Flashcards in Non-Surgical Treatment of Periodontitis 1 Deck (51)
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1
Give examples of periodontal diseases
Plaque induced gingivitis
Periodontitis
2
What causes periodontal disease
The formation and persistence of biofilm
3
Describe plaque and what it causes
Plaque is the biofilm
Sticky colourless deposit
Plaque bacteria can attach to tooth surfaces, periodontal tissues and connective tissues changing the microbial composition from health to disease
4
Describe calculus
Calcified deposits found attached to the surfaces of teeth
Often brown or pale yellow
Is always covered by plaque biofilm
Can be supra and subgingival
Is detected by direct vision, probing or on radiographs
5
What are the risk factors of developing periodontal disease
Environmental - smoking, dental plaque accumulation, socioeconomic status
Host-specific - genetic factors and overall inflammatory burden
6
What are the clinical presentations of plaque induced gingivitis (7)
Change in colour of the gingivae
Marginal gingival swelling
Loss of contour (blunting) of interdental papilla
Bleeding from the gingival margin on probing or brushing
Plaque present at gingival margin
No alveolar bone loss
Gingival sulcus measures 3mm or less from the gingival margin to the base of the junctional epithelium - which is still at the CEJ
7
What are the clinical presentations of periodontitis (3)
Loss of periodontal connective tissue attachment
Gingival sulcus measures >3.0mm from the gingival margin to the base of the junctional epithelium which has migrated apical with the formation of a true periodontal pocket
Alveolar bone loss
8
What resistance is present to preventing periodontal disease (3)
Innate immune response
Adaptive immune response
Inflammation
9
What are the 4 stages of periodontal management
Screening
Assessment
Treatment - as part of an overall treatment strategy
Monitoring
10
What should be carried out during screening for periodontal disease
Basic Periodontal Examination (BPE)
11
What are the different types of BPE probe
WHO probe
UNC probe
12
Describe a WHO probe
A ball end 0.5mm in diameter
Black band from 3.5-5.5mm
Second black band from 8.5-11.5mm
13
Describe a UNC probe
15mm long
Markings at each mm and colour coding at the 5th, 10th and 15th mm
14
Describe how the dentition is divided for periodontal screening
Into 6 sextants:
UR7-UR4 UR3-UL3 UL4-UL7
LR7-LR4 LR3-LL3 LL4-LL7
15
When should 3rd molars be examined on a BPE
Only when the 1st and 2nd molars are missing
16
What qualifies a sextant for recording on a BPE
Each sextant must have at least 2 teeth
17
How should a BPE be carried out
The probe should be walked around the sulcus/pockets in each sextant and the highest score should be recorded
18
What does the score 0 mean on a BPE
Pockets <3.5mm
First black band entirely visible
Actual pocket depth range <3mm
No bleeding on probing
No calculus or overhangs
No need for periodontal treatment
19
What does the score 1 mean on a BPE
Pockets <3.5mm
First black band entirely visible
Actual pocket depth range <3mm
Bleeding on probing
No calculus or overhangs
Give oral hygiene instruction
20
What does the score 2 mean on a BPE
Pockets <3.5mm
First black band entirely visible
Actual pocket depth range <3mm
Possible bleeding on probing
Calculus or overhangs present
OHI, removal of plaque retentive factors including all supra- and sub-gingival calculus
21
What does the score 3 mean on a BPE
Probing depth 3.5-5.5mm
First black band partially visible
Actual pocket depth range 4-5mm
Possible bleeding on probing
Possible calculus or overhangs
OHI, root surface debridement
22
What does the score 4 mean on a BPE
Probing depth >5.5mm
First black band disappears
Actual pocket depth range >6mm
Possible bleeding on probing
Possible calculus or overhangs
OHI, RSD, Assess the need for more complex treatment ie - referral to a specialist
23
What does * mean on a BPE
Furcation involvement if identified (visibly or on probing)
Should be recorded in additional to the numerical score
OHI, RSD, Assess the need for more complex treatment ie - referral to a specialist
24
What is furcation involvement
??
