Non-Surgical Periodontal Treatment: Addressing Non-Responders

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Questions and Answers

What is the primary goal of initial periodontal therapy?

  • Achieving a plaque score of less than 5%.
  • Performing periodontal surgery to eliminate deep pockets.
  • Reducing inflammation and modifying patient behavior to improve oral hygiene. (correct)
  • Restoring function and aesthetics with implants or orthodontics.

A patient exhibits bleeding on probing (BOP) at 15% of sites and a plaque score (PS) of 20% after initial periodontal treatment. Probing depths are consistently 3mm with no furcation involvement. Which of the following is the MOST appropriate next step in management?

  • Re-emphasize oral hygiene instructions and monitor the patient more frequently. (correct)
  • Initiate corrective periodontal therapy, including periodontal surgery.
  • Transition to supportive periodontal therapy with 6-month recall intervals.
  • Prescribe adjunctive antimicrobials and reassess in 3 months.

Which of the following clinical findings would indicate unsuccessful periodontal treatment?

  • Lack of furcation probeability.
  • Low Plaque Score (PS).
  • High Bleeding On Probing (BOP). (correct)
  • Probing depths of 3mm or less.

After initial periodontal therapy, a patient presents with persistent pockets of 6mm with bleeding on probing. What phase of periodontal treatment should be considered next?

<p>Corrective periodontal therapy (A)</p> Signup and view all the answers

What is the MOST important aspect of supportive periodontal therapy?

<p>Patient involvement in maintaining their periodontal health. (D)</p> Signup and view all the answers

A patient has completed initial periodontal therapy. Which finding suggests the need for corrective periodontal therapy?

<p>Isolated pockets of 5mm with bleeding on probing. (D)</p> Signup and view all the answers

Which of the following is typically included in initial periodontal therapy?

<p>Oral hygiene instructions and scaling. (D)</p> Signup and view all the answers

A patient presents with a persistent high plaque score despite good oral hygiene. What additional factor should be evaluated?

<p>The patient's diet and dexterity. (A)</p> Signup and view all the answers

What is a key characteristic of corrective periodontal therapy?

<p>It may include periodontal surgery to address remaining pockets. (A)</p> Signup and view all the answers

A patient undergoing periodontal treatment has probing depths reduced to 3mm or less with no bleeding on probing. What is the next appropriate phase of treatment?

<p>Supportive periodontal therapy for maintenance. (B)</p> Signup and view all the answers

Which of the following operator factors is MOST likely to contribute to the failure of periodontal treatment?

<p>Utilizing dull or damaged instruments. (C)</p> Signup and view all the answers

A patient presents with continued periodontal issues despite initial non-surgical periodontal therapy (NSPT). Which patient factor would be MOST important to investigate FIRST?

<p>The patient's level of plaque control and oral hygiene practices. (B)</p> Signup and view all the answers

Which site-related factor presents the GREATEST challenge to successful periodontal treatment and long-term maintenance?

<p>Very deep infra-bony pockets. (A)</p> Signup and view all the answers

What is the MOST appropriate initial step when encountering a patient who is not responding to periodontal treatment?

<p>Thoroughly reinvestigating potential contributing factors and reinforcing oral hygiene instructions. (A)</p> Signup and view all the answers

A patient with generalized 5mm pockets, bleeding on probing (BOP), and adequate oral hygiene is undergoing supportive periodontal therapy. Which of the following is the MOST appropriate next step?

<p>Increase the frequency of supportive periodontal therapy appointments and consider adjunctive therapies. (B)</p> Signup and view all the answers

What is the PRIMARY goal of supportive periodontal therapy?

<p>To prevent the recurrence and progression of periodontal disease. (D)</p> Signup and view all the answers

Which of the following is the MOST critical aspect of addressing non-responsive sites during periodontal maintenance?

<p>Thorough debridement and disruption of the biofilm. (C)</p> Signup and view all the answers

In a patient with controlled periodontitis undergoing supportive periodontal therapy, which pocket depth measurement would typically warrant more aggressive intervention?

<p>6 mm with bleeding on probing. (C)</p> Signup and view all the answers

Which systemic condition is MOST likely to negatively impact a patient's response to periodontal treatment?

<p>Uncontrolled diabetes. (B)</p> Signup and view all the answers

What is the overarching goal of non-surgical periodontal treatment?

