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
46
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
117
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119
BDS3 - CDS
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