Treatment Plan and Phase 1 Therapy

Question 1

What is the sequence of periodontal treatment?

Answer 1

1. comprehensive exam and diagnosis
2. preliminary phase (emergency tx)
3. nonsurgical phase (phase 1 tx)
4. surgical phase (phase 2 tx) if necessary
5. restorative phase (phase 3)
6. maintenance phase (phase 4)

Question 2

during which phase do you extract hopeless teeth?

Answer 2

phase 1

Question 3

what are the 4 classification sof abscesses? describe them briefly

Answer 3

1. Periodontal: infection located contiguous to periodontal pocket
2. Gingival: infection located to the marginal gingiva and interdental tissues
3. Periapical: associated with endodontic disease usch as periapical periodontitis
4. Pericoronal: associated with the crown of a partially erupted tooth

Question 4

Ddx of periodontal and periapical abscesses

comment on: pulp vitality, swelling, pain, sensitivity

Answer 4

Periodontal abscess

• associated with preexisting periodontal pocket, xrays show periodontal angular bone loss and furcation radiolucency
• VITAL pulp
• swelling included gingival tissue, with occasional fistula
• pain is usually dull and localized
• sensitivity to percussion may or may not be present

Periapical abscess

• tooth may have large restoration
• may have no periodontal pocket or narrow pockets present
• NON VITAL tooth
• swelling often localized to apex, with a fistulous tract
• pain often severe and difficult to localize
• sensitivity to percussion

Question 5

What are the tx options for periodontal abscess? (5)

Answer 5

• drainage through pocket retraction on incision
• Scaling and root planing
• periodontal surgery
• systemic antibiotics
• tooth removal

Question 6

What are indications for antibiotic treatment for acute periodontal abscess? (5)

Answer 6

1. cellulitis (nonlocalized, spreading infection)
2. deep, inaccessible pocket
3. fever
4. regional lymphadenopathy
5. immunocompromised patient

Question 7

What is involved in maintenance phase? (phase 4)

Answer 7

control plaque and calculus, control pockets and inflammation, occlusion, tooth mobility, and other pathologic changes

Question 8

List 5 local factors that affect healing in phase 1

Answer 8

1. bacteria in plauqe
2. excessive tissue manipulation or trauma during treatment
3. foreign body present (i.e. excess cement from provisional restoration)
4. compromised blood supply
5. smoking

Question 9

List 4 systemic factors that can affect healing in Phase 1

Answer 9

1. age (atherosclerotic vascular changes and reduction in blood supply?)
2. insufficient nutrients
3. hormonal change
4. stress

Question 10

In terms of healing after non-surgical periodontal therapy, how do you define Repair and Long Junctional Epithelium?

Answer 10

Repair: healing of a wound by tissue that does not fully restore the architecture or function of the part. NO new cementum, PDL, or alveolar bone

Long Junctional Epithelium: if the eptihelium proliferates along the tooth surface before the other tissues reach the area, the result will be a LJE.