Non-Surgical Treatment of Periodontitis 2 Flashcards Preview

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Flashcards in Non-Surgical Treatment of Periodontitis 2 Deck (40)
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What is the most important factor in prevention and treatment of periodontal disease

The patient’s oral hygiene


Explain how oral hygiene instruction should be carried out

Ask patient to bring current oral hygiene aids
Ask how the are being used in a non-judgmental way
Ask patient to demonstrate technique and modify accordingly
Use disclosing tablets to identify areas patient is missing


When are single tufted brushes used

To clean maligned teeth
To clean distal surfaces of last molar tooth
For teeth affected by localised gingival recession


When should interdental brushes be used

If there is any primal attachment loss


What advice for mouthwash should be given to patients

Use fluoridated mouthwash with no alcohol


When should a patient be advised to use a chlorhexidine mouthwash

When pain limits mechanical plaque removal


Why is scaling and root surface debridement necessary

To remove both supra gingival and sub gingival plaque and calculus deposits
To create a root surface compatible with biological reattachment


What is root surface debridement

The removal of contaminated material leaving the root surface smooth and hard


What are the different types of scalers

Chisel - push scaler
Sickle scaler - for supra gingival plaque and calculus removal


Why are sharp instruments preferred over dull ones

To improve efficiency
More likely to remove deposits than burnish them
Reduces the amount of forced used so reduced fatigue


What are the differences between powered and hand instruments

No difference in effectiveness of debridement
Powered are quicker, less fatiguing and easier to use
Powered have a poorer tactile sensation
Powered may leave a rougher surface
Powered produces aerosols


What is the aim of full mouth disinfection

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


How should full mouth disinfection be carried out

At one or more sittings on the same day
Use chlorhexidine for subgingival irrigation, tongue brushing and mouth rinsing


What is the difference between full mouth disinfection and a quadrant approach

Both methods are equally effective
FMD is intense and may not be realistic in practice


What effect does scaling and RSD have on the micro flora

Significantly reduces the levels and prevalence of pathogenic species such as P.gingivalis and T.denticola
Complete elimination is unrealistic


What effect does scaling and RSD have on the hard and soft tissues

Decrease in gingival inflammation
Shrinkage of the gingival tissues leads to recession
Increase in collagen fibres in the connective tissue beneath the pocket and formation of long junctional epithelial attachment


Describe the healing following RSD

Gain in attachment is due to long junctional epithelium formation and improved tissue tone - inflammatory infiltrate is replaced with collagen
Greatest changes observed 4-6 weeks after therapy
Gradual repair and maturation of tissues over 9-12 months


What plaque retentive factors are present in restorations

Overhang margins
Marginal discrepancies
Subgingival margins
Overcontoured crowns


What plaque retentive factors are present in RPDs

Gingival coverage
Direct trauma
Uncontrolled loads


What plaque retentive factors are present in orthodontic appliances

Access to interdental cleaning may be compromised
Bands can lie close to the gingival margin


How is success measured in non-surgical periodontal treatment

Good oral hygiene
No bleeding on probing
No pockets >4mm
No increasing tooth mobility
A functional and comfortable dentition


What does probing depth indicate

The difficulty of treatment and the likelihood of recurrence


What are attachment levels a measure of

Tissue destruction (pre-treatment) and the extend of repair (post-treatment)


What effect does supragingival plaque control alone have

Decreased gingival inflammation
Limited effect on probing depth
No change in attachment levels
No alteration in subgingival microflora in deep pockets


What are the effects of RSD without supragingival plaque control

Initial reduction in inflammation and pocket depth
Pockets are re-colonised by bacteria from supragingival plaque
Disease recurs


What are the effects of RSD with supragingival plaque control

Decreased gingival inflammation
Reduction in probing depth
Gain in probing attachment level
Marked changes in the subgingival microflora


What should be compared during re-evaluation

Probing depths
Bleeding score
Plaque score
Attachment levels
Tooth mobility


Why does periodontal treatment fail

Inadequate patient plaque control
Residual subgingival deposits - deep pockets, furcation lesions, inexperienced operator
Systemic risk factors - smoking, diabetes


How often should periodontal treatment be carried out

Intervals of approximately 3 months are appropriate for most patients


What does periodontal charting measure

Probing depth
Recession - works out attachment level
Bleeding on probing - disease activity


What is measured on periodontal probing

From top of pocket (gingival margin) to base of pocket


Describe grade 1 furcation involvement

Initial furcation involvement
The furcation opening can be felt on probing but the involvement is less than one third of the tooth width


Describe grade 2 furcation involvement

Partial furcation involvement
Loss of support exceeds one third of the tooth wife the but does not include the total width of the furcation


Describe grade 3 furcation involvement

Through-and-through involvement
The probe can pass through the entire furcation


Describe grade 0 tooth mobility

Physiological mobility measured at the crown level
The tooth is mobile within the alveolus to approx 0.1-0.2mm in a horizontal direction


Describe grade 1 tooth mobility

Increased mobility of the crown of the tooth to at the most 1mm in a horizontal direction


Describe grade 2 tooth mobility

Visually increased mobility of the crown of the tooth exceeding 1mm in a horizontal direction


Describe grade 3 tooth mobility

Severe mobility of the crown of the tooth in both horizontal and vertical directions impinging on the function of the tooth


What is the difference between a PCP and WHO probe

PCP doesn’t have a ball end


What may influence manual probing measurements

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