perio - tutorials Flashcards
(40 cards)
ideal outcomes of perio tx according to SDCEP (4)
- high levels of plaque control
- bleeding <10% and plaque <15%
- PPD <4mm throughout mouth
- absence of bleeding at 4mm sites
what does healing depend on
- anatomy of pocket
- immune system
- local risk factors
- anatomy of teeth at which site of pocket is
if >50% pockets healing tx is working so if less then there is an issue with instrumentation
‘engaging’ patient according to BSP
plaque levels <20% and marginal bleeding <30%
OR
>50% reduction in plaque & marginal bleeding from baseline recordings
what is a ‘non responding’ site
> 10% sites with PPD >4mm and BoP at >20% sites 1 year after active treatment
pocket depth v clinical attachment loss
pocket depth = inflammation
clinical attachment loss = bone loss
factors influencing decision for referral for perio surgery (8)
- smoking
- compliance
- OH
- systemic disease
- suitability of sites i.e. access soft & hard tissue factors
- prognosis of tooth / important of tooth
- availability of specialist tx
- pt preference
4 types of perio surgery
- access
- resective
- regenerative
- mucoginigval
access perio surgery
to gain more access to root surface in persisting pockets; inc raising full thickness mucoperiosteal flap & removal of granulose tissue
aim = improved visibility & accessibility for subgingival instrumentation of both hard & soft root surface deposits which have not been removed by non surgical means
resective perio surgery
to remove infected soft tissue of gingivae & infected bone
gingivectomy = during crown lengthening before prosthetic tx
reduction of gingival excess facilitates plaque control, restorative dentistry & improves appearance
regenerative perio surgery
indications -
1. 2 and 3 walled bony defects
2. grade II mandibular furcation defects
3. grade II buccal maxillary furcation defects
aim is to increase periodontal attachment of severely compromised teeth, a decrease in deep pockets so more maintainable range & reduction in vertical & horizontal component of furcation defects
mucogingival therapy
gingival augmentation, root coverage, gingival preservation at ectopic tooth eruption, preservation of ridge collapse associated with tooth xla
symptoms of periodontal emergency
pain
localised swelling
increased bleeding
increased mobility
ulceration
halitosis
bad taste in mouth
signs of systemic involvement i.e. fever, malaise
signs of spreading infection i.e. cellulitis, lymph node involvement
what will help diagnose perio emergency
radiographs i.e. PA
vitality testing
clinical exam
pain hx i.e. SOCRATES
location of swelling i.e. how far up root
perio exam - check pocketing in area, are they are perio pt or not
vertical bone loss more likely to be abscess in area or furcation and pocket in furcation
perio abscess v periapical abscess
for perio abscess there must be clinical attachment loss
for periapical abscess the infection has began in the pulp chamber / root canal and spread out through apices of tooth
note - the 2 can occur simultaneously in endo-perio lesion
endo perio lesion classification
- with root damage
- root # or cracking
- root canal or pulp chamber perforation
- external root resorption - without root damage
- perio pt
- non perio pt
grade 1 - narrow deep pocket in 1 tooth surface
grade 2 - wide deep pocket in 1 tooth surface
grade 3 - deep perio pocket in >1 tooth surface
sdcep mx of endo perio lesions
- consider overall prognosis of tooth & assess whether retention is possible or desirable
- if to be retained carry out endo tx of affected tooth
- following endo tx mx of perio tissues as indicated non surgically or surgically
- do not prescribe ABs unless there are signs of spreading infection or systemic involvement
when could a periodontal abscess occur
following subgingival PMPR when not all of debris is removed from base of pocket & there is healing at coronal part but not apical part so pt will present 2-3 days later with abscess
step by step of mx of perio abscess
- careful subgingival instrumentation short of base of pocket to avoid iatrogenic damage (LA likely to be required)
- if pus present in perio abscess drain by incision or through pocket
- recommend optimal analgesia i.e. paracetamol / NSAIDs
- do not prescribe ABS unless signs of spreading infection or systemic involvement
- recommend use of 10ml x2 daily 0.2% CHX MW until acute symptoms reside // H2O2 6% 15ml diluted x 3 daily
- following acute mx r/v in 10 days and carry out definitive perio instrumentation & arrange appropriate recall
if endo perio with root damage due to perforation
sectional CBCT for that area if suspecting perforation / # of roots
could:
- lift flat find perforation & treat
- xla
- refer to specialist
if no apical area no need to re endo
mta used to restore perforation
if remove post warn pt of risk of # and risk increases with increasing length of post
what ABs to use
pen V 500mg x 4 daily for 5 days
metronidazole 400mg TID for 5 days
MUST be used in conjunction with mechanical therapy to reduce bacterial load and disrupt the biofilm
NG/NP symptoms
severe pain
punched out papilla (can end up with a lot of recession following tx)
yellow / grey sloughing
halitosis
bleeding readily provoked
risk factors of NG/NP
stress (suppresses immune system)
smoking
immunocompromised
severe malnutrition
key factor about NG/NP
OPPORTUNISTIC INFECTION - bacteria already there but they thrive in this environment
tx of NG/NP
1st visit - LA as very painful, supra gingival debridement to encourage healing, prescribe CHX MW / H2O2 MW, identify & address risk factors
2nd visit (3-5 days later) - r/v, subgingival debridement
if continuation of symptoms consider referral to specialist in primary or secondary care
if systemic involvement / spreading infection prescribe 400mg metronidazole TID for 3 days
