S3 guidelines for stage l-lll UK-main Flashcards
(120 cards)
1
Q
Q: How is clinical periodontal health defined?
A
A: By less than 10% bleeding on probing (BOP) sites and absence of attachment and bone loss from previous periodontitis.
2
Q
Q: What defines a case of gingivitis?
A
A: Gingival inflammation with BOP at ≥10% sites and no detectable attachment loss from previous periodontitis.
3
Q
Q: How is localized gingivitis differentiated from generalized gingivitis?
A
A: Localized gingivitis: 10%-30% BOP sites; Generalized gingivitis: >30% BOP sites.
4
Q
Q: How is periodontitis defined?
A
A: By loss of periodontal tissue support, assessed by radiographic bone loss or interproximal clinical attachment loss.
5
Q
Q: What additional features can describe periodontitis?
(probing depth with/without BOP) & others
A
A: Teeth with probing depth ≥4 mm (with BOP), ≥6 mm, teeth lost due to periodontitis, intrabony lesions, or furcation lesions.
6
Q
Q: What are the two components used to characterize periodontitis cases?
A
- Stage (severity and complexity of management)
- grade (biological features like rate of progression and risks).
7
Q
Q: What defines a stable periodontitis patient post-treatment?
A
A: Gingival health on a reduced periodontium with <10% BOP, probing depths ≤4 mm, and no 4 mm sites with BOP.
8
Q
Q: What is a stable periodontitis patient with gingival inflammation?
A
A: A patient with <4 mm probing depths but >10% BOP post-treatment.
9
Q
Q: What criteria indicate unstable periodontitis?
A
A: Persistent probing depths ≥4 mm with BOP.
10
Q
Q: What are the 4 steps in the clinical pathway for diagnosing periodontitis?
A
1 Identify suspected periodontitis,
2) Confirm the diagnosis,
3) Stage the case,
4) Grade the case.
11
Q
Q: What conditions must be differentiated from periodontitis?
A
- Gingivitis
- vertical root fractures
- cervical decay
- cemental tears
- external root resorption
- tumors
- trauma-induced recession
- endo-periodontal lesions
- periodontal abscess,
- necrotizing periodontal diseases.
12
Q
Q: What is the prerequisite to starting periodontal therapy?
A
A: Inform the patient of the:
- diagnosis,
- causes
- risk factors
- treatment options
- risks/benefits
- and agree on a personalized care plan.
13
Q
Q: What is the first step of periodontal therapy?
A
A: Guiding behavior change through motivation, oral hygiene instruction (OHI), supragingival biofilm control, and risk factor control (e.g., smoking cessation, metabolic control).
14
Q
Q: What professional intervention is included in the first step of therapy?
A
A: Professional Mechanical Plaque Removal (PMPR), including removal of supragingival plaque, calculus, and plaque-retentive factors.
15
Q
Q: When should the first step of therapy be reevaluated?
A
A: Frequently, to build motivation, develop biofilm removal skills, and modify as needed.
16
Q
Q: What is the goal of the second step of therapy?
A
A: Control subgingival biofilm and calculus through subgingival instrumentation and adjunctive therapies (e.g., antimicrobials, host-modulating agents).
17
Q
Q: When are steps 1 and 2 delivered simultaneously?
A
A: In specific situations, such as deep probing depths (≥6 mm), to prevent periodontal abscess development.
18
Q
Q: What should be done if endpoints (no ≥4 mm pockets with BOP) are not achieved after step 2?
A
A: Proceed to the third step of therapy.
19
Q
Q: What is the third step of therapy aimed at?
A
A: Treating unresponsive areas with ≥4 mm pockets with BOP or ≥6 mm deep pockets, and addressing complex lesions (intrabony, furcation).
20
Q
Q: What interventions may be included in the third step of therapy?
A
- Subgingival instrumentation
- access flap surgery
- resective or regenerative periodontal surgery.
21
Q
Q: What is the fourth step of therapy?
A
Supportive periodontal care (SPC) to maintain stability with preventive and therapeutic interventions at regular intervals.
22
Q
Q: What happens during supportive periodontal care?
A
- Recalls include monitoring for recurrent disease
- re-treatment as needed
- reinforcing compliance with oral hygiene and healthy lifestyles.
23
Q
Q: When might tooth extraction be considered during therapy?
A
A: If affected teeth have a hopeless prognosis.
24
Q
Q: What defines Stage 1 (Early/Mild) periodontitis in terms of severity?
A
A: Interproximal bone loss <15% or <2 mm.
25
Q: What defines Stage 2 (Moderate) periodontitis in terms of severity?
A: Bone loss limited to the coronal 1/3 of the root.
