Non-surgical management of plaque related periodontal diseases

Question 1

what is calculus?

Answer 1

• plaque retentive factor
• calcified deposits found attached to the surfaces of teeth
• appear brown or pale yellow

Question 2

what are the clinical manifestations of plaque induced gingivitis?

7

Answer 2

• change of colour of gingivae
• marginal gingival swelling
• loss of contouring of interdental papilla
• bleeding from the gingival margin on probing/brushing
• plaque is present at gingival margin
• no clinical attachment loss or alveolar bone loss
• gingival sulcus measures 3mm or less from gingival margin to the base of the junctional epithelium at the ACJ

Question 3

what are the clinical manifestations of periodontitis?

3

Answer 3

• loss of periodontal connective tissue attachment
• alveolar bone loss
• gingival sulcus measures more than 3.0mm from the gingival margin to the base of the junctional epithelium which has migrated apically with the formation of a periodontal pocket

Question 4

what is the aim of periodontal treatment?

4

Answer 4

• arrest the disease process
• regenerate tissue lost
• maintain periodontal health long term
• keep teeth

Question 5

what are the steps of periodontal treatment?

5

Answer 5

• basis of therapy - immediate/emergency care
• initial / disease control
• re-evaluation
• recontructive
• maintenance / supportive care

Question 6

what is carried out in the basis of therapy step in periodontal treatment?

3

Answer 6

• examination
• assessment of risk factors
• diagnosis

Question 7

what is carried out in step 1 of periodontal treatment?

3

Answer 7

• control of local and systemic factors
• OHI
• professional mechanical plaque removal (PMPR)

Question 8

what is carried out in step 2 of periodontal treatment?

4

Answer 8

• step 1- control of local and systemic factors, OHI, PMPR
• subgingival and instrumentation +/- adjunctive measures

Question 9

what is carried out in step 3 of periodontal treatment?

2

Answer 9

• repeated subgingival instrumentation
• periodontal surgery - access flap, resective, regenerative

Question 10

what is carried out in step 4 of periodontal treatment?

Answer 10

• supportive periodontal therapy
• continuous monitoring of local and systemic factors

Question 11

what types of radiographs are used when diagnosing periodontitis?

3

Answer 11

• horizontal / vertical bitewings
• periapicals
• dental panoramic tomographs

Question 12

what is the importance of radiographs in diagnosing for periodontitis?

5

Answer 12

• aids in diagnosis and helps with staging and grading
• helps determining prognosis of teeth
• can assess morphology of affected teeth
• can find pattern and degree of alveolar bone loss
• can monitor the long term stability of periodontal health

Question 13

what are the benefits of horizontal bitewings when diagnosing periodontitis?

3

Answer 13

• might show early localised bone loss
• can show presence of poorly contoured restorations
• can identify subgingival calculus

Question 14

what are the benefits of vertical bitewings when diagnosing periodontitis?

Answer 14

• provides non-distorted views of bone levels in relation to ACJ
• can provide better visualisation of bone level than horizontal bitewings

Question 15

what are the benefits of periapical radiographs when diagnosing periodontitis?

Answer 15

• gold standard in periodontal assessment
• picture of bone levels in relation to both ACJ and total root length
• can identify furcation involvement and possible endodontic complications

Question 16

what are the advantages and disadvantages of using dental panoramic tomographs (DPT)?

Answer 16

• less uncomfortable
• quicker
• might need supplement periapical views due to risk of distortion of anterior teeth

Question 17

what are Ramfjord’s teeth? which teeth are they?

Answer 17

6 index teeth distributed in order to best reflect the condition of the whole mouth
* UR6 (16)
* UL1 (21)
* UL4 (24)
* LL6 (36)
* LR1 (41)
* LR4 (44)

Question 18

what would you do if a Ramfjord’s tooth is missing?

Answer 18

use the adjacent teeth

Question 19

what would you do if a whole quadrant was missing teeth for a modified chart?

Answer 19

mark as missing with ‘N’

Question 20

how would you take a modified plaque score?

