Non-surgical management of plaque-related periodontal diseases

Question 1

what is option 1 on action on recording BPE 3 (BSP)

Answer 1

if a sextant scores 3, this sextant should be reviewed and a 6 point pocket completed for that sextant only (and only after treatment)

Question 2

what is option 2 on action on recording BPE 3 (SDCEP)

Answer 2

if a sextant scores 3, a 6 point pocket chart should be completed for that sextant before treatment and after.
where code 3 is observed in only one sextant, carry out full periodontal examination and root surface instrumentation of affected teeth in that sextant only

Question 3

what is non surgical management also known as

Answer 3

cause related therapy

hygiene phase therapy

Question 4

what is the aim of periodontal therapy

Answer 4

to arrest the disease process
ideally to regernate lost tissue
to maintain periodontal health long term

Question 5

what is the disease control phase

Answer 5

extraction of hopeless teeth
hygiene phase therapy
caries management
endodontic therapy 
provisional prostheses

Question 6

what is periodontal therapy

Answer 6

supra gingival plaque control including scaling

Question 7

what is periodontitis

Answer 7

loss of attachment and true pocket formation

colonization of the root surface - importance of removing this

Question 8

what is hygiene phase therapy

Answer 8

dental health education 
oral hygiene instruction 
scaling and root surface debridement
removal of other plaque retention factors 
reevaluation

Question 9

how should dental health education be individualized

Answer 9

evaluate patients reasons for attendance, attitudes to health care, motivation tc
explain the natures of disease using diagrams, photographs, models ect
discuss findings of examination

Question 10

what does dental health education consist of

Answer 10

demonstrate health and disease in the patients mouth
explain the nature and consequences of treatment
use language the patient will understand

Question 11

what happens in oral hygiene instruction

Answer 11

talk about tooth brushing
interdental cleaning
disclosing agent

Question 12

what is scaling

Answer 12

the removal of plaque and calculus from tooth surfaces

Question 13

what is root surface debridement

Answer 13

encompasses the process of scaling and removal of supra gingival calculus

Question 14

what are the scaling instruments

Answer 14

hand instruments

powered instruments

Question 15

what are the powered scaling instruments

Answer 15

ultrasonic and sonic instruments

rotating and reciprocating instruments

Question 16

what does the ultrasonic/sonic tip do better

Answer 16

may allow access to furcations
may be faster and less demanding on the operator
may result in less unwanted tooth tissue removal

Question 17

how do the powered instruments work

Answer 17

the vibrations against calculus removes it

Question 18

where can ultra sonic instruments be used

Answer 18

supra and sub gingival

Question 19

what is the advantage of hand instruments

Answer 19

they have greater tactile sensitivity

can tell when you are at the base of the pocket

Question 20

what is the disadvantages of powered instruments

Answer 20

the water coolant may produce cavitation
powered instruments produce aerosols
powered instruments may leave a rougher surface

Question 21

what are problems with restorations

Answer 21

their margins (location and adaptation)
restoration contour
partial dentures

Question 22

what are the problems seen with partial dentures

Answer 22

gingival coverage
direct trauma
uncontrolled loads

Question 23

how is success of periodontal therapy treatment measured

Answer 23

inflammation (bleeding on probing indices)
reduction in probing depth
gain in probing attachment level

Question 24

what does probing depth indicate

Answer 24

the difficulty of treatment and the likelihood of recurrence

Question 25

what do attachment levels indicate

Answer 25

they are a measure of tissue destruction (pretreatment) and the extent of repair (post treatment)

Question 26

what may manual probing measurements be influenced by

Answer 26

the resistance of the tissues size, shape and tip diameter of the probe site and angle of probe insertion pressure applied presence of obstructions such as calculus patient discomfort

Question 27

what is the effect of supra gingival plaque control alone

Answer 27

decreased gingival inflammation limited effect on probing depth no change in attachment levels no alteration in sub gingival microflora in deep pockets

Question 28

what is the effect of RSD alone

Answer 28

initial reduction in inflammation and pocket depth pockets are recolonized by bacteria from supra gingival plaque disease recurs

Question 29

what are the effects of RSD with supra gingival plaque control

Answer 29

decreased gingival inflammation reduction in proving depth gain in probing attachment level marked changes in the sub gingival microbial flora

Question 30

what is the gain in attachment due to

Answer 30

long junctional epithelium formation and improved tissue tone (inflammatory infiltrate is replaced by collagen)

Question 31

when is the greatest changes observed

Answer 31

4-6 weeks after therapy

Question 32

when does gradual repair and maturation of tissues occur

Answer 32

over 9-12 months

Question 33

what are the 2 ways treatment can be organized

Answer 33

quadrant approach or full mouth disinfection approach

Question 34

what is the objective of the full mouth disinfection

Answer 34

prevent treated pockets being decolonized by intra oral translocation of bacteria

Question 35

what happens in full mouth disinfection

Answer 35

full mouth RSD at one or more sittings on the same day | use of chlorhexidine for sub gingival irrigation, tongue brushing and mouth rinsing

Question 36

what is the effect of debridement

Answer 36

reduces microbial challenge - decreased inflammation | inoculation with plaque organisms, boosts immune response

Question 37

what is revaluation

Answer 37

what has been the response to the initial therapy

Question 38

what do you look at in reevaluation

Answer 38

patient plaque control bleeding on probing residual probing depths and attachment levels tooth mobility

Question 39

what are the factors that determine the success of treatment

Answer 39

``` good oral hygeine no bleeding on probing no pockets > 4mm no increasing tooth mobility a functional and comfortable dentition ```

Question 40

what are the 3 categories of the reevaluations age

Answer 40

``` poor OH (persistent inflammation) good OH (inflammation resolved) good OH (persistent deep pockets) ```

Question 41

what should be done if there is poor OH and persistent inflammation

Answer 41

identify the reason for poor OH then supportive care or repeat cause related therapy

Question 42

what should be done if there is good oral hygiene and the inflammation is resolved

Answer 42

support care and proceed with treatment plan

Question 43

what should be done if there is good oral hygiene but persistent deep pockets

Answer 43

surgical access or repeat RSD then reevaluate

Question 44

why does treatment fail

Answer 44

poor compliance inadequate debridement host factors (mainly smoking)

Question 45

what are the limitations of non surgical therapy

Answer 45

``` root morphology furcation involvement deep pockets skill level time ```

Question 46

what is the maintenance in supportive periodontal care

Answer 46

maintain periodontal health detect and treat recurrence maintain an accepted level of disease manage tooth loss

Question 47

what are the intervals for supportive periodontal care

Answer 47

3months for most

Question 48

what happens in the supportive periodontal care

Answer 48

OH must be reinforced examine for signs of recurrent disease scaling: RSD, polishing and other treatment as necessary

Question 49

What is the treatment plan for periodontal therapy

Answer 49

``` emergency care disease control re-evaluation reconstruction supportive care ```