Updated S3 perio guidance

Question 1

What is the BSP guidelines an adaptation of?

Answer 1

EFP 4 step approach

Question 2

what are the 4 stages of the EFP approach?

Answer 2

1. risk factor management
2. subgingival debridement
3. reassessment
4. maintenance/ supportive perio therapy

Question 3

What is step 1 of the BSP S2-level guidlines?

Answer 3

building foundations for optimal treatment outcomes

Question 4

What are local risk factors controlled in step 1?

Answer 4

supra gingival biofilm control

Question 5

what are systemic risk factors controlled in stage 1?

Answer 5

smoking cessation and glycaemic control in patients with diabetes

Question 6

How is supra-gingival biofilm controlled?

Answer 6

oral hygiene instruction
PMPR
removal over restorative overhangs

Question 7

What should be the outcomes of an engaging patient?

Answer 7

favourable improvement in oral hygiene 50% reduction in plaque and bleeding scores
OR
plaque scores less than or equal to 20% and bleeding score less than or equal to 30%
OR
patient has met targets outlined by healthcare professionals

Question 8

What is step 2 in the BSP S3 guidlines?

Answer 8

subgingival instrumentation

Question 9

What is subgingival debridement known as?

Answer 9

PMPR

Question 10

What is the aim of subgingival debridement in step 2?

Answer 10

disrupt the dysbiotic subgingival biofilm and remove subgingival calculus

Question 11

In what instance is full mouth PMPR not suitable and why?

Answer 11

systemic disease due to increased systemic inflammation

Question 12

what should not be used to treat periodontitis?

Answer 12

systemic antibiotics

Question 13

when may systemic antibiotics be used in periodontitis patients?

Answer 13

grade C cases
younger patients

Question 14

when may patients be re-evaluated (step2)?

Answer 14

3 months

Question 15

what is step 3 of the BSP S3 guidelines?

Answer 15

managing non-responding sites

Question 16

why may treatment fail?

Answer 16

• inadequate oral hygiene
• inadequate PMPR

Question 17

what type of pockets may we referred for perio surgery?

Answer 17

deep residual pockets especially associated complex anatomy

Question 18

what is considered complex perio anatomy?

Answer 18

vertical bony defects, furcations

Question 19

what would happen if referral isnt possible for unmanageable sites?

Answer 19

treatment under palliative supportive care

Question 20

What is step 4 of the BSP S3 guidelines?

Answer 20

maintenance

Question 21

what is maintained in step 4?

Answer 21

risk factors especially OHI and PMPR

Question 22

Why is caution needed with palliative supportive periodontal care?

Answer 22

risk of accusation of supervised neglect

Question 23

what does supra-gingival PMPR replace?

Answer 23

scale and polish

Question 24

How far may supra-gingival PMPR enter the gingival crevice?

Answer 24

2-3mm

Question 25

Why may supragingival PMPR go subgingivally?

Answer 25

to get underneath supra gingival calculus

Question 26

What replaces “root surface debridement”?

Answer 26

sub-gingival PMPR

Question 27

What depths of pockets would need subgingival PMPR?

Answer 27

more than 4mm

Question 28

What would you need to rinse with before subgingival PMPR?

Answer 28

chlorhexadine moutwash

Question 29

Why would you rinse with chlorhexadine mouthwash before subgingival PMPR?

Answer 29

reduce bacterial load in aerosol