Perio Flashcards
(119 cards)
1
Q
function of the periodontium
A
- to attach the teeth to the jaws
- dissipate occlusal forces
2
Q
types of horizontal forces
A
- constant - orthodontic
- intermittent - occlusal (jiggling)
3
Q
excessive occlusal force definition
A
- occlusal force that exceeds the reparative capacity of periodontal attachment aparatus
- results in occlusal trauma and/or excessive tooth wear
4
Q
occlusal trauma definition
A
- injury which results in changes within periodontal attachment aparatus
- as a result of occlusal force(s)
- may occur in a intact periodontium or in a reduced periodontium caused by periodontal disease
5
Q
what is periodontal attachment aparatus
A
- periodontal ligament
- supporting alveolar bone
- cementum
6
Q
factors influencing tooth mobility
A
- width of PDL
- height of PDL
- inflammation
- number, shape and length of roots
7
Q
tooth mobility indicates
A
- successful adaptation of periodontium to functional demands
- reflects the nature of the remaining attachment
- does not necessarily represent a pathological state of affairs
8
Q
tooth mobility can be accepted unless
A
- it is progressively increasing
- it gives rise to symptoms
- it creates difficulty with restorative tx
9
Q
therapy to reduce tooth mobility (tx options)
A
- control of plaque-induced inflammation
- correction of occlusal relations
- splinting
10
Q
response of the healthy periodontium to primary occlusal trauma
A
- PDL width increases until forces dissapated
- tooth mobility increased
- this is successful adaptation to increased demand
- if demand is subsequently reduced the PDL width should return to normal
- if demand too great or PDL adaptibility reduces PDL width may continue to increase
11
Q
histological changes occuring during occlusal trauma to healthy periodontium
A
- on pressure side: increased vascularisation and permeability, necrosis of PDL, thrombosis, hameorrhage, bone resorption
- on tension side: elongation of PDL, apposition of alveolar bone and cementum
- density of alveolar bone decreases while width of PDL space increases
12
Q
secondary occlusal trauma
A
- injury which results in tissue changes
- from normal or excessive occlusal forces applied to tooth/teeth with reduced periodontal support
- occurs in presence of attachment loss, bone loss, and normal/excessive occlusal forces
13
Q
evidence of occlusal trauma
A
- tooth mobility which is progessively increasing
- tooth moblility associated with symptoms
- radiographic evidence of increased PDL width
14
Q
define fremitus
A
palpable or visible movement of a tooth when subjected to occlusal forces
15
Q
occlusal trauma
diagnosis made from
A
- progressive tooth mobility
- fremitus
- occlusal discrepancies
- wear facets
- tooth migration
- also…
- tooth fracture
- thermal sensitivity
- root resorption
- cemental tear
- widening of PDL space on radiograph
16
Q
tooth migration causes/results in
A
- loss of periodontal attachment
- unfavourable occlusal forces
- unfavourable soft tissue profile
17
Q
management of tooth migration
A
- treat the periodontitis
- correct oclusal relations
- either accept the position of the teeth and stabilise or move the teeth orthodontically and stabilise
18
Q
splinting for perio may be appropriate when
A
- mobility is due to advanced loss of attachment
- mobility is causing discomfort or difficulty in chewing
- teeth need to be stabilised for debridement
19
Q
negatives of splinting for perio
A
- does not influence the rate of periodontal destruction
- may create hygiene difficulties
- is a treatment of last resort
20
Q
effect of excessive occlusal forces on gingival recession
A
no correlation identified
21
Q
2017 perio disease classification
10 listed classifications
A
- health
- plaque induced gingivitis
- non plaque induced gingival disease and conditions
- periodontitis
- necrotising periodontal disease
- periodontitis as a manifestation of systemic disease
- systemic diseases or conditions affecting the periodontal tissues
- periodontal abscess
- periodontal-endodontic lesions
- mucogingival deformities and conditions
22
Q
2017 perio disease classification
gingival health
A
