Treatment Step 3 & Treatment Step 4 Flashcards
What are the components of Step 1 in periodontal therapy?
- Education/explanation.
- Oral hygiene instruction (OHI).
- Risk factor control.
- Professional mechanical plaque removal (PMPR) of accessible plaque and calculus.
- Arrangement for review.
What additional measures are included in Step 2 for pockets >4mm?
Subgingival instrumentation, sometimes with adjunctive measures (e.g., CHX chips, local/systemic antibiotics). Routine antibiotic therapy is not advised.
What are the advanced interventions in Step 3?
- Repeated subgingival instrumentation in residual pockets.
- Periodontal surgery:
Access flap.
Resective.
Regenerative (based on patient, tooth, and defect suitability).
What is the goal of Step 4 (SPT)?
To provide risk-adapted supportive therapy at intervals of 3–12 months, monitor local/systemic risk factors, and maintain a permanent state of PMPR. A periodontal patient requires ongoing supportive care.
What is re-evaluated after Steps 1–3?
Pocket depths.
Patient engagement in self-care.
Bleeding on probing (BoP).
Endpoint goal: pocket probing depths (PPD) ≤4mm without BoP.
What defines treatment success in periodontal therapy?
Good oral hygiene.
No BoP.
No pockets >4mm.
No increasing tooth mobility.
A functional and comfortable dentition.
Why is patient consent critical for periodontal treatment?
Advanced treatment depends on effective plaque removal at home. Patients must achieve plaque scores <20% and bleeding scores <10%.
How are decisions made at re-evaluation?
oral hygiene/ inflammation
Poor oral hygiene and inflammation: Identify cause, provide supportive care, or repeat therapy.
Good oral hygiene, resolved inflammation: Proceed with supportive care and treatment plan.
Good oral hygiene, persistent deep pockets with BoP: Consider surgical access or repeated root surface debridement (RSD).
What factors influence the decision to perform periodontal surgery?
- Patient-specific factors: smoking, compliance, oral hygiene, systemic disease.
- Site-specific factors: access, soft/hard tissue conditions, tooth prognosis.
- Availability of specialist care and patient preference.
What happens during the re-evaluation after Step 1?
- Assess oral hygiene and engagement.
- Evaluate pocket depths and any BoP.
- Determine if the patient is ready to proceed to Step 2.
What is assessed during re-evaluation after Step 2?
- Pocket depth reduction.
- Patient compliance with oral hygiene.
- Persistent inflammation or deep pockets with BoP may indicate the need for further intervention (Step 3).
What determines if Step 3 is needed?
- Residual pockets after Step 2.
- Depth of pockets (e.g., PPD ≥6mm may warrant surgical intervention).
- Suitability of the patient, tooth, and defect for surgery.
What are the treatment options in Step 3?
- Repeated subgingival instrumentation for PPD 4–5mm.
- Surgical approaches (e.g., access flap, resective, regenerative techniques) for PPD ≥6mm.
What is the role of Step 4 in periodontal care?
- Risk-adapted intervals for monitoring and intervention.
- Permanent supportive periodontal therapy (SPT) to prevent disease progression.
What is considered the ideal endpoint in periodontal therapy?
No pockets >4mm.
Pockets ≤4mm without BoP.
BoP <10%.
Functional and comfortable dentition.
Plaque scores <20% or patient-specific targets.
What factors are considered when deciding between surgery, repeated PMPR, or proceeding to Step 4?
Patient compliance and preferences.
Systemic conditions.
Tooth/site prognosis.
Specialist availability.
What are the objectives of Step 4: Supportive Periodontal Care?
- Maintain periodontal health.
- Detect and treat recurrence.
- Maintain an acceptable level of disease.
- Manage tooth loss.
Which patients require supportive periodontal care, and how is it communicated?
Patients who have undergone periodontal treatment.
GDPs receive a letter recommending 3-month intervals for SPT, which includes:
Supra- and subgingival plaque/calculus removal.
Oral hygiene instruction as needed.
Periodontal pocket probing depth reviews at 12-month intervals.
What are the risks of inadequate SPT or missing recall appointments?
Non-compliant patients have a 5.6x higher risk of tooth loss.
After regenerative therapy, patients without SPT are 50x more likely to experience probing attachment loss.
What is included in the examination phase of supportive care?
Medical history updates.
Pathological examination of oral mucosa.
Assessment of:
- Oral hygiene status.
- Gingival and pocket depth changes.
- Tooth mobility, occlusion, and caries.
- Restorative, prosthetic, and implant status.
What treatments are included in supportive periodontal care?
Oral hygiene reinforcement.
Supragingival scaling.
Root surface debridement.
Polishing.
What occurs during the report and scheduling phase of supportive care?
Writing the report in the patient chart.
Discussing findings with the patient.
Scheduling:
Next recall visit.
Additional periodontal treatment.
Restorative/prosthetic treatment (if needed).
Why should normal sites with shallow sulci (1–3mm) not be instrumented?
Repeated subgingival scaling in normal sites can cause significant attachment loss.
What factors can lead to the recurrence of periodontal disease?
Poor plaque control.
Infrequent SPT attendance.
Inadequate/insufficient treatment.
Incomplete calculus removal in hard-to-access areas.
Systemic diseases affecting host resistance.
