Perio

Question 1

How would one diagnose ANUG, explain it to a patient and what the treatment options are?

Answer 1

Signs / symptoms
- ulceration and necrosis of gingiva
- halitosis
- painful gums

Often seen in those who are
- stressed, smokers, poor OH, imunnocompromised, malnourished

Treatment
- OHI
- NSHPT under LA
- smoking cessation
- stress advice

• if systemic involvement / lymphadenopathy
• 400mg metronidazole for 3 days 3 times daily

Question 2

Discuss periodontitis
- risks factors
- prognosis / staging
- treatment options

Answer 2

Periodontitis is also known as gum disease
- large genetic predisposition especially in aggressive periodontitis
- large contribution of oral hygiene and risk factors
- 50% of pop will get it
- plaque accumulates around gum margins and releases inflammatory chemicals - resulting in inflamed and bleeding gums
- eventually leads to bone cell mismatch resulting in jaw bone loss and eventual tooth mobility and loss

Tx options
- give OHI
- interdental brushing demonstration
- CHX mouth rinse for 2 weeks
- high fluoride toothpaste
- smoking cessation advice
- 6ppc, PGI, supra and subgingival pmpr

Question 3

Why may periodontal tx fail?

Answer 3

Non compliance

Smoking continuation

Difficult areas to access for instrumentation e.g. deep pockets, furcations

Diabetes/pregnancy/systemic issues

Poor manual dexterity - Parkinson’s etc

Question 4

What makes perio localised or generalised?

Answer 4

less or more than 30% of all teeth involved

Question 5

What is stable periodontitis?

Answer 5

Bop <=10%

Pockets <=4mm

No BoP at 4mm sites

Question 6

What is periodontitis currently in remission?

Answer 6

Bop >=10%

Pockets <=4mm

No BoP at 4mm sites

Question 7

What is unstable periodontitis?

Answer 7

Pockets >= 5mm

Or BoP at 4mm sites

Question 8

How would one manage a periodontal abscess with no systemic involvement?

Answer 8

Take a PA radiograph of teeth in the area
- sensibility test the teeth in the area
- take pocket depths of the teeth
- lateral TTP and occlusal TTP

Treatment
- LA and localised debridement with saline
- irrigate in the pocket
- hot salt mouth rinse for next few days for pt

Question 9

What is step 1 perio?

Answer 9

OHI, teepee brush demonstration / tailored OHI

Removal of plaque retentive factors

mod P+B scores

Risk factor education and control

Supragingival pmpr

Question 10

Step 2 perio?

Answer 10

Subgingival instrumentation - if they are engaged
- reinforce OHI
- subgingingival pmpr

Question 11

Step 3 perio?

Answer 11

If patient is unstable after step 2
- reinforce OHI, risk factor control
- re-perform subgingival pmpr in pockets 4-5mm
- consider referral or adjunctive therapies in pockets >=6mm

Question 12

Perio step 4?

Answer 12

Only if periodontitis is stable
- supportive care
- reinforce OHI, risk factor and behaviour control
- regular targeted PMPR
- consider mouthwash / toothpaste

Question 13

What scalers are used where?

Answer 13

Grey - anteriors

Blue - posterior distal

Orange - posterior mesial

Green - buccal and lingual posteriors

Red hoe - mesial and distal

Yellow hoe - buccal and lingual