25
What do codes 0, 1 and 2 indicate on a BPE
Clinical gingival health or gingivitis
26
What does code 3 indicate on a BPE
Can be bone loss and interdental recession, or gums can be swollen creating a false pocket
If false pocket the patient should follow the same rules as gingivitis
27
What does code 4 indicate on a BPE
Periodontitis
28
What can the BPE screening information be used for
Radiographs for all codes 3 and 4 if justified
Modified plaque and bleeding charts if necessary
FMPC if one code 4 or evidence of interdental recession
FMPC of code 3 sextant or initial therapy of code 3 then FMPC
29
What is a FMPC
Full mouth pocket chart
30
When should a BPE test not be used
For monitoring
If the patient has implants as they will give deeper pockets
31
What is included in assessment for periodontal disease
Further investigations such as taking radiographs if necessary
32
What are the pros and cons of using horizontal bitewings for periodontal disease
If alveolar crest is visible if might show early localised bone loss
Shows sublingual calculus
Presence of poorly contoured restorations
33
What are the pros and cons of using vertical bitewings for periodontal disease
Provides a non distorted view of bone levels in relation to the CEJ
Can provide better visualisation of bone level than horizontal bitewings
Difficult to position accurately
34
What are the pros and cons of using periapicals in periodontal disease
Gold standard
2-dimensional picture of bone levels in relation to both CEJ and total root length
Identifies furcation involvement and possible endodontic complications
35
What are the pros and cons of using panoramic radiographs in periodontal disease
Quicker
More comfortable
Might need supplemented with periapical views especially in anterior sextants due to risk of distortion
36
How can periodontal disease be controlled (5)
Extraction of hopeless teeth
Hygiene phase therapy
Caries management
Endodontic therapy
Provisional prosthesis
37
What is included in hygiene phase therapy (5)
Dental health education
Oral hygiene instruction
Scaling and root surface debridement
Removal of other Plaque-Retentive Factors
Re-evaluation
38
Give examples of some Plaque-Retentive Factors
Defective restoration margins - overhangs or crown margins
Dentures
Orthodontic retainers
39
What is the aim of hygiene phase therapy
Arrest the disease process
Regenerate lost tissue
Maintain periodontal health long term
Result in keeping teeth
40
What should be discussed during dental health management
Modifiable risk factors
Plaque control
Behavioural change
Aim to educate the patient
41
What does solar mean in relation to communication
Square on to patient
Open posture, not crossed arms
Lean forward, look interested
Eye contact
Relaxed demeanour
42
Which teeth are used for modified plaque and bleeding scores
Ramfjord’s teeth
UR6 UL1 UL4
LR4 LR1 LL6
43
What is the modified plaque score
An index to measure status of oral hygiene by measuring dental plaque
44
Describe the different codes in a modified plaque score
0 - No plaque visible, even when a probe is used
1 - Some plaque visible only when a probe was used to skim the tooth surface
2 - Visible amount of plaque which can be seen without use of a probe
N - No measurement could be made for this surface/tooth
45
How is each Ramfjord tooth divided for a modified plaque score
Into 3 surfaces:
Interproximal
Buccal
Palatal/Lingual
46
How is a modified plaque score calculated
Scores for each surface are added to get a total
These are then divided by total number - maximum value is 36
47
Describe the modified bleeding score
Measures marginal bleeding rather than bleeding on probing because marginal bleeding reflects how well the patient can carry out effective plaque control daily
Periodontal probe is run gently at 45 degrees around the gingival sulcus in a continuous sweep
Check presence or absence of bleeding for up to 30s after probing
48
How is each Ramfjord tooth divided for a modified bleeding score
Into 4 surfaces:
Mesial
Distal
Buccal
Palatal/Lingual
49
Describe the different codes in a modified bleeding score
0 - Absence of bleeding on probing
1 - Presence of bleeding on probing
50
How is a modified bleeding score calculated
Scores for each surface should be added to get a total score
This is then divided by the maximum bleeding score possible - 24
51
