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Perio > Treatments introduction > Flashcards

Treatments introduction Flashcards

1
Q

What causes plaque induced gingivitis and periodontitis

A

The formation and persistance of biofilm

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2
Q

What occurs in the biofilm to prompt progression to periodontitis

A

The biofilm becomes dysbiotic

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3
Q

What is calculus

A

Calcified deposits found attached to the surfaces of teeth and other solid structures – often brown or pale yellow
Is always covered by plaque biofilm
Is a plaque retentive factor

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4
Q

What are the clinical manifestations of plaque induced gingivitis

A

Change in colour of the gingivae​

Marginal gingival swelling​

Loss of contour(blunting) of interdental papilla​

Bleeding from the gingival margin on probing or brushing​

Plaque is present at gingival margin ​

No clinical attachment loss or alveolar bone loss​

Gingival sulcus measures 3mm or less from the gingival margin to the base of the junctional epithelium which is still at CEJ​

Clinical changes are reversible

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5
Q

What are the clinical manifestations of periodontitis

A

Loss of periodontal connective tissue attachment​

Gingival sulcus measures more than 3.0mm from the gingival margin to the base of the junctional epithelium which has migrated apically with the formation of a true periodontal pocket​

Alveolar bone loss

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6
Q

What are the main aims of periodontal treatment

A

Arrest the disease process​

Ideally, to regenerate lost tissue​

To maintain periodontal health long term

RESULT = Keep teeth

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7
Q

What is the basis of therapy for periodontitis

A

Examination
Assessment of risk factors
Diagnosis

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8
Q

What is BPE

A

A screening tool used to check for periodontal disease for early diagnosis

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9
Q

What is the difference between the WHO and UNC BPE probes

A

WHO probe​

A ball end 0.5mm in diameter ​

Black band from 3.5-5.5mm​

Second black band 8.5-11.5mm​

UNC probe​

15mm long​

markings at each mm and colour coding at the 5th, 10 th and 15th mm

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10
Q

What teeth are not examined in most BPE screening

A

The 3rd molars UNLESS the 1st and 2nd are missing

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11
Q

How many teeth much be in each sextant to qualify for recording

A

atleast 2

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12
Q

What are the treatmant recomendations for each BPE score

A

0 - No need for periodontal treatment ​

1 - Oral hygiene instruction (OHI) ​

2 - OHI, removal of plaque retentive factors, including all supra- and subgingival calculus ​

3 - OHI, root surface debridement (RSD) ​

4 - OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated. ​

    • OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated
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13
Q

Does evidence of interdental recession mean there is no need for a BPE

A

No even if there is evidence of this the current regulation requires a BPE forall new patients

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14
Q

what does FMPC stand for

A

full mouth pocket chart

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15
Q

What are the next steps are BPE

A

Radiographs for all Codes 3 &4 if justified​

Modified Plaque and Bleeding charts if necessary​

FMPC if one code 4 and/or evidence of interdental recession​

FMPC of code 3 sextant (SDCEP guidelines)​

Code 3 - initial therapy then FMPC of that sextant (BSP guidelines)​

Do not use for monitoring - BPE is based upon BOP and PPD, rather than recording attachment and bone loss ​

Do not use for implants

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16
Q

Why are radiographs taken

A

Aid diagnosis and helps with staging and grading of the disease ​

Helps determine prognosis of teeth​

Assessment of the morphology of affected teeth​

Pattern and degree of alveolar bone loss ​

Monitoring the long-term stability of periodontal health

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17
Q

What do horizontal bitewings provide a view of

A

as long as alveolar crest is visible might show early localised bone loss​

Presence of poorly contoured restorations​

Subgingival calculus

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18
Q

What can vertical bitewings show

A

Provides non distorted views of bone levels in realation to CEJ ​

Can provide better visualization of bone level than horizontal bitewings​

Difficult to position accurately

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19
Q

What is the prefered radiograph in periodontal assessment

A

Periapical
2-dimensional picture of bone levels in relation to both CEJ’s and total root length, identify furcation involvement; possible endodontic complications

20
Q

What are the steps in a treatment plan

A

Immediate/ Emergency care ​

Initial/disease control​

Re-evaluation

Reconstructive​

Maintenance/Supportive care

21
Q

What things constitute risk factor intervention

A

Diabetes – is it controlled ? ​

Medications that might cause gingival overgrowth ​

Dental attendance : has patient been seen by dental hygienist/therapist, if not why? Is it work commitments other priorities, lack of knowledge​

Smoking – what , how much, how long, if ex-smoker when did they stop. Current smokers address issue if they would like to quit – cessation advice should be given – direct NHS services​

