Lecture 10

Question 1

biologic equilibrium

Answer 1

a state of balance in the body between the bacterial plaque and the host

Question 2

what happens if an individual’s immune system can effectively deal with a mouthful of periodontal pathogens

Answer 2

no destruction will occur

Question 3

nature’s balancing act

Answer 3

the situation can be thought of as a balance scale, with disease-promoting factors on one side of the scale and health-promoting factors on the other side

Question 4

periodontal disease results when

Answer 4

the balance tips between pathogenic bacteria and the hosts inflammatory and immune responses

Question 5

the balance of periodontal disease can be affected by

Answer 5

differences in host response
risk factors: local/systemic risk factors, systemic illness, medications, smoking, poor diet, stress

Question 6

risk assessment involves identifying elements that either

Answer 6

predispose a patient to developing periodontal disease or influence the progression of disease that already exists

Question 7

in addition to an evaluation of the risk factors…

Answer 7

educate patients concerning their risk
implement suitable intervention strategies
eliminate/minimize the impact of contributing/risk factors

Question 8

restoring balance: inadequate self-care

Answer 8

many patients are unable or unwilling
patient education/oral hygiene instruction
more frequent perio instrumentation

Question 9

is it possible to eliminate local contributing factors to help restore balance

Answer 9

faulty restorations
ill-fitting dentures
caries

Question 10

it is possible to compensate for local factors that cannot be eliminated

Answer 10

root concavities
palatal grooves
good home care around crowded teeth or anatomical challenges

Question 11

systemic contributing factors

Answer 11

patients can work to eliminate systemic risk factors to restore balance
diabetes: control blood glucose
quit smoking: TDE for all smokers

Question 12

genetic risk factors

Answer 12

at the present time, there are some risk factors that cannot be eliminated or controlled, such as genetic risk factors
frequent professional care can help to slow disease progression

Question 13

why is it important to be aware of your patient’s risk factors

Answer 13

as a dental professional you want to: eliminate/minimize the impact of contributing factors to maximize the success of nonsurgical periodontal therapy

Question 14

nonsurgical periodontal therapy

Answer 14

describes the many nonsurgical steps used to eliminate inflammation in the periodontium of a patient with periodontal disease and return the periodontium to a healthy state

Question 15

nonsurgical periodontal therapy (NSPT) consists of a combination of both

Answer 15

professional care and patient self-care

Question 16

types of procedures included in NSPT

Answer 16

patient education/individualized self-care instructions
home care recommendations
instrumentation of tooth surfaces
correction of local/systemic risk factors
evaluation of treatment

Question 17

treatment plans for NSPT

Answer 17

a list of procedures or interventions that addresses a patient’s periodontal health needs as identified during the periodontal assessment

Question 18

patient education/individualized self-care instructions

Answer 18

addressing all key concepts for patient education
individualized oral hygiene instruction/goals

Question 19

home care recommendations

Answer 19

antimicrobial agents/xerostomia products
specific interdental/brushing aids

Question 20

instrumentation of tooth surfaces

Answer 20

2 units of scaling: ultrasonic, hand instrumentation
select polishing

Question 21

correction of local/systemic risk factors

Answer 21

defective restorations, food impaction, patient habits
smokers? (TDE)
caries risk? nutritional counseling/FL TX (varnish/gel)

Question 22

evaluation in axium: diagnostic summary tab

Answer 22

are the outcomes met and goals obtained?
is a re-evaluation appointment necessary?