26
Q: What defines Stage 3 (Severe) periodontitis in terms of severity?
A: Bone loss involving the mid 1/3 of the root.
27
Q: What defines Stage 4 (Very Severe) periodontitis in terms of severity?
A: Bone loss involving the apical 1/3 of the root.
28
Q: How is localized periodontitis defined by extent?
A: Bone loss affecting up to 30% of teeth.
29
Q: How is generalized periodontitis defined by extent?
A: Bone loss affecting more than 30% of teeth or displaying a molar/incisor pattern.
30
Q: What is the progression rate for Grade A (Slow)?
A: % bone loss (BL)/age < 0.5.
31
Q: What is the progression rate for Grade B (Moderate)?
A: % bone loss (BL)/age 0.5 - 1.0.
32
Q: What is the progression rate for Grade C (Rapid)?
A: % bone loss (BL)/age > 1.0.
33
Q: What is the goal of the first step of periodontal therapy?
A: To provide patients with preventive tools, motivation, and risk factor control to facilitate adherence and ensure optimal treatment outcomes.
34
Q: What interventions are included in the first step of therapy?
A: Educational and preventive interventions, professional mechanical removal of supragingival plaque and calculus, and elimination of local plaque-retentive factors.
35
Q: How can supragingival biofilm control be achieved?
- By mechanical means (toothbrushing, interdental cleaning)
- chemical means (antiseptic agents in dentifrices and mouth rinses).
36
Q: What is the primary mechanical method for plaque control?
A: Toothbrushing with either manual or powered toothbrushes.
37
Q: What interdental cleaning tools are recommended for gingival inflammation?
A: Interdental brushes (IDBs), with alternatives suggested when IDBs are not appropriate.
38
Q: Are psychological methods for motivation effective in improving oral hygiene compliance?
A: Evidence shows no significant additional benefit from psychological interventions like motivational interviewing or cognitive theories.
39
Q: What are the limitations of psychological interventions for OHI adherence?
A: High risk of bias, inconsistent results, lack of clinical relevance, and no cost-benefit evaluation.
40
Q: What is needed for effective psychological approaches in patient motivation?
A: Special training for professionals and further research to improve implementation in general practice.
41
Q: What is recommended as part of the first step of periodontal therapy?
A: Supragingival Professional Mechanical Plaque Removal (PMPR) and control of plaque-retentive factors.
42
Q: What level of consensus supports PMPR as part of therapy?
A: Strong consensus with no abstentions.
43
Q: What is the recommendation for risk factor control in periodontitis therapy?
A: It should be included as part of the first step of therapy to address factors like diabetes and smoking.
44
Q: What level of consensus supports risk factor control interventions?
A: Unanimous consensus with no abstentions.
45
Q: What is recommended for patients undergoing periodontitis therapy who smoke?
A: Tobacco smoking cessation interventions.
46
Q: What is the level of consensus for implementing smoking cessation interventions?
A: Unanimous consensus with no abstentions.
47
Q: What is recommended for diabetes control in periodontitis patients?
A: Diabetes control interventions to improve periodontal outcomes.
48
Q: What is known about the efficacy of increased physical activity in periodontitis therapy?
A: It is unclear if increased physical activity improves periodontitis therapy.
49
Q: What is known about dietary counseling's impact on periodontitis therapy?
A: The efficacy of dietary counseling remains unclear.
50
Q: What is the evidence for weight-loss interventions in periodontitis therapy?
A: No clear evidence supports weight-loss interventions improving periodontitis outcomes.
51
Q: What is recommended for subgingival instrumentation in periodontitis therapy?
A: It should be employed to reduce pocket depths, inflammation, and diseased sites.
52
Q: Should subgingival instrumentation be performed with hand or powered instruments?
A: Both hand and powered (sonic/ultrasonic) instruments, alone or combined, are recommended.
53
Q: How can subgingival instrumentation be delivered?
Q: How can subgingival instrumentation be delivered?
54
Q: Are lasers recommended as adjuncts to subgingival instrumentation?
A: No, lasers are not recommended as adjuncts.
55
Q: Should probiotics be used as an adjunct to subgingival instrumentation?
A: No, probiotics are not recommended.
56
A: No, it is not recommended.
A: No, they are not recommended.
57
Q: Should systemic or local NSAIDs be used as adjuncts to subgingival instrumentation?
A: No, they are not recommended.
58
Q: Are Omega-3 PUFAs recommended as adjuncts to subgingival instrumentation?
A: No, they are not recommended.
59
Q: Should local administration of metformin gel be used as an adjunct?
A: No, it is not recommended.
60
Q: Can adjunctive antiseptics like chlorhexidine mouth rinses be considered?
A: Yes, they may be considered for a limited time in specific cases.
