Flashcards in Non-Surgical Treatment of Periodontitis 2 Deck (40)
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1
What is the most important factor in prevention and treatment of periodontal disease
The patient’s oral hygiene
2
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
3
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
4
When should interdental brushes be used
If there is any primal attachment loss
5
What advice for mouthwash should be given to patients
Use fluoridated mouthwash with no alcohol
6
When should a patient be advised to use a chlorhexidine mouthwash
When pain limits mechanical plaque removal
7
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
8
What is root surface debridement
The removal of contaminated material leaving the root surface smooth and hard
9
What are the different types of scalers
Chisel - push scaler
Sickle scaler - for supra gingival plaque and calculus removal
Hoe
Curettes
Jacquettes
10
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
11
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
12
What is the aim of full mouth disinfection
Prevent treated pockets being re-colonised by intra-oral translocation of bacteria
13
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
14
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
15
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
16
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
17
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
18
What plaque retentive factors are present in restorations
Overhang margins
Marginal discrepancies
Subgingival margins
Overcontoured crowns
19
What plaque retentive factors are present in RPDs
Gingival coverage
Direct trauma
Uncontrolled loads
20
What plaque retentive factors are present in orthodontic appliances
Access to interdental cleaning may be compromised
Bands can lie close to the gingival margin
21
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
22
What does probing depth indicate
The difficulty of treatment and the likelihood of recurrence
23
What are attachment levels a measure of
Tissue destruction (pre-treatment) and the extend of repair (post-treatment)
24
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
25
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
26
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
27
What should be compared during re-evaluation
Probing depths
Bleeding score
Plaque score
Attachment levels
Tooth mobility
Furcation
28
Why does periodontal treatment fail
Inadequate patient plaque control
Residual subgingival deposits - deep pockets, furcation lesions, inexperienced operator
Systemic risk factors - smoking, diabetes
29
How often should periodontal treatment be carried out
Intervals of approximately 3 months are appropriate for most patients
30
What does periodontal charting measure
Probing depth
Recession - works out attachment level
Bleeding on probing - disease activity
Mobility
Furcation
31
What is measured on periodontal probing
From top of pocket (gingival margin) to base of pocket
32
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
33
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
34
Describe grade 3 furcation involvement
Through-and-through involvement
The probe can pass through the entire furcation
35
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
36
Describe grade 1 tooth mobility
Increased mobility of the crown of the tooth to at the most 1mm in a horizontal direction
37
Describe grade 2 tooth mobility
Visually increased mobility of the crown of the tooth exceeding 1mm in a horizontal direction
38
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
39
What is the difference between a PCP and WHO probe
PCP doesn’t have a ball end
40