Question 23

biofilm-induced gingivitis

Answer 23

NSPT primary type of care
periodontal surgery may be needed to correct other existing problems (gingival recession, gingival overgrowth)

Question 24

stage 1 and stage 2 periodontitis

Answer 24

NSPT can bring many cases under control
may require periodontal surgery to correct damage done by the disease

Question 25

stage 3 and stage 4 periodontitis

Answer 25

will require thorough NSPT as well as more advanced perio procedures such as perio surgery as severity of disease increases document the possible need for more advanced treatment and inform patient when the need for such treatment appears likely surgery is indicated for patients with more advanced periodontitis after NSPT is completed NSPT may minimize the extent of surgery that is needed

Question 26

instrumentation during NSPT objective

Answer 26

physical removal of microorganisms and their products (calculus/biofilm) to prevent and treat periodontal infections

Question 27

why do we instrument during NSPT

Answer 27

physical removal/disruption is the most effective mechanism of control

Question 28

rationale for instrumentation

Answer 28

to eliminate inflammation in the periodontium to arrest progress of periodontal disease to induce positive changes in subgingival bacterial flora to increase effectiveness of patient self-care to prevent recurrence of periodontal disease during periodontal maintenance

Question 29

power instrumentation vs hand instrumentation for periodontal debridement

Answer 29

very effective in deplaquing tooth surfaces more effective treatment of furcations slim tips reach deeper into periodontal pockets low/medium power setting less root surface damage water irrigation removes toxins reduced instrumentation time

Question 30

scaling

Answer 30

instrumentation of the crowns and root surfaces to remove plaque biofilm and calculus

Question 31

dental prophylaxis

Answer 31

includes scaling and polishing to remove coronal plaque biofilm, calculus and stain

Question 32

root planing

Answer 32

removes rough cementum or surface dentin and the associated calculus, toxins or microorganisms

Question 33

periodontal instrumentation/periodontal debridement

Answer 33

the removal or disruption of plaque biofilm, its by-products and calculus from coronal and root surfaces to the extent needed to reestablish periodontal health and restore a balance between the bacterial flora and the host's immune responses

Question 34

periodontal instrumentation/periodontal debridement involves

Answer 34

thorough biofilm and calculus removal but does not include the deliberate, aggressive removal of cementum root surfaces should be instrumented only to a level that results in resolution of tissue inflammation

Question 35

end point for instrumentation during NSPT

Answer 35

to return the periodontium to a state of soft tissue health that is free of inflammation

Question 36

the primary type of healing in a site of attachment loss after periodontal instrumentation is through the formation of

Answer 36

long junctional epithelium

Question 37

long junctional epithelium

Answer 37

as inflammation resolves, epithelial cells may readapt to the tooth surface this adaptation of the epithelial cells to the root surface is referred to as the long junctional epithelium

Question 38

following periodontal instrumentation there is no formation of

Answer 38

new alveolar bone cementum periodontal ligament

Question 39

tissues responses to instrumentation

Answer 39

shrinkage of the soft tissue/resolution of inflammation resulting in a shallow pocket depth/reduction in probing depth forming a long junctional epithelium: readaptation of the tissue to the root resulting in a shallow pocket depth/reduction in probing depth little change in the level of soft tissues resulting in a residual periodontal pocket

Question 40

the re-evaluation appointment

Answer 40

occurs after the completion of NSPT ideally 4-6 weeks after completion of NSPT (true tissue response will not occur for at least 1 month) allows time for complete tissue healing

Question 41

steps in re-evaluation

Answer 41

medical status update thorough periodontal assessment compare results with initial assessment decide on the next step in therapy additional nonsurgical therapy periodontal maintenance possible referral for periodontal surgery

Question 42

options for treatment following re-evaluation

Answer 42

additional NSPT: revisit unresponsive sites establish maintenance program recognize the need for periodontal surgery/referral

Question 43

initial therapy

Answer 43

reduce the number of bacteria remove calculus and biofilm accumulation patient education: critical with perio patients

Question 44

maintenance therapy

Answer 44

Q 3 months debridement review patient education and goals: reinforce home care strategies

Question 45

periodontitis and its treatment may involve both

Answer 45

non-surgical therapy and surgical approaches

Question 46

goal of treating all of the periodontium's problems

Answer 46

try to reduce the number of harmful bacteria, create architecture easier for the patient and hygienist to maintain