- intact periodontium - absence of bleeding on probing, erythema and edema, pt symptoms and attachment and bone loss
- reduced periodontium due to causes other than periodontitis
- <10% bleeding sites and probing depths <= 3mm
- physiological bone levels range from 1-3mm apical to CEJ
23
Q
2017 perio disease classification
plaque induced gingivitis
A
- BPE score 1 or 2
- associated with biofilm alone
- mediated by systemic or local risk factors - drug influenced gingival enlargement etc
- no radiological bone loss
- no interdental recession
- bleeding on probing <30% localised and >30% generalised
24
Q
plaque induced gingivitis modifying factors
A
- can exacerbate but not cause gingivitis
- drug induced gingival enlargement - amlodipine (ca channel blocker), anticonvulsants, immunosuppresants
- sex steroid hormones - puberty, pregnancy, oral contraception
- hyperglycemia
- smoking
- malnutrition
- prominent subgingival restoration margins
- hyposalivation
25
2017 perio disease classification
non-plaque induced gingival diseases
* genetic/developmental disorders - eg hereditary gingival fibromatosis
* specific infections - herpetic gingival stomatitis
* endocrine, nutritional and metabolic diseases - vitamin c deficiency
* inflammatory and immune conditions - lichen planus
* traumatic lesions
* gingival pigmentation
26
2017 perio disease classification
necrotising periodontal diseases
* necrotising gingivitis - necrosis and ulcer in interdental papilla
* necrotising periodontitis - signs and symptoms of NG plus periodontal attachment and bone destruction
* necrotising stomatitis - larger areas of osteitis and bone sequestrum
27
predisoposing conditions for necrotising periodontal disease in chronically, severely compromised adults
* HIV +/ AIDS with CD4 counts < 200 and detectable viral load
* other severe systemic conditions eg immunosuppression
28
predisoposing conditions for necrotising periodontal disease in chronically, severely compromised children
* severe malnourishments
* extreme living conditions
* severe (viral) infections
29
predisoposing conditions for necrotising periodontal disease in temporarily/moderately compromised pt
* uncontrolled factors - stress, nutrition, smoking, habits
* previous NPD - residual craterss
* local factors - root proximity, tooth malposition
* common predisposing factors
30
2017 perio disease classification
periodontitis as a manifestation of systemic disease
* mainly rare diseases that affect the course of periodontitis
* resulting in early presentation of severe periodontitis
* papillon lefevre syndrome
* leucocyte adhesion deficiency
* downs syndrome
31
2017 perio disease classification
systemic diseases or conditions affecting the periodontal tissues
* mainly rare conditions affecting perio tissues independantly of dental plaque biofilm induced inflamation
* may mimic clinical presentation of periodontitis
* squamous cell carcinoma
* langerhans cell histocytosis
* does not include common systemic diseases that modify course of perio such as uncontrolled diabetes - instead included as descriptor in staging and grading process
32
2017 perio disease classification
periodontal abscess
* in periodontitis patients - acute exacerbation or after treatment
* in non periodontitis patients
33
causes of periodontal abscess in periodontitis patients
* acute exacerbation - untreated periodontitis, non-responsive to perio therapy
* after treatment - post-scaling, post-surgery, post-medication
34
causes of periodontal abscess in non perio patients
* impaction - dental floss, rubber dam, popcorn hulls etc
* harmful habits - nail biting, clenching
* orthodontic factors - ortho forces, cross-bite
* gingival overgrowth
* alteration of root surface - perforations, cracked tooth syndrome, odontodysplasia
35
2017 perio disease classification
periodontal endodontic lesions
* endo periodontal lesions with root damage - root #, root canal or pulp perforation, external root resoprtion
* endo-perio lesions without root damage - can either be in perio patients or not in perio patients
36
2017 perio disease classification
mucogingival deformities and conditions
* gingival recession
* recession type 1 (RT1)
* recession type 2 (RT2)
* recession type 3 (RT3)
