Perio Quiz 4 (non surgical perio therapy) – Flashcards
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Does the clincial assessment indicate health or disease in the periodontium?
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Both
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Problem based learning identifies
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significant problems from the patients medical/dental history from which a dental hygiene diagnosis will be developed
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What is therapeutic decision making?
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study of the best possible outcomes for decisions made under varying conditions for treatment on individual cases
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What is prognosis?
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the predicition of the future course of a problem with or without treatment
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Determination of prognosis is important in
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treatment planning
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Good prognosis
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adequate periodontal support around the tooth and can be easily maintained
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Fair prognosis
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-about 25% bone loss -Class I furcation (can be properly maintained) -May worsen in the future
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Guarded prognosis
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-about 50% bone loss. -Class II furcation (maintained with difficulty) -Treatment efforts may not succeed
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Poor Prognosis
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-greater than 50% bone loss -Class II and III furcation (cannot be maintained) -condition is expected to worsen even with treatment
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Hopeless prognosis
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-not enough bony support to be maintained in its socket -extraction is reccomended
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What are the parameters of care?
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strategies to assist oral health care providers in making clinical decisions from a range of treatment options to achieve a desired outcome
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When non-surgical periodontal treatment does not achieve peridontal health,
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surgery may be indicated to restore periodontal health
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What are the goals of nonsurgical periodontal therapy?
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-to restore the periodontium to a comfortable and functional state of health - to prevent initiation, progression, or recurrence of perio disease
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What is phase I in the sequence of treatment for the perio patient?
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non surgical/initial periodontal therapy: -conditions associated with pain such as abcesses, NUG -evaluate
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What is phase II in the sequence of treatment for the perio patient?
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surgical therapy
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What is phase III in the sequence of treatment for the perio patient?
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restoarative therapy and evaluate
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What is phase IV in the sequence of treatment for the perio patient?
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Periodontal maintenance
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Which phases are dental hygienists able to perform?
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Phase I and IV
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What is goal 1 of Non surgical/initial periodontal therapy (phase I)?
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to minimize the bacterial challenge to the patient
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What is goal 2 of Non surgical/initial periodontal therapy (phase I)?
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to eliminate or control local enviromental risk factors for periodontal disease
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What is goal 3 of Non surgical/initial periodontal therapy (phase I)?
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to minimize the impact of systemic risk actors for periodontal disease
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What is scaling?
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removal of: -dental plaque -calculus -stains from the crown and root surfaces
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What is root planing?
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removal of cementum or surface dentin on the root that is rough with calculus or contaminated with toxins or microorganisms
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What is the main goal of root planing?
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to provide a root surface that is biologically conductive to the healing process
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What is peridontal debridement?
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removal of: -plaque -calculus -dead tissue from crown, root surface, pocket and bone surface
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What category of prognosis do perio patients fall in?
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guarded prognosis
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What are contraindicaions for root planning procedures?
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-roots previously planed to avod over instrumentation -root caries evident -acute gingival conditions
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What is the general sequence of treatment?
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-sextant -quadrant -1/2 mouth -full mouth
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What are the factors that can influence the sequence and/or number of appointments ?
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-extent of deposit -extent of pockets -# of teeth -time -patient cooperation -sensitivity
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Do NOT probe before 4 weeks after therapy because
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probing will disrupt the attachment process
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What is the treatment endpoint?
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there is NO endpoint, treatment is ongoing(maintenance)
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After treatment, how long should the patient usually wait to come back in order to maintain periodontal health?
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3 month recall
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What are the steps of nonsurgical peridontal therapy evaluation?
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- to updqte the medical status of the patient -to perform a periodontal clinical assessment -to compare the data gathered at the initial assessment with the data at the reevaluation
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What are the factors that can compromise root planing and contribute to needing surgical intervention?
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-root anatomy -furcations -deep probing depths
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Periodontal surgical procedures may be _____ or _____ or in some cases both.
