Non-Surgical Treatment of Periodontal Disease

Question 1

What is 1st step in sequence for treatment of periodontitis?

Answer 1

Patient motivation, supragingival plaque control and risk factor control

Question 2

What is 2nd step in sequence for treatment of periodontitis?

Answer 2

Cause related therapy, control subgingival biofilm and calculus

Question 3

What is 3rd step in sequence for treatment of periodontitis?

Answer 3

Treatment of areas non-responding to second step (surgery)

Question 4

What is 4th step in sequence for treatment of periodontitis?

Answer 4

Supportive periodontal care: maintain periodontal stability

Question 5

What are the goals of non-surgical management/subgingival PMPR?

Answer 5

Control of risk factors, removal and disruption of biofilm, reduction of bacterial load, reduce gingival inflammation, reduce deepened pockets, regain periodontal attachment of tooth, and prevent tooth loss and loss of dental functions

Question 6

What is step 1 in the management of periodontitis?

Answer 6

Supra-gingival plaque control, patient behaviour modification, risk factor control, OHI and PMPR

Question 7

What is supragingival PMPR?

Answer 7

Disruption of plaque biofilm and removal of hard deposits and stain in accessible areas

Question 8

What are accessible areas sometimes defined as?

Answer 8

Up to 3-4mm subgingival

Question 9

What is polishing (prophylaxis)?

Answer 9

Removal of soft deposits and unacceptable stain

Question 10

What are ‘prophy’ pastes usually?

Answer 10

Abrasive

Question 11

What else can be used for polishing (prophylaxis)?

Answer 11

Pumice and water

Question 12

What is the potential effectiveness of OHI on its own?

Answer 12

Can reduce 50% of number of diseased sites

Question 13

What is the potential effectiveness of OHI with addition of supragingival PMPR?

Answer 13

A 2/3 reduction

Question 14

What does calculus not itself induce?

Answer 14

Inflammation

Question 15

What has calculus not been shown to be always linked with?

Answer 15

More severe attachment loss

Question 16

When should you re-evaluate?

Answer 16

After 2 weeks to allow resolution of inflammation (eliminate chances of false pocketing)

Question 17

How should you re-evaluate?

Answer 17

Do PI, BI and potentially comprehensive periodontal examination

Question 18

What is the comprehensive periodontal examination?

Answer 18

6 PPC, recession, CAL, mobility, and furcation

Question 19

What is a non-engaging patient?

Answer 19

Insufficient improvement in OH < 50% in PI and BI, plaque levels >20% and BI >30%, and patient states preferences for a palliative approach to periodontal care

Question 20

What is an engaging patient?

Answer 20

Favourable improvement in OH by 50%, plaque levels ≤20%, bleeding scores ≤ 30%, and patient has met targets outlined by their self-care plan

Question 21

What should you do if you have a non-engaging patient after re-evaluate?

Answer 21

Return to step 1 and repeat

Question 22

What should you do if you have an engaging patient after re-evaluate?

Answer 22

Move to step 2 or consider referral

Question 23

What is subgingival PMPR?

Answer 23

Subgingival debridement/scaling, root planing, subgingival scaling/curettage, subgingival instrumentation, and RSD

Question 24

When you should you only do RSD?

Answer 24

After successful first step therapy

Question 25

What is step 2 in the management of periodontitis?

Answer 25

Reinforce OH, subgingival PMPR: US/Hand/US, and adjunctive antibiotics

Question 26

Why should you do subgingival PMPR?

Answer 26

Reduce soft and hard deposits --> reduce soft tissue inflammation --> pocket closure, no BoP

Question 27

Who needs step 2 in the management of periodontitis?

Answer 27

Periodontally susceptible, engaged patients with periodontal pockets

Question 28

How should you carry out subgingival PMPR?

Answer 28

With hand instrumentation/powered isntrumentation/both

Question 29

What should you bear in mind when deciding to do quadrants/full mouth subgingival PMPR?

Answer 29

Medical history and patient preference

Question 30

What is full mouth disinfection?

Answer 30

Undertake S&P/RSD with extensive additional use of chlorhexidine

Question 31

What can full mouth disinfection do?

Answer 31

Prevent re-infection of previously treated sites

Question 32

What other adjunctive therapies should not be used?

Answer 32

Laser, antimicrobial photodynamic therapy, host modulating agents (statins), probiotics, local/systemic NSAIDs, and bisphosphonates

Question 33

What other adjunctive therapies may be used?

Answer 33

Chlorhexidine mouth rinses and subgingivally sustained release, locally sustained-release antibiotics, and systemic antibiotics

Question 34

What are the new tendencies in periodontal disease?

Answer 34

Minimally invasive Non-surgical Management (MINST), use of Magnification loupes/microscope, use of slim line thin US tips and micro curettes (Micro mini 5 Gracey curettes), avoid over–instrumentation, attempt to stimulate a stable blood clot after debridement

Question 35

How long should you wait to re-evaluate after step 2?

Answer 35

3 months

Question 36

What should you do for patients with residual pockets <6mm after re-evaluate after 3 months?

Answer 36

Repeat subgingival PMPR

Question 37

What should you do for patients with residual pockets >6mm after re-evaluate after 3 months?

Answer 37

Repeat subgingival PMPR but if in practice consider referral

Question 38

What should you do for stable and remission patients after re-evaluate after 3 months?

Answer 38

Can progress to step 4 (supportive periodontal therapy)

Question 39

What are the clinical features of a currently unstable periodontitis patient?

Answer 39

PPD >5mm/PPD at >4mm and Bop

Question 40

What are the clinical features of a currently stable periodontitis patient?

Answer 40

BoP <10%, PPD <4mm, and no BoP at 4mm sites

Question 41

What are the clinical features of a periodontitis patient currently in remission?

Answer 41

BoP >10%, PPD <4mm, and no BoP at 4mm sites