37
mucogingival deformaties and conditions
recession type 1
* gingival recession with no loss of interproximal attachment
* interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth
38
mucogingival deformaties and conditions
recession type 2
* gingival recession associated with loss of interproximal attachment
* amount of attachment loss measured from interproximal CEJ to depth of sulcus/pocket
* is LESS THAN OR EQUAL TO buccal attachment loss which is measured from buccal CEJ to end of buccal sulcus/pocket
39
mucogingival deformaties and conditions
recession type 3
* gingival recession associated with loss of interproximal attachment
* amount of attachment loss measured from interproximal CEJ to end of sulcus/pocket
* is GREATER than the buccal attachment loss
40
necrotising periodontal disease
characteristics
* rapidly destructive and debilitating
* most severe inflammatory periodontal disease caused by plaque
* painful, bleeding gums and ulceration
* necrosis of interdental papilla - punched-out appearance
* seen more in developing countries
* due to predisposing factors
41
classification of necrotising periodontal disease
* necrotising gingivitis - when only the gingival tissues affected
* necrotising periodontitis - when necrosis progresses into PDL and alveolar bone leading to attachment loss
* necrotising stomatitis - when necrosis progresses to deeper tissues beyond mucogingival line - including lip or cheek mucosa, tongue etc
42
diagnoses of necrotising periodontal disease
general overview
* based on symptoms not any test
* histopathology and microbiology not characteristic for NPD
* constant flora - prevotella intermedia, fusobacterium sp.
* bacteria isolated from large number of necrotic lesions but not always found in primary lesion so no evidence of primary etiologic importance
43
diagnoses of necrotising periodontal disease
necrotising gingivitis
* ulcerated and necrotis papillae and gingival margin - punched-out appearance
* ulcers covered by a yellowish, white or greyish slaim (NOT psuedomembrane)
* when slaim removed the underlying CT becomes exposed and bleeds
* lesions develop quickly and are very painful
44
diagnoses of necrotising periodontal disease
what is slaim
* yallowish, white or greyish slouthing covering ulcers
* made of fibrin, necrotic tissue, leucocytes, erythrocytes and mass of bacteria
45
where are first lesions of necrotising gingivitis commonly seen
interproximally in mandibular anterior region
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diagnoses of necrotising periodontal disease
necrotising periodontitis
* ulcerations often associated with deep pockets formation
* gingival necrosis coincides with loss of alveolar crest bone
* ulcers with central necrosis develop into craters
* adenopathies (enlarged lymph nodes) found in most severe cases - affects submandibular LN more than cervical
* very rarely fever
47
diagnoses of necrotising periodontal disease
necrotising stomatitis
* affected bone extends through alveolar mucosa
* larger bone sequestra (bone that has been separated from the surrounding bone during the process of necrosis) may occur
* large areas of osteitisand oral-antral fistulae
* greater severity in pt with severe systemic compromise - AIDS and pt with severe malnutrition
48
necrotising periodontal diseases should be differentiated from the following
* oral mucositis
* HIV-associated periodontitis
* herpes simplex virus
* scurvy
* gingivostomatitis
* leukemia
* desquamative gingivitis
49
risk factors for necrotising periodontal disease
* in developed countries - stress, sleep deprivation, poor oral hygiene, smoking, immunosuppression (HIV, leukemia) and/or malnutrition
* in developing countries - mostly in malnourished children
50
how herpetic gingivostomatitis differs from necrotising periodontal disease
* caused by herpes simplex virus not bacteria
* affects gingiva and entire oral mucosa whereas NPD affects interdental papillae and rarely outside mouth
* lasts 1-2 weeks whereas NPD lasts 1-2 days if treated
* can get partial immunity
* is contageous
* no permanent destruction vs NPD destruction of periodontal tissue remains
51
necrotising periodontal disease
