Podcast
Questions and Answers
During Step 1 of periodontal treatment, what is the MOST comprehensive way to explain the importance of oral hygiene to a patient?
During Step 1 of periodontal treatment, what is the MOST comprehensive way to explain the importance of oral hygiene to a patient?
- Encouraging and supporting behavior change for oral hygiene improvement, including risks and benefits. (correct)
- Scheduling the patient for regular prophylaxis appointments.
- Recommending specific brands of toothpaste and mouthwash.
- Distributing pre-printed pamphlets about brushing techniques.
In the context of managing periodontal disease, what is the MOST critical consideration when deciding on the recall period for a patient following initial treatment?
In the context of managing periodontal disease, what is the MOST critical consideration when deciding on the recall period for a patient following initial treatment?
- The availability of appointments with the dental hygienist.
- The patient's preference for appointment frequency.
- Insurance coverage for periodontal maintenance.
- Published guidelines while also considering individual risk factors such as smoking and diabetes. (correct)
When managing non-responding sites during periodontal treatment (Step 3), what is the MOST appropriate initial action if a patient presents with moderate (4-5mm) residual pockets?
When managing non-responding sites during periodontal treatment (Step 3), what is the MOST appropriate initial action if a patient presents with moderate (4-5mm) residual pockets?
- Re-perform subgingival instrumentation at the affected sites. (correct)
- Prescribe systemic antibiotics to reduce inflammation.
- Immediately refer the patient for pocket management surgery.
- Apply locally delivered antimicrobials into the pockets.
How should a practitioner determine whether to use adjunctive systemic antimicrobials in conjunction with subgingival instrumentation during Step 2 of periodontal treatment?
How should a practitioner determine whether to use adjunctive systemic antimicrobials in conjunction with subgingival instrumentation during Step 2 of periodontal treatment?
What is the BEST approach to enhance the effectiveness of self-performed plaque removal in periodontal patients, according to BSP top tips?
What is the BEST approach to enhance the effectiveness of self-performed plaque removal in periodontal patients, according to BSP top tips?
After completing initial periodontal therapy, what factors indicate a favorable improvement in oral hygiene?
After completing initial periodontal therapy, what factors indicate a favorable improvement in oral hygiene?
When a patient is considered 'non-engaging' in their periodontal treatment, according to the BSP guidelines, what is the MOST appropriate next step?
When a patient is considered 'non-engaging' in their periodontal treatment, according to the BSP guidelines, what is the MOST appropriate next step?
During the maintenance phase (Step 4) of periodontal treatment, what is the PRIMARY goal of regular targeted Professional Mechanical Plaque Removal (PMPR)?
During the maintenance phase (Step 4) of periodontal treatment, what is the PRIMARY goal of regular targeted Professional Mechanical Plaque Removal (PMPR)?
After subgingival instrumentation, how long should the practitioner wait before re-evaluating the periodontal condition, according to the guidelines?
After subgingival instrumentation, how long should the practitioner wait before re-evaluating the periodontal condition, according to the guidelines?
What is the BEST way to approach interdental cleaning for periodontal patients?
What is the BEST way to approach interdental cleaning for periodontal patients?
Flashcards
Step 1 in periodontal treatment
Step 1 in periodontal treatment
Explain the disease, risk factors, treatment options and their benefits, including the option of no treatment.
Subgingival Instrumentation
Subgingival Instrumentation
Reinforce oral hygiene, control risk factors, and modify behavior.
Managing non-responding sites
Managing non-responding sites
Address non-responsive sites by reinforcing oral hygiene, re-instrumenting moderate pockets, considering alternative causes for deep pockets or referring for surgery.
Maintenance (Step 4)
Maintenance (Step 4)
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Largest treatment benefit
Largest treatment benefit
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Supplement toothbrushing
Supplement toothbrushing
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Favorable improvement in OH
Favorable improvement in OH
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Insufficient improvement in OH
Insufficient improvement in OH
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Maintenance recall
Maintenance recall
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Next step after subgingival instrumentation
Next step after subgingival instrumentation
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Study Notes
- BSP UK Clinical Practice Guidelines pertain to the treatment of periodontal diseases.
Oral Health and Risk Assessment, Diagnosis & Care Plan
- Diagnosis can be periodontal health, gingivitis, or periodontitis.
- For periodontitis, extract teeth with hopeless prognosis or unsavable teeth, such as grade III mobile teeth.
Step 1: Building Foundations for Optimal Treatment Outcomes
- Explain disease, risk factors, treatment alternatives, risks, and benefits, including no treatment.
- Explain the importance of Oral Hygiene (OH), encourage and support behavior change for OH improvement.
- Reduce risk factors, including removal of plaque retentive features, smoking cessation, and diabetes control interventions.
- Provide individually tailored OH advice, including interdental cleaning and adjunctive efficacious toothpaste & mouthwash, in addition to Professional Mechanical Plaque Removal (PMPR) including supra and subgingival scaling of the clinical crown.
- Select a recall period following published guidance and considering risk factors like smoking and diabetes.
- Oral Health Educators (I, II), Hygienists, Therapists (I - IV), Dentists, and Practitioners accredited for Level 2 and 3 care (I - V) can provide this information.
Re-evaluation After Step 1
- For non-engaging patients, return to Step 1 and repeat.
- For engaging patients, move to Step 2 and consider a referral.
Step 2: Periodontitis (Continued)
- Subgingival Instrumentation involves root surface debridement and PMPR on the root.
- Reinforce OH, risk factor control, and behavior change.
- Use subgingival instrumentation, hand or powered (sonic/ultrasonic), either alone or in combination.
- Adjunctive systemic antimicrobials are determined by Practitioner accredited for Level 2 and 3 care
Managing Non-Responding Sites (Step 3)
- Reinforce OH, risk factor control, and behavior change.
- For moderate (4-5mm) residual pockets, re-perform subgingival instrumentation.
- For deep residual pocketing (≥6mm), consider alternative causes.
- Consider referral for pocket management or regenerative surgery.
- If referral is not possible, re-perform subgingival instrumentation.
- If all sites are stable after Step 3, proceed to Step 4.
Maintenance (Step 4)
- Supportive periodontal care is strongly encouraged.
- Reinforce OH, risk factor control, and behavior change.
- Regular targeted PMPR is required to limit tooth loss.
- Consider evidence-based adjunctive efficacious toothpaste and/or mouthwash to control gingival inflammation.
- Maintenance recall (Step 4) involves individually tailored intervals from 3-12 months.
BSP Top Tips
- Patients should be made aware that regular effective self-performed plaque removal offers the largest treatment benefit and engage in a verbal contract to perform daily plaque control.
- Toothbrushing should be supplemented by the use of interdental brushes where anatomically possible.
- Individual patient's abilities, needs, preferences, and manual dexterity should be considered when selecting a toothbrush and interdental brush.
- Refer to the BSP website for further clarification and a glossary of terms.
Defining Engaging and Non-Engaging Patients
- Favorable improvement in OH is indicated by ≥50% improvement in plaque and marginal bleeding scores OR Plaque levels ≤20% & bleeding levels ≤30% OR Patient has met targets outlined in their personal self-care plan as determined by their healthcare practitioner.
- Insufficient improvement in OH is indicated by <50% improvement in plaque and marginal bleeding scores OR Plaque levels >20% & bleeding levels >30% OR Patient states preference to a palliative approach to periodontal care
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