61
Q: What chlorhexidine concentrations are available in the UK?
A: 0.2% (more intense use) and 0.06% (daily use, without alcohol).
62
Q: What are the adverse effects of chlorhexidine?
A: Staining, altered taste sensation, and potential cost considerations.
63
Q: When is 0.2% chlorhexidine mouthwash recommended?
A: For short-term use in cases like periodontal surgery or compromised plaque control.
64
Q: What is the evidence regarding alcohol in chlorhexidine formulations?
A: Alcohol in formulations may enhance efficacy, though not considered in this recommendation.
65
Q: What should be optimized before using chlorhexidine as an adjunct?
A: Mechanical plaque control.
66
Q: What are the specific cases to consider for chlorhexidine use?
A: The patient's medical status and discomfort from mechanical plaque control.
67
Q: What are the adverse effects of chlorhexidine
A: 1–2 weeks.
68
Q: Can sustained-release chlorhexidine be used as an adjunct to subgingival instrumentation?
A: It may be considered.
69
Q: Can sustained-release antibiotics be used as an adjunct to subgingival instrumentation?
A: They may be considered in specific cases.
70
Q: Is the routine use of systemic antibiotics recommended as an adjunct?
A: No, it is not recommended due to concerns about public health and individual health risks.
71
Q: When may systemic antibiotics be considered as an adjunct?
A: For specific patient categories, such as generalized periodontitis Grade C in young adults with high progression rates.
72
Q: How are patient complexity levels defined in UK periodontal care?
73
Q: What underpins the complexity levels of care?
A: A referral process between primary, intermediate, and specialist care.
74
Q: When should advanced procedures in Step 3 be implemented?
A: Only within the context of UK healthcare philosophy after reviewing outcomes of the first phase of care.
75
Q: Should surgery follow a single phase of non-surgical care?
A: No, it is usually contraindicated unless the outcome of the first phase is reviewed.
76
Q: What is the recommendation for non-engaging patients?
A: Surgery should be avoided until patients engage in behavior change and improve oral hygiene.
77
Q: How should 5–6mm probing pocket depths without bleeding at recall visits be managed?
A: These sites may be stable and should be monitored closely rather than immediately opting for surgery.
78
Q: What is the recommendation when a primary care practitioner is unsure about advanced care needs?
A: Refer the patient to level 2 or 3 services for further evaluation.
79
Q: What is recommended for patients with deep residual pockets (PPD ≥ 6 mm) after the first and second steps of periodontal therapy in periodontitis stage III?
A: Access flap surgery is suggested for deep residual pockets (PPD ≥ 6 mm). For moderately deep residual pockets (4–5 mm), subgingival instrumentation is recommended.
80
Q: What does the evidence say about the choice of flap procedures in periodontitis stage III?
A: There is insufficient evidence for a specific recommendation on flap procedures; access periodontal surgery may be carried out using different flap designs.
81
Q: When is resective periodontal surgery suggested in periodontitis stage III?
A: Resective periodontal surgery is suggested for deep residual pockets (PPD ≥ 6 mm), with consideration of the potential increase in gingival recession.
82
Q: Who should provide surgical treatment for periodontitis?
A: Surgical treatment should be provided by dentists with additional specific training or specialists in referral centers. Efforts should be made to improve access to this level of care for patients.
83
Q: What is the minimum requirement in high-quality step 1 and 2 treatments?
A: Repeated scaling and root instrumentation with or without access flaps and a frequent program of supportive periodontal care are recommended.
84
Q: Why is periodontal (including implant) surgery not recommended in some cases?
A: Surgery is not recommended for patients who are not achieving and maintaining adequate levels of self-performed oral hygiene.
85
Q: When is periodontal regenerative surgery recommended?
A: Periodontal regenerative surgery is recommended for residual deep pockets associated with intrabony defects 3 mm or deeper.
86
Q: What biomaterials are recommended in regenerative therapy?
A: Barrier membranes or enamel matrix derivatives with or without bone-derived grafts are recommended for patients undergoing regenerative therapy.
87
Q: What flap designs are recommended in regenerative therapy?
A: Specific flap designs, such as papilla preservation techniques, are recommended to maximize preservation of interproximal soft tissue and optimize wound stability.
88
Q: Should molars with class II and III furcation involvement receive therapy?
A: Yes, it is recommended that molars with residual pockets and class II/III furcation involvement receive periodontal therapy. Furcation involvement is not a reason for extraction.
89
Q: What is recommended for mandibular molars with residual pockets and class II furcation involvement?
A: Treating mandibular molars with residual pockets associated with class II furcation involvement using periodontal regenerative surgery is recommended.
90
Q: What is the recommendation regarding supportive periodontal care (SPC) visits?