Answer 20

• each Ramfjord’s tooth is split into 3 surfaces - IP, B, P/L
• each surface can get a score of 0,1,2
• scores from each tooth surface are added up and divided by 36
• if a tooth is missing and cannot be replaced, record X and divide by 30 not 36
• use code N if no teeth present in quadrant

Question 21

work out the modified plaque score for this patient

Answer 21

12/30 = 40%

Question 22

what does each score on the modified plaque score mean?

Answer 22

• 0 - no plaque
• 1 - no visible plaque but a probe skimmed over tooth reveals plaque
• 2 - visible plaque without use of probe

Question 23

how would you take a modified bleeding score?

Answer 23

• each Ramfjord’s tooth is split into 4 surfaces - M, D, B, P/L
• each surface can get a score of 0,1
• scores from each tooth surface are added up and divided by 24
• if a tooth is missing and cannot be replaced, record X and divide by 20 not 24
• use code N if no teeth present in quadrant

Question 24

work out the modified bleeding score for this patient

Answer 24

10/20 = 50%

Question 25

how would you tell if a patient is engaged or not?

Answer 25

* less than **35% bleeding** score AND less than **30% plaqu**e score * OR **greater than 50% improvement** in bleeding and plaque scores * OR patient **meets target agreed** with clinician

Question 26

what should you do if a patient is not engaged?

Answer 26

* don't use the word engagement as can be negative * patient should be informed * subginigval PMPR should be delayed * identify any barriers e.g. manual dexterity * continue with oral health education, motivation and behaviour change

Question 27

what order should you carry out a baseline pocket chart?

Answer 27

* record missing teeth * probing depth * record gingival margin in relation to ACJ * bleeding on probing * mobility * furcation * any suppuration

Question 28

what is the difference between a baseline pocket chart and a modified pocket chart?

Answer 28

* baseline includes gingival margin, pocket depth, LOA, BOP, furcation and mobility * modified includes furcation, mobility, pocket depth and BOP

Question 29

what kind of pocket chart is this?

Answer 29

modified pocket chart

Question 30

what kind of pocket chart is this?

Answer 30

baseline pocket chart

Question 31

how would you calculate loss of attachment with a baseline pocket chart?

Answer 31

* **record gingival margin** - if gingival margin is coronal to ACJ, record as negative number and if apical to ACJ, record as positive number * **record pocket depth** * **add** pocket depth and gingival margin figure

Question 32

what order would you go around the mouth when charting a 6ppc?

Answer 32

1. buccal of upper right arch 2. buccal of upper left 3. palatal of upper left 4. palatal of upper right 5. buccal of lower right 6. buccal of lower left 7. lingual of lower left 8. lingual of lower right

Question 33

what probe do you use to measure furcation involvement?

Answer 33

Nabers furcation probe

Question 34

what are the gradings for furcation involvement? what do they mean?

Answer 34

* grade 1: initial furcation involvement **less than 1/3 of the tooth width** - up to 3mm horizontal attachment loss * grade 2: partial furcation involvement **exceeding 1/3 of the tooth width** but not the total width - greater than 3mm attachment loss * grade 3: **through-and-through involvement** where probe can pass through entire furcation

Question 35

how do you test tooth mobility?

Answer 35

* use an **index finger** and **instrument handle** to move tooth bucco-lingually * graded 0,1,2,3

Question 36

what are the gradings for tooth mobility? what do they mean?

Answer 36

* grade 0: **physiological mobility** - **0.1-0.2mm** in horizontal direction * grade 1: **0.2-1.0mm mobility** in horizontal direction * grade 2: mobility **exceeding 1mm** in horizontal direction but no mobility in vertical direction * grade 3: **severe mobility** of crown in both **horizontal and vertical directions**, impinging on function of the tooth - greater than 2mm

Question 37

what can manual probing measurements be influenced by? | 6

Answer 37

* resistance of the tissues * size, shape and tip diameter of probe * site and angle of probe insertion * pressure applied * presence of obstruction e.g. calculus * patient discomfort | smokers have tender gingival margins so you tend to under-probe