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arrestive; regenerative
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Why are restorations designed ?
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to satisfy aesthetic, comfort and functional needs without compromising future periodontal health
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What does periodontal maintenance care (phase IV) include?
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-reexamination -assessment of periodontal conditions -home care
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What is an informed consent?
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a written agreement by patients to voluntarily agree to the treatment plan
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Informed consent for periodontal patients should reflect
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that the patient understands and accepts the need for periodontal maintenance and OHI
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What is periodontal health?
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Patients with: -no bleeding -gentle probing -light to no supragingival plaque -only require a prophylaxis
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What is slight periodontitis ?
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-attachement loss -PD: 4-5 mm -responds adequately to periodontal debridement and effective OHI
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What is moderate periodontitis?
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-attachment loss -PD: 6-7 mm
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What is severe periodontitis?
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-attachment loss -PD: more than 8 mm -Following OHI and debridement, patients are usually referred for surgery
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What is refractory periodontitis?
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Patients that do not respond to periodontal treatment despite OHI and maintenance and is referred to a periodontist
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Aggressive periodontitis
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patients under 30 years of age can have underlying immune system issues that may manifest as periodontitis with rapid attachment loss and bone destruction
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Treatment for aggressive periodontitis is similar to that of chronic forms except that
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surgical intervention and/or antiobiotic theapy are often used immediately
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What is NUG ?
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an infection localized to the gingiva
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what are contributory risk factors for NUG?
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-stress -poor oral hygiene -smoking -HIV
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What is NUP?
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involves supporting structures
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what are contributory risk factors for NUP?
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-systeic conditions -HIV -Malnutrition
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Treatment for NUG and NUP
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-analgesics -antibiotics -periodontal debridement -refer to a periodontist if necessary
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What is peri-implantitis?
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inflammation around a dental implant
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Treatment of peri-implant diseases includes
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-periodontal debridement -OHI -Mouthrinses -antibiotics -arrestive and regenerative surgery -implant removal(if necessary)
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Adjunctive therapies- antimicrobials:
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-controlled released antimicrobial drug systems may be indicated when clinical signs of inflammation persist in pockets of 5 mm or greater in localized sites
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What is prescribed for periods where mechanical plaque removal is not possible?
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chlorhexidine gluconate
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Subgingival plaque plays an important role
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in the progression of periodontal diseases
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What is the primary goal of prevention ?
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to achieve the lowest plaque levels possible
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What is primary prevention?
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preventive measures taken to prevent disease from occuring
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What is secondary prevention?
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prevent disease from progressing
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What are some types of interdental care?
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-proxabrush -flossing -stimulators -oral irrigators
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Type I gingival embrasure
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embrasure is completely filled with gingiva
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Type II gingival embrasure
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slight to moderate recession of the interdental papillae
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Type III gingival embrasure
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extensive or complete loss of interdental papillae
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What are are chemotherapeutic agents?
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drugs are that are used to treat various forms of bacterial diseases
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Mouthrinses and oral irrigation are two methods used
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for supragingival application of antiseptic solutions
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Indications for use of chemotherapeutic agents
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1. home care regimes that failed to acheive plaque control 2.an addition to perio instrumentation 3.inadequate oral hygiene 4.following surgical procedures 5.pre-procedural rinse 6. maintenance of dental implants 7. no antimicrobial rinse has been shown to be effective againts periodontitis
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1st generation oral rinse agents
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-antibacterial properties -low substantivity -limited therapeutic value in reducing plaque and gingivitis
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2nd generation oral rinse agents
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-antibacterial properties -substantivity -chlorhexidine: only one proven to prevent and control gingivitis
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What is oral irrigation?
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mechanical water pressure device
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what type of patient would use an oral irrigator?
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-patient with physical chalenges, orthodontics, and prosthetics - patient with plaque induced gingivitis
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An oral irrigator is ideal
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- for delivering antimicrobial agents deeper into pockets -adjunctive aid when mechanical aids are not sufficient
