Week 2 Non-surgical Perio Therapy

Question 1

Define Non-Surgical Periodontal Therapy (NSPT).

Answer 1

plaque removal, plaque control, scaling, root planing, and adjunctive chemical agents to treat periodontitis without surgery.

Question 2

Define Scaling

Answer 2

Removal of plaque, calculus, and stains from the tooth surfaces.

Question 3

Define Root Planing

Answer 3

Removal of rough or contaminated root surfaces to create a smooth surface, facilitating healing​

Question 4

Define Periodontal debridement

Answer 4

Removal of plaque, calculus, and diseased tissue from the periodontium

Question 5

Define Full mouth debridement

Answer 5

Removal of plaque and calculus from all tooth surfaces to perform a comprehensive evaluation

Question 6

Define Prophylaxis

Answer 6

Routine cleaning to remove coronal plaque, calculus, and stains, primarily for preventing gingivitis

Question 7

Define Periodontal maintenance

Answer 7

Ongoing care to prevent disease progression after active treatment​

Question 8

Define Coronal Polishing

Answer 8

Polishing the tooth surface to remove stains and biofilm​

Question 9

Define Selective Polishing

Answer 9

Polishing only stained or biofilm-affected areas​

Question 10

Define gingival curettage

Answer 10

Removal of inflamed soft tissue lining of the periodontal pocket

Question 11

What is the rationale for Non-Surgical Periodontal Therapy (NSPT)?

Answer 11

The rationale is to remove the etiologic agents, reduce gingival inflammation, decrease probing depths, and achieve clinical attachment gains.

Question 12

Describe the multifaceted approach to treatment

Answer 12

Treatment includes controlling bacterial infection, eliminating local contributing factors (e.g., calculus), managing systemic factors (e.g., diabetes), and reinforcing oral hygiene

Question 13

Discuss the role that plaque biofilm removal effects NSPT

Answer 13

Plaque biofilm is the primary cause of periodontal disease, and its removal is essential to disrupt the bacterial colonies. Supragingival removal alone is insufficient for deep pockets

Question 14

Describe the specific plaque hypothesis and periodontal pathogens

Answer 14

Certain bacteria such as Aggregatibacter Actinomycetemcomitans
Porphyromonas gingivalis
Treponema denticola
Tannerella forsythia
plays a role in periodontal disease

Question 15

How does calculus affect periodontal disease and NSPT?

Answer 15

Calculus serves as a surface for bacterial attachment, contributing to inflammation. Its removal is crucial, although deep pockets make complete removal challenging.

Question 16

What are the short-term goals of NSPT?

Answer 16

The short-term goals include oral hygiene instruction, removal of plaque biofilm, calculus, and stains, debridement and smoothing of root surfaces, and decreasing bacterial load.

Question 17

What are the long-term goals of NSPT?

Answer 17

The long-term goals include maintaining gingival health, reducing gingival inflammation, reducing probing depths, gaining clinical attachment, and preventing disease recurrence.

Question 18

Explain the limitations of calculus removal and expectations of clinical proficiency

Answer 18

Calculus removal becomes progressively difficult in deeper pockets. Even the most skilled clinicians may leave residual deposits, but small deposits do not necessarily cause treatment failure

Question 19

What are two of the four main goals of NSPT?

Answer 19

) Minimize the bacterial challenge to the patient.
2) Eliminate or control local contributing factors for periodontal disease.

Question 20

How much time is needed to perform NSPT?

Answer 20

Time varies depending on factors such as pocket depth and deposit tenacity, but typically a maximum of 10 minutes per tooth is required.

Question 21

What instruments are used during NSPT?

Answer 21

hand instruments: curettes (universal and area-specific), sickle scalers, and
powered instruments: ultrasonic and sonic scalers.

Question 22

What is the goal of root planing?

Answer 22

The goal is to remove rough or contaminated root surfaces to promote healing and reattachment of the gingiva.

Question 23

How does root texture affect scaling and gingival health?

Answer 23

Rough root surfaces can trap plaque, inhibiting healing. Smoothing the root helps reduce plaque retention

Question 24

Differentiate between periodontal debridement and full-mouth debridement.

Answer 24

Periodontal debridement is the removal of plaque, calculus, and diseased tissue from the periodontium,
while full-mouth debridement is an initial cleaning to allow for a comprehensive evaluation.

Question 25

Differentiate between scaling, root planing, periodontal debridement and NSPT.

Answer 25

• Scaling and root planing: Targets removal of calculus and smoothing of the root surface
• Periodontal debridement: Involves the removal of plaque, calculus, and diseased tissue.
• NSPT: Encompasses scaling, root planing, plaque control, and adjunctive chemical therapy.

Question 26

What is the difference between closed curettage and inadvertent curettage?

Answer 26

Closed curettage is the intentional removal of inflamed soft tissue from the pocket wall, while
inadvertent curettage is the accidental removal of pocket lining during SRP.

Question 27

What is the role of gingival curettage in NSPT?

Answer 27

Gingival curettage has no additional benefit compared to SRP alone and is not commonly endorsed.

Question 28

What are the expectations of healing after NSPT?

Answer 28

Healing includes reduced inflammation, reattachment of the junctional epithelium, reduced pocket depths, and is greatest 4-6 weeks after NSPT.

Question 29

What is gingival curettage?

Answer 29

Scraping or cleaning the walls of a cavity or surface by means of a curette, including the junctional epithelium and the underlying inflamed connective tissue

Question 30

How do microorganisms repopulate after NSPT?

Answer 30

Bacterial repopulation occurs in a specific order,
* Streptococcus and Actinobacillus
* Veillonella, Bacteriodes, Porphyromonas,
* Prevotella, Fusobacterium
* Capnocytophaga
* Spirochetes
shifting from gram-negative to gram-positive bacteria, and can fully repopulate in 6 months.

Question 31

What are the limitations of NSPT healing?

Answer 31

Healing may be limited by factors such as poor plaque control, severe attachment loss, root anatomy, and systemic conditions, occlusal forces, mobility, diagnostic deficency and clinican skill.

Question 32

What are common reasons for failure of gingiva to respond to NSPT?

Answer 32

Common reasons include diagnostic deficiencies, poor plaque control, residual calculus, or uncorrected contributing factors.

Question 33

How can you evaluate successful NSPT?

Answer 33

monitoring pocket depths, clinical attachment levels, bleeding on probing, and radiographic changes such as crestal lamina dura reappearance.