treatment of the acute phase
* two main objectives:
1. arrest disease process/tissue destruction
2. control pt discomfort and pain
* careful superficial debridement to remove soft and mineralised deposits - ultrasonics recommended
* performed daily deeper and deeper for as long as acute phase lasts
* limit mechanical oral hygiene - brushing into wound may impair healing and cause pain
* pt use chlorhexidine based mouthrinses twice daily
52
necrotising periodontal disease
further treatment if debridement unsatisfactory
* use of systemic antimicrobials may be considered if unsatisfactory response to debridement or show systemic effects (fever and/or malaise)
* metronidazole 400mg TID 3 days
* locally delivered antimicrobials not recommended as drug will not be able to achieve adequate conc - because of large number of bacteria in tissues
53
necrotising periodontal disease
treatment follow up
* have to be followed up very closely - daily if possible
* as symptoms and signs improved strict mechanical hygiene measures should be enforced
* complete debridement of the lesions
54
necrotising periodontal disease
treatement of pre-existing condition
* pt with NPD usually have pre-existing gingivitis or periodontitis
* once acute phase controlled treat pre-existing condition
* professional prophylaxis and/or scaling and root planning
* OHI enforced
* evaluate local factors such as overhanging res, tooth malposition etc and treat
* control of systemic predisposing factors - smoking, stress reduction etc or tx of systemic conditions
55
necrotising periodontal disease
corrective tx of disease
* correct altered gingival form/features
* gingival craters may favour plaque acculumation and disease recurrence
* gingivectomy or gingivoplasty procedures for superficial craters
* periodontal flap surgery, regenerative surgery for deep craters
56
what to screen for if healthy individual without any predisposing factors has NPD
* HIV
* necrotising periodontal disease in healthy individuals suggestive of HIV infection
57
acute perio conditions 2018 classification
types of abscesses
* periodontal abscess
* gingival abscess
* endo-perio abscess
* dentoalveolar abscess
* pericoronitis
* other - trauma, surgery
58
abscesses of the periodontium
gingival abscess
* localised to the gingival margin
* can be caused by localised trauma, food packing etc
59
abscesses of the periodontium
periodontal abscess
* usually related to preexisting deep pocket
* also associated with food packing and tightening of gingival marging post PMPR
* if bacterial plaque removal insufficient --> pocket constrained and virulent bacteria could cause localised abscess
* infection in a periodontal pocket which can be acute or chronic and asymptomatic if freely draining (SDCEP)
* rapid destruction of periodontal tissues - negative effect on prognosis of tooth
60
abscesses of the periodontium
pericoronal abscess
* associated with partially erupted tooth
* most commonly 8s
* pericoronitis
61
endodontic-periodontal lesion
* tooth is suffering from varying degrees of endodontic and periodontal disease
* endo-perio abscess
* pathological communication between the endodontic and periodontal tissues of a tooth
* can be acute or chronic
* swelling around apex
62
periodontal abscess signs and symptoms
* swelling
* pain - not usually agonising
* tooth may be TTP laterally
* deep periodontal pocket
* bleeding
* suppuration - pus formation
* enlarged regional lymph nodes - submandibular, submental, cervical
* fever
* tooth usually vital
* tend to be more low-grade compared to dental abscesses
63
periodontal abscess
SDCEP guidance
* careful sub-gingival instrumentation - short of the base of the pocket to avoid iatrogenic damage
* LA may be required
* if pus present drain by incision or through periodontal pocket - recommend optimal anaesthesia
* do not prescribe antibiotic unless signs of spreading infection or systemic involvement
* recommend the use of 0.2% chlorhexidine MW until acute symptoms subside
* review and carry out definitive perio instrumentation
64
periodontal abscess
use of systemic antibiotics
* only if signs of spread and systemic effects - increased WCC, pyrexic >37.5 degrees C, increased RR, HR, trismus, difficulty swallowing etc
