Perio treatment step 3 and 4

Question 1

what is step 1 for the BSP treatment of perio diseases?
number I

Answer 1

building foundations for optimal treatment outcomes

I: explain disease, risk factors and tx alternatives, risk and benefits including no treatment

Question 2

what is step 1 for the BSP treatment of perio diseases?
number II

Answer 2

building foundations for optimal treatment outcomes

II: explain importance of OHI, encourage and support behaviour change for OH improvement

Question 3

what is step 1 for the BSP treatment of perio diseases?
number III

Answer 3

building foundations for optimal treatment outcomes

III: reduce risk factors including plaque retentive features , smoking cessation and diabetes control interventions

Question 4

what is step 1 for the BSP treatment of perio diseases?
number IV

Answer 4

building foundations for optimal treatment outcomes

IV: provide individually tailored OH advice including interdental cleaning.
+/- adjunctive efficacious toothpaste and mouthwash,
+/- professional mechanical plaque removal (PMPR) including supra and subgingival scaling of clinical crown

Question 5

what is step 1 for the BSP treatment of perio diseases?
number V

Answer 5

building foundations for optimal treatment outcomes

V: select recall period following published guidance and considering risk factors such as smoking diabetes

Question 6

what is step 1 for the BSP treatment of perio diseases?
number VI

Answer 6

building foundations for optimal treatment outcomes

VI: oral health educator (I,II), hygienist therapist (I-IV), dentist, practitioner accredited for level 2 and 3 care (I-V)

Question 7

what do you do after step 1 for bsp guidelines of perio?

Answer 7

re-evaluate
non engaging patient repeat step 1
engaging patient move to step 2
consider referral

Question 8

what is step 2 of bsp guidelines for perio?
Number 1

Answer 8

subgingival instrumentation (root surface debridement/ PMPR on root)
I: reinforce OH, risk factor control, behaviour change

Question 9

what is step 2 of bsp guidelines for perio?
Number 2

Answer 9

subgingival instrumentation (root surface debridement/ PMPR on root)

II: subgingival instrumentation, hand or powered (sonic/ ultrasonic) either alone or in combination

Question 10

what is step 2 of bsp guidelines for perio?
Number 3

Answer 10

subgingival instrumentation (root surface debridement/ PMPR on root)

III: use of adjunctive systemic antimicrobials determined by practitioner accredited for level 2 and 3 care

Question 11

if step unstable and you go to step 3 for bsp perio guidelines what do you do?
Number I

Answer 11

managing non-repsonding sites:
I: reinforce OH, risk factor control, behaviour chnage

Question 12

what do you do after step 2 of bsp perio guidelines?

Answer 12

re-evaluate after 3 months
unstable -> step 3
stable -> step 4

Question 13

if step unstable and you go to step 3 for bsp perio guidelines what do you do?
number II

Answer 13

managing non-repsonding sites:

II: moderate (4-5mm) residual pockets - re-preform subgingival instrumentation

Question 14

if step unstable and you go to step 3 for bsp perio guidelines what do you do?
number III

Answer 14

managing non-repsonding sites:

III: deep residual pocketing (6>=mm) consider alternative causes

Question 15

if step unstable and you go to step 3 for bsp perio guidelines what do you do?
number IV

Answer 15

managing non-repsonding sites:

IV: consider referral for pocket management or regenerative surgery

Question 16

if step unstable and you go to step 3 for bsp perio guidelines what do you do?
number V

Answer 16

managing non-repsonding sites:

V: if referral not possible, re-perform subgingival instrumentation (if all sites stable after step 3 proceed to step 4)

Question 17

if stable and you to step 4. what step 4 for the bsp perio guidelines?
Number I

Answer 17

maintenance
I: supportive periodontal care strongly recommended

Question 18

if stable and you to step 4. what step 4 for the bsp perio guidelines?
Number II

Answer 18

maintenance

II: Reinforce OH, risk factor control, behaviour change

Question 19

if stable and you to step 4. what step 4 for the bsp perio guidelines?
Number III

Answer 19

maintenance

III: regular targeted PMPR as required to limit tooth loss

Question 20

if stable and you to step 4. what step 4 for the bsp perio guidelines?
Number IV

Answer 20

maintenance

IV: consider evidence based adjunctive efficacious tooth paste and or mouthwash to control gingival inflammation

Question 21

after step 4 of bsp perio guidelines?

