Non surgical management of periodontitis

Question 1

What are the stages of Hygiene Phase therapy?

Answer 1

• Dental Health Education
• Oral Hygiene Instruction
• Scaling and Root Surface Debridement
• Removal of other Plaque-Retention Factors
  e.g. defective restoration margins; overhangs or crown margins
  Dentures
  Orthodontic retainers
• Re-evaluation

Question 2

Aim of disease control in periodontal treatment?

Answer 2

Arrest disease process
Maintain periodontal health long-term
Ideally - regenerate lost tissue

RESULT = keep teeth

Question 3

What to do if perio treatment is successful & patient progresses to <4mm in all quadrants & no BOP?

Answer 3

Supportive care - review appointments, re-enforce OHI and managements of modifiable risk factors

Question 4

Why does period treatment fail?

Answer 4

Inadequate OH - lack of patient compliance or manual dexterity

Residual sub-gingival calculus - not enough time or correct technique used on RSD, furcation or root grooves, deep pockets

Systemic risk factors - smoking, uncontrolled diabetes

Question 5

What to do if good OH but persistent deep pockets and BOP following perio therapy?

Answer 5

Surgical access
Further RSD
Adviser to modify risk factors - smoking, uncontrolled diabetes

THEN RE-EVALUATE

Question 6

Effects of RSD

Answer 6

Decrease gingival inflammation
Increase gingival recession

Inflammatory infiltrate replaced with collagen in CT at base of pocket - leads to increase in attachment due to formation of long junctional epithelium

ALL ABOVE LEAD TO DECREASE IN POCKET DEPTH

Horizontal bone loss - very little change

Vertical defects - more likely to display some infill and gain in bone height

Question 7

When are the greatest changes after RSD observed?

Answer 7

4-6 weeks

Question 8

What is the purpose of a full mouth dis-infection?

Answer 8

To prevent treated pockets being re-colonised by intra-oral translocation of bacteria

Question 9

What are the stages of disease control?

Answer 9

Extraction of hopeless teeth
Hygiene Phase Therapy
Caries management
Endodontic therapy – dressing and  temporisation
Provisional prostheses

Question 10

What are the most important parts/ purpose of dental health education?

Answer 10

EDUCATE PATIENT
Modifiable risk factors
Plaque control
Behavioural change - management of risk factors, effective plaque removal (importance of OH and give OHI)

Question 11

What are the 6 ramfjord teeth and when and why do you use these?

Answer 11

16, 21, 24, 36, 41, 44
(if teeth are missing then use a suitable alternative or miss out)

Used to determine whether a patient is engaging or non-engaging, would determine if they could progress to specific repeated root surface instrumentation.

Question 12

What are the thresholds for engaging patients with perio treatment?
Plaque and bleeding scores

Answer 12

•	Less than 30% plaque score
AND
•	Less than 35% bleeding score
 OR
Greater than 50% improvement in both

Question 13

When should you record plaque and bleeding scores?

Answer 13

At every treatment and review visit

Question 14

What are some benefits of a full mouth pocket chart?

Answer 14

Gives the picture of the entire patient’s mouth

Question 15

What are some drawbacks of a full mouth pocket chart?

Answer 15

Very time consuming
Possibility for variable measurements between professionals
Can be uncomfortable for the patient

Question 16

What are the benefits of doing modified plaque and bleeding scores?

Answer 16

Simple and quick
Allows snapshot assessment of patient’s OH over a period of time
Clear objective results easily presentable to patients
Identifies engaging patients

Question 17

What does modified bleeding score measure?

Answer 17

Marginal bleeding rather than BOP - reflects how well patient can carry out plaque control daily

Question 18

What to do with a non-engaging patient?

Answer 18

RSD delayed
Patient informed
Identify barriers
Continue with OH education, motivation and behavioural change
Review

Question 19

What does BOP at base of pocket indicate vs marginal bleeding?

Answer 19

BOP at base of pockets - indicates disease activity and periodontal breakdown

Marginal bleeding - reflects how well patient is able to carry out effective plaque control daily

Question 20

What is the max score a patient can get for plaque and bleeding?

Answer 20

plaque - 36

bleeding - 24

Question 21

What is supportive perio therapy?

Answer 21

Re-enforce plaque control (re-motivate and re-educate patient)
Examine for signs of recurrent disease
Re-treat as necessary - RSD, scaling, polishing etc.
Review appointments to monitor perio status

Question 22

What are the purposes of supportive care?

Answer 22

Prevents recurrence of the disease
Stabilises periodontal condition
Maintains optimal perio health

3 month intervals are usually appropriate