* penicillin V 250mg preferred or amoxicillin 500mg or metronidazole 400mg
* 5 day course
* must only be used in conjunction with careful RSD in order to reduce bacterial load and disrupt biofilm
65
endo-perio lesion
acute/chronic
* acute - trauma, perforation during RCT
* chronic - pre-existing periodontitis, slow progression without evident symptoms
* swelling around apex - pus could drain buccally or up periodontal space
66
endo-perio lesion
signs and symptoms
* deep periodontal pockets
* negative or altered response to pulp vitality tests
* bone resorption in apical or furcation region
* spontaneous pain
* pain on palpation and percussion
* pus
* tooth mobility
* sinus tract
67
endo-perio lesion
possible routes of communication
* lateral canal
* furcal canal
* apical foramen
68
endo-perio lesion
lateral and accessory canals
* 30-40% of all teeth have lateral and accessory canals
* most in apical third of root
* furcal canal - at the furcation of molars - may be direct pathway of communication between the pulp and periodontium
* not all furcal canals extend the full length from the pulp chamber to the floor of the furcation
69
endo-perio lesion
apical foramen
* main route of communication between the pulp and periodontium
* microbial and inflammatory by-products may exit apical foramen - causing periapical pathoses
* apex also portal of entry for inflammatory by-products from deep periodontal pockets to affect the pulp
70
endo-perio lesion
perforation
* results in communication between the root-canal system and peri-radicular tissues, PDL or oral cavity
* causes - extensive dental caries, resorption, operator error (RC instrumentation or post preparation)
71
endo-perio lesion
developmental groove
* invagination/vertical radicular groove
* especially on upper incisors
* if periodontal attachment breached the groove can become contaminated - infrabony pocket can form along its length
* channel provides a place for accumulation of bacteria and route for progression of periodontitis - may also affect the pulp if it extends to the apex
* radiographically the area of bone destruction follows the course of the groove
72
endo-perio lesion associated with trauma or iatrogenic factors
* root/pulp chamber perforation
* root fracture or cracking - trauma or prep for post
* external root resorption - trauma
* pulp necrosis because of trauma draining through the periodontium
73
classification of endo-perio lesion
* by pulp infection that secondarily affects the periodontium or periodontal destruction that secondarily affects the root canal
* 2 catergories - endo-perio lesion with root damage or endo-perio lesion without root damage
* with root damage - fracture or cracking, perforation, external root resorption
* without root damage - split further into lesion in perio patients and lesion in non-perio patients
74
endo-perio lesion
SDCEP tx
* carry out primary endodontic therapy of the affected tooth
* recommend optimal analgesia
* do not prescribe antibiotics unless signs of spreading infection or systemic involvement
* recommend use of 0.2% chlorhexidine MW until the acute symptoms subside
* following acute management of lesion - review within 10 DAYS and carry out supra and sub-gingival instrumentation if necessary
* arrange an appropriate recall interval
75
endo-perio lesion
additional tx
* non surgical scaling unlikely to be successful
* surgical instrumentation and mechanical removal - open flap debridement etc
* guided tissue regeneration - bone regeneration etc
76
perio tx step 1
* explain disease, risk facors, risks and benefits of tx
* give OHI - interdental cleaning
* reduce risk factors - remove overhangs, smoking cessation, diet control
* professional mechanical plaque removal (PMPR) supra and sub-ginival of clinical crown
* select recall period
77
perio tx step 1
recall period
* 6-8 weeks
* might not be appropriate for certain parts
* can be flexible
* some 2 weeks
78
perio tx step 1
what to evaluate
* non-engaging pt return to step 1 and repeat
* engaging pt move to step 2 or consider referral
79
perio tx step 2
* subgingival instrumentation - root surface debridement/PMPR on root