Answer 21

maintenance recall individually tailored intervals from 3 -12 months

Question 22

how do you define if a pt is engaging?

Answer 22

engaging - plaque levels <= 20 percent and bleeding levels <30 percent or 50 percent improvement

Question 23

what to do for decision making at re-evaluation? If he has Poor OH, persistent inflammation

Answer 23

 identify reason for poor OH, then supportive care or repeat cause-related therapy

Question 24

what to do for decision making for this perio lecture? Good OH, inflammation resolved?

Answer 24

 supportive care & proceed with treatment plan

Question 25

what to do for decision making for this perio lecture? Good OH, persistent deep pockets with BOP?

Answer 25

 consider surgical access or repeat RSD, then re-evaluate

Question 26

what is the ideal endpoint?

Answer 26

 No pockets > 4mm
 No pockets = 4mm with BOP
 BOP < 10%
 Functional and comfortable dentition
 Plaque scores < 20% (or target for patient)

 But not all patients will reach these….but they can still maintain a functional dentition…

Question 27

why supportive peridontal care?

Answer 27

 Patients who are not maintained in a supervised recall program subsequent to active treatment show obvious signs of recurrent periodontitis
 The more often patients present for recommended supportive periodontal treatment (SPT), the less likely they are to lose teeth.
 Treated patients who do not return for regular recall are at 5.6 times greater risk for tooth loss than compliant patients.

Question 28

how is supportive periodontal car done?

Answer 28

3 separate parts.
 Part I – exam
- MH changes
- oral pathologic examination oral hygiene status (plaque chart)-
- gingival changed
- pocket depth changes
- mobility changes
- occlusal changes
- dental caries
- restorative, prosthetic and implant status

 Part II – treatment
- oral hygiene reinforcement
- supra gingival scaling
- root surface debridement
- polishing

 Part III: report, cleanup and scheduling
- write report in chart
- discuss report with pt
- schedule next recall visit
- schedule further periodontal tx
- schedule or refer for restorative or prosthetic tx

Question 29

what is part 1 exam of the supportive periodontal care?

Answer 29

• Similar to the initial evaluation of the patient
• Updating medical history
• Oral mucosa inspected for pathologic conditions
• Evaluation of restorations, caries, prostheses, occlusion, tooth mobility, bleeding on probing, and periodontal and periimplant probing depths
• Analysis of the current oral hygiene status of the patient is essential.
• The dentist primarily looks for changes that have occurred since the last evaluation

Question 30

what is part II treatment of supportive periodontal care?

Answer 30

• Required scaling and root surface debridement (supra and subgingival PMPR) are performed, (based on pocket chart/plaque chart).
• don’t instrument sites non-deep sites with no calculus as could create attachment loss

Question 31

causes for recurrence of perio disease?

Answer 31

• Often can be traced to inadequate plaque control on the part of the patient or failure to comply with recommended SPT schedules.
• Inadequate or insufficient treatment that has failed to remove all the potential factors favoring plaque accumulation.
• Incomplete calculus removal in areas of difficult access.
• Inadequate restorations placed after the periodontal treatment was completed.
• Failure of the patient to return for periodic checkups. This may be a result of the patient’s conscious or unconscious decision not to continue treatment or the failure of the dentist and staff to emphasize the need for periodic examinations.
• Presence of some systemic diseases that may affect host resistance to previously acceptable levels of plaque.