Answer 14

if the patient has JUST finished active perio treatments then…

3 months INTERVAL is recommended(especially in 1st year)
then, if perio condition remains stable, 6 months INTERVAL in following years

NB. no fixed rule, should tailor it to the patients needs
you may need to allocate recall time to certain tooth e.g.