BPE

Question 1

what is the aetiological agent of gingivitis and periodontitis

Answer 1

plaque

Question 2

what is gingivitis

Answer 2

Plaque induced gingivitis is an inflammatory response of the gingival tissues resulting from bacterial plaque accumulation located at and below the gingival margin

Question 3

what are the clinical signs of gingivitis

Answer 3

○ Bleeding on probing
○ High plaque score
○ High bleeding scores
○ Gingival swelling and redness

Question 4

what will the patient notice in gingivitis

Answer 4

○ Blood in saliva
○ Bleeding with toothbrushing and interdental cleaning
○ Bad breath (halitosis)

Question 5

what are key points to gingivitis

Answer 5

○ Reversible inflammation of the gingival tissues
○ Swelling and bleeding at the gingival margins
○ Risk factor for periodontitis
○ Probing depths < 3mm
○ No attachment loss
○ No radiographic bone loss

Question 6

define periodontitis

Answer 6

Periodontitis is an inflammatory disease initiated by bacteria which, in susceptible people, can cause severe inflammation and loss of bone around the teeth

Question 7

what are the clinical signs of periodontitis

Answer 7

○ Bleeding on probing
○ Radiographic bone loss
○ Gingival recession
○ Probing depths >4mm (clinical attachment loss)

Question 8

what does the patient notice in periodontitis

Answer 8

○ Blood in saliva
○ Bleeding with tooth brushing and interdental cleaning
○ Bad breath (halitosis)
○ Black triangles (spaces between teeth)
○ Tooth movement

Question 9

what are the key points of periodontitis

Answer 9

○ Inflammation of the supporting structures of the teeth
○ Bleeding on probing in active disease
○ Probing depths > 4mm
○ Radiographic bone loss
○ Susceptible patients most at risk for bone loss
	§ Some are more susceptible than others
○ Can be modified by systemic disease
○ More aggressive in younger patients

Question 10

what questions should you ask to identify the oral hygiene regime that the patient uses

Answer 10

• How often do you brush your teeth?
• Do you use a manual or powered toothbrush?
• What toothpaste do you use?
• Do you clean in between your teeth with floss or interdental brushes?
• Do you use any mouth rinse?
• Do you attend the dentist regularly?
• Do you have your teeth cleaned by the dentist / hygienist?

Question 11

what does BPE stand for

Answer 11

basic periodontal examination

Question 12

what is the BPE

Answer 12

• Screening tool for periodontal disease to quickly assess someone to see if they have gum disease or not
• mouth is divided into sextants
• WHO CPITN probe walked around the gingival margin of the teeth
• indicates what further assessment and periodontal treatment the patient requires

Question 13

how is the mouth divided into sextants

Answer 13

• upper right (17 to 14)
• upper anterior (13 to 23)
• upper left (24 to 27)
• lower right (47 to 44)
• lower anterior (43 to 33)
• lower left (34 to 37)

Question 14

what does a BPE score of 0 mean

Answer 14

black band completely visible

No probing depth > 3.5mm
No calculus / overhangs
No bleeding after probing

Question 15

what does a BPE score of 1 mean

Answer 15

black band completely visible

No probing depth > 3.5mm
No calculus / overhangs
Bleeding after probing

Question 16

what does a BPE score of 2 mean

Answer 16

black band completely visible

No probing depth > 3.5mm
Supra- and sub- gingival calculus / overhangs present

Question 17

what does a BPE score of 3 mean

Answer 17

black band partially visible

Probing depths of 3.5-5.5mm present

Question 18

what does a BPE score of 4 mean

Answer 18

black band entirely within the pocket

Probing depths of 6mm or more present

Question 19

what does * represent on a BPE score

Answer 19

furcation involvement
= disease between the roots of the teeth
can only happen in posterior sextants where there is more than one root present

Question 20

what would the treatment be for a patient with a BPE score of 2

Answer 20

remove calculus / overhang

give oral hygiene instruction

Question 21

what is included in a personalised hygiene regime

Answer 21

• Toothpaste
• Toothbrush
• Method
• Duration
• Frequency
• Interdental cleaning
• Mouth rinse
• Denture hygiene

Question 22

what can chlorhexidine mouth rinse do

Answer 22

reduce gingivitis and plaque build up

Question 23

what ppm of fluoride should adults with permanent dentition use

Answer 23

1000/1100 ppm

Question 24

what does sensitive toothpaste for dentine hypersensitivity include

Answer 24

§ potassium-
§ stannous fluoride-
§ potassium and stannous fluoride-
§ calcium sodium phosphosillicate-
§ arginine-
containing desensitizing toothpastes

Question 25

what type of desensitising toothpaste shows no evidence for working

Answer 25

strontium containing desensitising toothpaste

Question 26

what technique should be used for manual brushing

Answer 26

modified bass technique

Question 27

what does powered toothbrush show that it is better than a manual toothbrush

Answer 27

reduction in plaque and gingivitis after use

Question 28

how long should you brush your teeth

Answer 28

2 mins | longer if you have periodontitis (especially when considering need for interdental cleaning devices)

Question 29

how does frequency of brushing impact periodontal disease

Answer 29

• Relatively few studies evaluating the association between tooth brushing frequency and periodontitis A clear effect was observed, indicating that infrequent tooth burhsing was associated with severe forms of periodontal disease

Question 30

how does interdental cleaning affect periodontal disease

Answer 30

• Using floss or interdental brushes in addition to toothbrushing may reduce gingivitis or plaque or both, more than toothbrushing alone Interdental brushes may be more effective than floss

Question 31

what does corsodyl do as a mouth rinse

Answer 31

○ Reduce gingivitis and plaque build up ○ Masks how well patient cleans teeth § Like weed killer for teeth as it kills all bacteria ○ Rinsing with chlorhexidine mouth rinse for 4 weeks or longer causes extrinsic tooth staining ○ Other adverse effects such as calculus building up, transient taste disturbance and effects on the oral mucosa were reported in the included studies ○ Not recommended for routine every day use

Question 32

what does Fluoride mouth rinse do

Answer 32

○ Large reduction in tooth decay in children's permanent teeth ○ Little information on potential adverse effects and acceptability ○ Recommended for routine daily use if high caries risk ○ Use when not brushing ○ Gives an extra dose of fluoride on exposed dentine surfaces

Question 33

what should plaque scores be for treatment to work well

Answer 33

less than 20%

Question 34

what can be said about patient behaviour change

Answer 34

- Learning a skill can take minutes or hours but changing a habit takes weeks or months - Instruction is meaningless and easily forgotten without understanding the context in which it fits - A few appropriately selected and delivered words are more effective than a full lecture delivered with the hole that the patient will grasp the relevant details - Repeating instructions multiple times will not increase motivation, in fact, it may offend and decrease motivation - Offering assistance, and seeking permission to give knowledge or teach skills facilitates patient ownership of the task ○ Remember the natural response to force is resistance - Motivation is not static but can vary as an individual is affected by other life related factors and stresses

Question 35

what helps to guide what is important in oral hygiene instruction

Answer 35

TIPPS

Question 36

What is TIPPS

Answer 36

• Talk ○ About the causes of dental disease and discuss any barriers to effective plaque removal • Instruct ○ The patient on the best ways to perform effective plaque removal • Practise ○ Ask the patient to clean his / her teeth and to use the interdental cleaning aids whilst in the dental surgery • Plan ○ Put in place a plan which specifies how the patient will incorporate oral hygiene into daily life • Support ○ Provide support to the patient by following up at subsequent visits