A: Supportive periodontal care visits should be scheduled at intervals of 3 to 12 months, tailored to the patient’s risk profile and periodontal status after active therapy.
91
Q: Why is adherence to supportive periodontal care emphasized?
A: Adherence is crucial for long-term periodontal stability and improving periodontal status.
92
Q: What is recommended for tailored oral hygiene instructions during SPC?
A: Repeated and individually tailored instructions in mechanical oral hygiene, including interdental cleaning, are recommended to control inflammation and avoid disease progression.
93
Q: How should toothbrush and interdental brush designs be chosen?
A: Based on the patient’s abilities, preferences, and manual dexterity.
94
Q: Can powered toothbrushes be used as an alternative to manual brushing in SPC?
A: Yes, powered toothbrushes may be considered as an alternative to manual brushing.
95
Q: When should tooth brushing be supplemented by interdental brushes?
A: If anatomically possible, tooth brushing should be supplemented by the use of interdental brushes.
96
Q: What evidence supports the use of powered toothbrushes in SPC?
A: Five RCTs with 216 patients indicated powered toothbrushes can be effective, with strong consensus.
97
Q: What are the key benefits of using interdental brushes during SPC?
A: Interdental brushes enhance plaque removal and control inflammation when used alongside brushing.
98
Q1: What is the recommendation for mandibular molars with residual pockets and Class II furcation involvement?
A: Treat with periodontal regenerative surgery (3.11).
99
Q2: What is suggested for maxillary molars with residual pockets and buccal Class II furcation involvement?
A: Suggest periodontal regenerative surgery (3.12).
100
Q3: How should mandibular and maxillary molars with Class II furcation be treated?
A: Recommend regenerative therapy using enamel matrix derivative or bone-derived graft (3.13).
101
Q4: What treatments may be considered for maxillary Class II furcation involvement?
A: Non-surgical instrumentation, OFD, regeneration, root separation, or resection (3.14).
102
Q5: What is recommended for Class III and multiple Class II furcations in the same maxillary tooth?
A: Non-surgical instrumentation, tunneling, or root resection (3.15).
103
Q6: What is suggested for mandibular Class III and multiple Class II furcations in the same tooth?
A: Recommend similar options as maxillary Class III furcations (3.16).
104
Q7: What is the suggested interval for supportive periodontal care (SPC)?
A: Between 3 to 12 months tailored to the patient’s risk and status (4.1).
105
Q8: Why is adherence to SPC crucial?
A: It ensures long-term stability and further improvements (4.2).
106
Q9: What are tailored oral hygiene instructions for SPC patients?
A: Repeated, individualized mechanical cleaning with interdental cleaning (4.3).
107
Q11: Can powered toothbrushes be considered for SPC patients?
A: Yes, as an alternative to manual brushing (4.5).
108
Q12: Should tooth brushing be supplemented with interdental brushes?
A: Yes, if anatomically possible (4.6).
109
Q13: Is flossing recommended as the first choice for interdental cleaning?
A: No, it is not suggested as the first choice (4.7).
110
Q15: What does the "First Step of Therapy" recommend?
A: Utilizing educational and motivational strategies (4.9).
111
Q17: What is suggested for antiseptic dentifrices in SPC?
A: Use products with chlorhexidine, triclosan, or stannous fluoride (4.12).
112
Q18: What is suggested for antiseptic mouth rinses in SPC?
A: Use formulations with chlorhexidine, essential oils, or cetylpyridinium chloride (4.13).
113
Q19: What is the role of routine professional plaque removal in SPC?
A: It is suggested to limit tooth loss and improve stability (4.14).
114
Q20: Should PMPR be replaced with alternative methods like lasers?
A: No, it is not suggested (4.15).
115
Q21: Are adjunctive methods like sub-antimicrobial doses recommended?
A: No, they are not suggested in SPC (4.16).
116
Q22: What role do risk factor interventions play in SPC?
A: They are strongly recommended (4.17).
117
Q: What is the recommendation for tobacco smoking cessation interventions in supportive periodontal care?
Q: What is the recommendation for tobacco smoking cessation interventions in supportive periodontal care?
118
Q: What is the recommendation regarding diabetes control interventions in supportive periodontal care?
A: It is suggested to promote diabetes control interventions for patients in supportive periodontal care.
119
Q: Is there evidence supporting the role of physical exercise, dietary counseling, or lifestyle modifications in supportive periodontal care?
A: No evidence currently supports the relevance of physical exercise, dietary counseling, or lifestyle modifications aimed at weight loss in supportive periodontal care.
120
Q: Should systemic sub-antimicrobial doxycycline (SDD) be used as an adjunct?
A: No, it is not recommended.