* hand or powered (sonic/ultrasonic) either alone or in combination
* reinforce OHI, risk factor control, behaviour change
* use of adjunctive systemic antimicrobials if appropriate
80
perio tx step 2 evaluation
* BDS - re-evaluate after 3 months
* unstable - go to step 3
* stable - go to step 4
81
when to go to step 3 perio
* pt unstable after step 2 perio
* step 2 perio re-evaluated after 3 months and then pt goes to step 3
82
perio tx step 3
* managing non-responding sites
* OHI, risk factor control, behaviour change
* moderate (4-5mm) residual pockets - re-perform subgingival instrumentation
* deep residual pockets (>6mm) consider alternative causes and referral for pocket management or regenerative surgery
* if referral not possible reperform subgingival instrumentation
83
perio tx step 3 recall
* 3 months
* if all sites stable after step 3 proceed to step 4
84
perio tx step 4
* maintenance
* supportive periodontal care encouraged
* reinforce OHI, risk factor control, behaviour change
* regular targeted PMPR as required to limit tooth loss
* maintenance recall - individually tailored intervals from 3-12 months
85
BSP top tips
* pt should be aware that regular self-performed plaque removal offers largest tx benefits
* toothbrushing should be supplemented by use of interdental brushes
86
BSP defining engaging pt
* >50% improvement in plaque and marginal bleeding scores OR
* plaque levels <20% and bleeding levels <30% OR
* pt has met targets outlined in their personal self-care plan
87
BSP defining non-engaging pt
* insufficient improvement in OH - <50% improvement in plaque and marginal bleeding scores OR
* plaque levels >20% and bleeding levels >30% OR
* pt states preference to a palliative approach to periodontal care
88
define success at perio review
* good oral hygiene
* no BOP
* no pockets >4mm
* no increase in tooth mobility
* a functional and comfortable dentition
89
perio tx step 3 tx options
PPD 4-5mm repeted subgingival instrumentation
PPD >= 6mm consider surgical approach
90
factors influencing decision for periodontal surgery
* smoking
* compliance
* oral hygiene
* systemic disease
* suitability of site - access, soft and hard tissue factors
* prognosis of tooth and importance of tooth
* availability of specialist tx
* patient preference
91
perio tx ideal endpoint
* no pockets >4mm
* BOP <10%
* functional and comfortable dentition
* plaque scores <20% or target for pt
92
perio tx step 4 main aims
* maintain periodontal health
* detect and retreat recurrence
* maintain an accepted level of disease
* manage tooth loss
93
why perio maintenance (step 4)
* pt not maintained in recall program show obvious signs of recurrent periodontitis
* the more often pt present for supportive periodontal therapy, the less likely are to loose teeth
* pt who do not return for regular recall 5 X greater risk for tooth loss than compliant pt
94
how to do step 4 perio tx
* part 1 examination - history, OH status, pocket depth changes, mobility, update pocket charts and mod bleeding and plaque scores
* part 2 PMPR - supra and subgingival based on pocket chart
* care must be taken not to instrument normal sites with shallow sulci (1-3mm) with no calculus as studies show can lead to loss of attachment
95
causes for periodontal disease recurrence
* inadequate plaque control - pt failure to comply with recommended SPT schedules
* failure to remove all potential plaque retentive factors
* incomplete calculus removal in areas of difficult access
* inadequate restorations placed after perio tx was completed
96
periodontal maintenance
6PPC frequency/location
* for pt with BPE 4 - full mouth periodontal charting annually
* for BPE 3 in more than one sextant - full mouth periodontal charting annually
* BPE 3 in 1 sextant - full periodontal charting of that sextant annually
97
supportive periodontal therapy
debridement
* carry out root surface instrumentation at sites >4mm where sub-gingival deposits present or bleeding on probing
* for sites <4mm only carry out sub-gingival instrumentation where deposits are present
98
perio guidelines
why changes have been made
1. perio quality improvement project
