Treatments introduction Flashcards
What causes plaque induced gingivitis and periodontitis
The formation and persistance of biofilm
What occurs in the biofilm to prompt progression to periodontitis
The biofilm becomes dysbiotic
What is calculus
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
What are the clinical manifestations of plaque induced gingivitis
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
What are the clinical manifestations of periodontitis
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
What are the main aims of periodontal treatment
Arrest the disease process
Ideally, to regenerate lost tissue
To maintain periodontal health long term
RESULT = Keep teeth
What is the basis of therapy for periodontitis
Examination
Assessment of risk factors
Diagnosis
What is BPE
A screening tool used to check for periodontal disease for early diagnosis
What is the difference between the WHO and UNC BPE probes
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
What teeth are not examined in most BPE screening
The 3rd molars UNLESS the 1st and 2nd are missing
How many teeth much be in each sextant to qualify for recording
atleast 2
What are the treatmant recomendations for each BPE score
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
Does evidence of interdental recession mean there is no need for a BPE
No even if there is evidence of this the current regulation requires a BPE forall new patients
what does FMPC stand for
full mouth pocket chart
What are the next steps are BPE
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
Why are radiographs taken
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
What do horizontal bitewings provide a view of
as long as alveolar crest is visible might show early localised bone loss
Presence of poorly contoured restorations
Subgingival calculus
What can vertical bitewings show
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
What is the prefered radiograph in periodontal assessment
Periapical
2-dimensional picture of bone levels in relation to both CEJ’s and total root length, identify furcation involvement; possible endodontic complications
What are the steps in a treatment plan
Immediate/ Emergency care
Initial/disease control
Re-evaluation
Reconstructive
Maintenance/Supportive care
What things constitute risk factor intervention
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
What is Ramfjord’s teeth
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
What are the 3 surfaces of the 6 ramfjord’s teeth
Interproximal
buccal
palatal/lingual
Within a modified plaque score what are the possible scores and the meaning of each
2 = visible plaque without use of probe
1 = no visible plaque but a probe skimmed over tooth surface reveals plaque
0 = no plaque
How is the modified plaque score calculated
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)
How is patients engagement recorded using a modified plaque score
Recorded at every appointment to see if percenatge remains or increases (indicates whether or not patient is putting advice into practice)
How is a bleeding score different to a plaque score
Each tooth is split into 4 instead of 3:
Mesial
Distal
Buccal
Ligual/palatal
Only 2 possible scores
0-no bleeding
1-bleeding
How is the probe used to carry out a modified bleeding score
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.
What is the difference between marginal bleeding and bleeding on probing
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.
What is a marginal bleeding score divided by
24
6 teeth x 4 surfaces x 1 (max score)
Is a full periodontal assessment required with a BPE of 3
No
Treatment is carried out first and then an assessment should be carried out
What must be altered if there is a missing tooth with no alternative
the maximum score
ex - Plaque score now 30
Bleeding score now 20
What scores indicate an enaged patient
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)
Which score is more important in determining engagement in smokers
Bleeding score
How can you deal with non-engaging patients
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
What does periodontal charting reveal
Probing depth
Recession - works out attachment level
Bleeding on probing – disease activity
Mobility
Furcation
What does probing depth indicate
the difficulty of treatment and the likelihood of recurrence
What are attachment levels
a measure of tissue destruction (pre-treatment) and the extent of repair (post-treatment)
How is furcation measured
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)
What are the grades of tooth mobility
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.
What happens if the charting is wrong
If the charting is wrong deep pockets won’t be treated and disease will progress
What factors can influence manual probing measurements
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
What are the S3 guidelines AIMS
To reduce tooth loss associated with periodontitis
improve overall systemic health and quality of life
to improve quality of periodontal treatment in Europe
What are tje 4 working groups outlined by S3 guidelines
periodontitis stages I and II
Periodontitis Stage III
Periodontitis Stage III with intraosseous defects and/or furcations
Supportive periodontal care
