Non-Surgical Management

Question 1

What are the aims of periodontal therapy?

Answer 1

• Arrest disease process
• Regenerate lost tissue
• Maintain long term perio health

==> As a result preserve functional dentition

Question 2

What is included in non-surgical management (aka HPT)?

Answer 2

• Dental health education
• OHI
• Scaling & RSD
• Correct PFRs
• Re-evaluation

Question 3

What is discussed in dental health education to the patient?

Answer 3

1. Discuss reason for attendance
2. Explain nature of disease (use diagrams, photos, models etc.)
3. Discuss findings of exam
4. Demonstrate health and disease in pts mouth
5. Explain nature and consequences of tx

–> using language pt understands

Question 4

What oral hygiene instructions are given to the patient?

Answer 4

1. Toothbrushing (modified bass)
2. Interdental cleaning (floss, interdent brushes)
3. Toothpaste (+/- mw)
4. Disclosing agents

Question 5

What does attachment levels indicate?

Answer 5

Measurement of tissue destruction (PRE and POST tx)

Question 6

What factors may influence probing measurements?

Answer 6

• Resistance of tissues
• Size and shape of probe tip
• Site and angulation of insertion
• Pressure
• Obstructions e.g. calculus
• Pt discomfort

Question 7

How is attachment gained?

Answer 7

• Long junctional epithelium formation

- Imrpoved tissue tone (inflammatory infiltrate replaced by collagen)

Question 8

Why does treatment fail?

Answer 8

OPERATOR
- Inadequate debridement

PATIENT

• Poor compliance
• Smoking

Question 9

What are the limitations to non-surgical therapy?

Answer 9

• Root morphology
• Furcation involvement
• Deep pockets
• Skill level
• Time

Question 10

What are the categories patients may fall into at re-evaluation? And their management?

Answer 10

1. OH inadequate with persistent inflammation
   - -> repeat cause-related therapy OR accept -> maintenance programme
2. OH good, no evidence of inflammation
   - -> maintenance programme, proceed reconstructive tx
3. OH good but persistent deep pockets and inflammation
   - -> Repeat cause-related therapy OR surgical exposure to RSD