2. new guidelines introduced
99
key perio guidelines
* British society of periodontology:
- BPE
- UK clinical practice guidelines for tx of periodontal disease
- 2017 classification of periodontal disease
* Scottish Dental Clinical Effectiveness Programme
* no difinitive guideline on which charts to use when - at glasgow GDH complete 6PPC used as baseline and review charts for pts at review
100
complete 6PPC advantages and disadvantages
* A - gives a full picture of periodontal attachment loss
* D - more time consuming
101
abbreviated/review perio chart advantages and disadvantages
* quicker to complete
* can efficiently highlight areas requiring further tx
* does not record periodontal attachment loss - progress could be un-recorded
102
genetic considerations associated with impairment of immune system
* papillon-lefevre syndrome
* LAS syndrome
* downs syndrome
* chronic granulomatous disease
103
diseases leading to impairment of immunce system
* leukaemia
* agranulocytosis
* neutropenia
* HIV infection
104
categories of periodontal risk factors
* local risk factors - aquired and anatomical
* systemic risk factors - non-modifiable and modifiable
105
perio local risk factors
acquired
* plaque
* calculus
* overhanging and poorly contoured restorations
* orthodontic appliances
* occlusal trauma
106
perio local risk factors
anatomical
* malpositioned teeth
* root grooves
* concavities and furcations
* enamel pearls
107
systemic perio risk factors
non-modifiable
* ageing
* genetic factors
* down syndrome
* papillon-lefevre syndrome
108
systemic perio risk factors
modifiable
* smoking
* poorly controlled diabetes
* HIV
* leukaemia
* osteoporosis
* stress
* medications
* poor nutrition
* socioeconomic status
109
why is smoking a perio risk factor
* effect on oral microbiota - change to anaerobic bacteria
* increase activation of immune systm - due to chemicals
* decreased healing capacity - reduced blood flow
110
why sub-optimally controlled diabetes is perio risk factor
* hyperglycaemia may modulate RANKL:OPG ratio - contribute to bone destruction
* in hyperglycaemia production of advanced glycation end products (AGE) leads to exacerbation of inflammation
111
drugs which are risk factors for diabetes
* anticonvulsant - phenytoin
* immunosuppresants - cyclosporin
* calcium channel blockers - nifedipine etc
* interaction between drug and host fibroblasts - increased deposition of CT
112
relationship between periodontitis and diabetes control
* untreated periodontitis can result in circulating bacteria and antigens - systemic inflammatory state and impaired insulin signalling and reistence - elevated HbA1c levels and exacerbation of diabetes
* periodontal tx results in reduced circulating bacteria and antigens and reduction in systemic inflammatory state - improvement in insulin signalling and resistance - reduction in HbA1c and improved diabetes control
113
structure to supportive periodontal care
* part 1 examination - history, plaque chart, pocket depth changes, gingival changes, mobility changes, occlusal changes etc
* part II tx - OHI, supra PMPR, RSD, polishing
* part III report, cleanup and scheduling - write report in chart, discuss report with pt, schedule rext recall visit/further perio tx
114
supportive periodontal therapy
examination
* updating medical history
* oral mucosa inspected for pathologic conditions
* evaluation of restoration, cariesm prosthesis, occlusion, tooth mobility, BOP, periodontal/periimplant probing depths
* analysis of current oral hygiene status
* primarily look for changes that have occurred since last evaluation
115
supportive periodontal therapy
shallow sulci
* care to not instrument normal sites with shallow sulci
* 1-3mm deep
* that do not have any calculus
* studies show repeated subgingival scaling in normal periodontal sites result in significant loss of attachment
116
supportive periodontal therapy
challenges
* periodontal pts at risk of disease recurrence for the rest of their lives
* pockets in furcation areas may not have been eliminated by inital tx
* no test accurately predicts disease activity - clinicians rely on clinical measurements etc
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