Holistic approach – lifestyle factors- stress, poor diet

22
Q

What is Ramfjord’s teeth

A

Six index teeth, distributed in order to best reflect the condition of the whole mouth.
upper right 6
upper left 1
upperleft 4
lower right 4
lower right 1
lower left 6

23
Q

What are the 3 surfaces of the 6 ramfjord’s teeth

A

Interproximal
buccal
palatal/lingual

24
Q

Within a modified plaque score what are the possible scores and the meaning of each

A

2 = visible plaque without use of probe ​

1 = no visible plaque but a probe skimmed over tooth surface reveals plaque ​

0 = no plaque

25
Q

How is the modified plaque score calculated

A

Score given for each surface of the ramfjord’s teeth
Scores added together and divided by the maximum total of 36
​

If the patient is missing one of Ramfjord’s teeth – use the neighboring equivalent eg if 4 missing use 5; if 6 missing use 7. If no substitute available then record x and divide by 36 minus 6 (or more if more than one tooth not recorded)

26
Q

How is patients engagement recorded using a modified plaque score

A

Recorded at every appointment to see if percenatge remains or increases (indicates whether or not patient is putting advice into practice)

27
Q

How is a bleeding score different to a plaque score

A

Each tooth is split into 4 instead of 3:
Mesial
Distal
Buccal
Ligual/palatal

Only 2 possible scores
0-no bleeding
1-bleeding

28
Q

How is the probe used to carry out a modified bleeding score

A

To carry out the MBS, each of the six Ramfjord’s teeth should have a periodontal probe run gently at 45 degrees around the gingival sulcus in a continuous sweep. For up to 30 seconds after probing check for the presence or absence of bleeding.

29
Q

What is the difference between marginal bleeding and bleeding on probing

A

Marginal bleeding reflects how well the patient is able to carry out effective plaque control daily, whilst bleeding on probing from the base of the pockets indicates disease activity and periodontal breakdown.

30
Q

What is a marginal bleeding score divided by

A

24
6 teeth x 4 surfaces x 1 (max score)

31
Q

Is a full periodontal assessment required with a BPE of 3

A

No
Treatment is carried out first and then an assessment should be carried out

32
Q

What must be altered if there is a missing tooth with no alternative

A

the maximum score
ex - Plaque score now 30
Bleeding score now 20

33
Q

What scores indicate an enaged patient

A

If Less than 35% bleeding score​

AND ​

Less than 30% plaque score​

OR​

Greater than 50% improvement in both​

OR​

Patient meets target agreed by patient and clinician (which may be brush teeth twice per week/show up to appointments)

34
Q

Which score is more important in determining engagement in smokers

A

Bleeding score

35
Q

How can you deal with non-engaging patients

A

If patient is non-engaging subgingival PMPR should be delayed​

Patient should be informed​

Identify any barriers​

Continue with oral health education, motivation and behaviour change

36
Q

What does periodontal charting reveal

A

Probing depth ​

Recession - works out attachment level​

Bleeding on probing – disease activity ​

Mobility ​

Furcation

37
Q

What does probing depth indicate

A

the difficulty of treatment and the likelihood of recurrence

38
Q

What are attachment levels

A

a measure of tissue destruction (pre-treatment) and the extent of repair (post-treatment)

39
Q

How is furcation measured

A

grade 1 - initial furcation involvement (less than 1 third of the tooth width
grade 2 - Partial furcation, loss of support exceeds 1 third of the tooth width but does not include the total width of furcation
grade 3 - through and through involvement (probe can pass through the entire furcation)

40
Q

What are the grades of tooth mobility

A

0 - ‘Physiological’ mobility measured at the crown level. The tooth is mobile within the alveolus to approximately 0.1 – 0.2 mm in a horizontal direction. ​

1 - Increased mobility of the crown of the tooth to at the most 1 mm in a horizontal direction. ​

2 - Visually increased mobility of the crown of the tooth exceeding 1 mm in a horizontal direction. ​

3 - Severe mobility of the crown of the tooth in both horizontal and vertical directions impinging on the function of the tooth.

41
Q

What happens if the charting is wrong

A

If the charting is wrong deep pockets won’t be treated and disease will progress

42
Q

What factors can influence manual probing measurements

A

The resistance of the tissues​

Size, shape and tip diameter of the probe​

Site and angle of probe insertion​

Pressure applied​

Presence of obstructions such as calculus​

Patient discomfort

43
Q

What are the S3 guidelines AIMS

A

To reduce tooth loss associated with periodontitis ​

improve overall systemic health and quality of life​

to improve quality of periodontal treatment in Europe

44
Q

What are tje 4 working groups outlined by S3 guidelines

A

periodontitis stages I and II​

Periodontitis Stage III​

Periodontitis Stage III with intraosseous defects and/or furcations​

Supportive periodontal care

45
Q
A

Perio (6 decks)

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