Treatment And Management Of Gingival And Perio Diseases

Question 1

What is the definition of periodontal diseases

Answer 1

A group of diseases affecting the periodontal tissues, representing an immune reaction (innate and adaptive) to adjacent microbial plaque

Question 2

What does periodontitis start as

Answer 2

Periodontitis

Question 3

Why are antibiotics not commonly given out for periodontal disease

Answer 3

Antimicrobial resistance

Question 4

Periodontal health is…

Answer 4

The outcome of the balance between bacteria of the dental plaque and the host immune system

Question 5

The periodontal disease develops from…

Answer 5

The interaction of dental biofilm with the immune system of the host which brings implications for the treatment

Question 6

What are the treatment strategies for periodontal disease

Answer 6

• mechanical disruption
• systemic antibiotics or local Antimicrobials
• host modulation therapy

Question 7

What is the main goal of periodontal treatment

Answer 7

• plaque control
• removal of plaque retention factors

Question 8

What is a score of 0 for periodontal disease

Answer 8

Pockets <3.5mm
No calculus/overhangs, no bleeding on probing (black band entirely visible)

Question 9

What is a score of 1 for periodontal disease

Answer 9

Pockets <3.5mm
No calculus/overhangs, bleeding on probing (black band visible)

Question 10

What is a score of 2 of Peridontal disease

Answer 10

Pockets <3.5mm
Supra or subgingival calculus/overhangs (black band entirely visible)

Question 11

Describe a score of 3 for periodontal disease

Answer 11

Probing depth 3.5-5.5mm
Black band partially visible, indicating pocket of 4-5mm

Question 12

What is a score of 4 for periodontal disease

Answer 12

Probing depth >5.5mm

Black band disappears indicating a pocket of 6mm or more

Question 13

Describe a score of * in periodontal disease

Answer 13

Furcation involvement

Question 14

What is the difference between supragingival biofilm and sublingual biofilm

Answer 14

Supragingival plaque on tooth’s surface, subgingival plaque in the pocket below the gingival

Question 15

What are the two terms used that manage plaque in periodontal disease

Answer 15

Supra gingival PMPR
Sub gingival PMPR

Question 16

What does PMPR stand for

Answer 16

Professional mechanical plaque removal PMPR

Question 17

Describe step 1 of the treatment plan for periodontal disease

Answer 17

Control of local (calculus, overhangs ect) systemic (diabetes, smoking)
Risk factors

Supragingival professional mechanical plaque removal (PMPR)

Question 18

Describe the initial phase in periodontal treatment

Answer 18

• examination and proper diagnosis
• oral hygiene instruction
• elimination of the local retentive factors mostly overhanging fillings and calculus
• PMPR

Additionally
- extracting teeth with bad prognosis
- endodontic treatment (endo-perio lesions)
- initial occlusal correction (early contacts and traumatic occlusion)

Question 19

Give some examples of what oral hygiene instruction you would give for periodontal disease

Answer 19

• tooth brushing technique, modified bass technique
• flossing
• interdental brushes

Question 20

What can be used for supra-gingival PMPR

Answer 20

Sonic scalers
Ultrasonic scalers - piezoelectric and magnetostrictive

Question 21

What is the working edge of the scaler

Answer 21

Lateral surfaces 2-3 last mm of the tip

Question 22

What angle should the scaler tip be placed at

Answer 22

0-15 degrees angle between the working edge and the tooth’s surface, slight pressure applied

Question 23

Describe step 2 of non surgical periodontal therapy

Answer 23

• subgingival PMPR
• teeth splinting
• further correcting of traumatic occlusion
• dentine hypersensitivity prevention
• reinforcement of OH
• controlling modifiable risk factors

Question 24

What are some advantages of local antimicrobials

Answer 24

Reduced systemic dose
High local concentration
Superinfections such as clostridium difficile, unlikely
Drug interactions unlikely
Site specific
Patient compliance not an issue as applied by healthcare provider
Can utilise agents which can be utilised systemically eg chlorexidine

Question 25

What are some disadvantages of local antimicrobials

Answer 25

• expensive
• still require RSD or biofilm disruption
• limited indications

Question 26

Name some local Antimicrobial antibiotics

Answer 26

1) arestin - 1mg minoyccline HCL microspheres
2) atridox - doxycycline hyclate 10%
3) elyzol - 25% metronidazole

Question 27

What is periochip

Answer 27

A small chip containing the Antimicrobial agent chlorohexidine digluconate, it eliminates the disease causing bacteria and is used in combination with mechanical removal of plaque in the treatment of chronic periodontal disease in adults

Question 28

What happens if there is improvement after 8 weeks of step 2

Answer 28

PPD < mm without BoP
Maintenance phase

Question 29

What happens if there is improvement but still some residual pockets after 8 weeks of step 2 completion

Answer 29

A) targeted PMPR
B) surgery step 3

Question 30

What happens if there is no improvement after 8 weeks of step 2 completion

Answer 30

Repeat the treatment from the beginning

Question 31

What is step 3 of periodontal treatment

Answer 31

Step 1 and 2 plus

Periodontal surgery - access flap, resecrective, regenerative

Only in cases with suitable patient tooth and defect factors

In certain cases - repeated subgingival instrumentation

Question 32

Describe step 4 of periodontal treatment and management

Answer 32

Supportive periodontal therapy (SPT)

Risk adapted intervals 3-12 months

Continuous monitoring of local and systemic risk factors

PMPR

Question 33

Give some examples of host modulation therapy

Answer 33

1) anti-cytokine and biological therapies
2) lipid mediators of resolution of inflammation
3) small molecules compounds
4) biphosphonates