<p>To halt or slow the advancement of periodontal disease and reduce potential tooth loss. (D)</p> Signup and view all the answers

After initial periodontal therapy, a patient continues to exhibit bleeding on probing and inflammation in localized areas despite good oral hygiene. What is the MOST appropriate next step in managing these non-responsive sites?

<p>Consider referral to a periodontist for further evaluation and treatment. (D)</p> Signup and view all the answers

Which of the following findings would suggest the failure of non-surgical periodontal treatment?

<p>Continued attachment loss and persistent deep pockets. (A)</p> Signup and view all the answers

A patient presents with continued inflammation and bleeding despite thorough scaling and root planing. What is the MOST likely reason for the persistent inflammation?

<p>Inadequate plaque control in difficult-to-reach areas. (D)</p> Signup and view all the answers

A patient has persistent periodontal inflammation around a lower molar despite repeated non-surgical interventions. Radiographic examination reveals a furcation involvement not previously noted. What is the next appropriate step?

<p>Refer the patient for surgical periodontal evaluation and possible treatment. (B)</p> Signup and view all the answers

Which factor is MOST important to include in a supportive periodontal therapy (SPT) appointment following active non-surgical treatment?

<p>Comprehensive periodontal charting and assessment of oral hygiene. (D)</p> Signup and view all the answers

A patient with well-controlled diabetes reports fluctuating blood sugar levels during periodontal maintenance. How does this affect periodontal treatment outcomes?

<p>Fluctuating glycemic control may impair healing and increase the risk of periodontal disease progression. (D)</p> Signup and view all the answers

A patient consistently demonstrates poor plaque control despite repeated oral hygiene instructions. What psychological or sociological factor is MOST likely contributing to this?

<p>Lack of motivation or perceived value in oral health. (A)</p> Signup and view all the answers

After non-surgical periodontal therapy, a patient exhibits persistent bleeding on probing at several sites, but probing depths have decreased. What is the MOST likely explanation?

<p>Inflammation is still present despite pocket reduction. (D)</p> Signup and view all the answers

A patient who underwent successful non-surgical periodontal treatment now wants to know how frequently they need to have maintenance appointments? Which recall frequency range is generally recommended for patients following active periodontal treatment to prevent disease recurrence?

<p>Every 2-3 months. (C)</p> Signup and view all the answers

What is the significance of recognizing changes in a patient’s reported oral health status during supportive periodontal therapy?

<p>It indicates the need to adjust the patient's recall interval or treatment plan. (C)</p> Signup and view all the answers

Flashcards

Primary objective of periodontal treatment

To slow down or halt the progression of periodontal disease and minimize tooth loss.

GDC Learning Outcome 1.1.2

Describe oral diseases and their relevance to prevention, diagnosis and treatment

GDC Learning Outcome 1.1.11

Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases and the success of treatment

GDC Learning Outcome 1.2.2

Recognise the importance of and record a comprehensive and contemporaneous patient history

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GDC Learning Outcome 1.2.3

Recognise the significance of changes in the patient’s reported oral health status and take appropriate action

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GDC Learning Outcome 1.5.3

Plan the delivery of, and carry out, care in the best interests of the patient

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GDC Learning Outcome 1.7.3

Recognise the need to monitor and review treatment outcomes

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GDC Learning Outcome 1.7.8

Recognise the need for and make arrangements for appropriate follow-up care

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GDC Learning Outcome 1.10.5

Assess the results of treatment and provide appropriate aftercare and ongoing preventive advice

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GDC Learning Outcome 1.11.1

Assess and manage the health of periodontal and soft tissues taking into account risk and lifestyle factors

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Ideal BOP after treatment

Bleeding on probing should be less than 10%.

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Ideal Plaque Score After Treatment

Plaque score should be less than 15%.

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Ideal Pocket Depth After Treatment

Periodontal probing depths should ideally be less than 4mm.

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Unsuccessful Treatment: High PS

Treatment is unsuccessful if plaque scores are high.

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Unsuccessful Treatment: High BOP

Treatment is unsuccessful if bleeding on probing is high.

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Unsuccessful Treatment: Pockets >5mm

Treatment is unsuccessful if pockets are greater than 5mm.

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Initial Periodontal Therapy

Initial periodontal therapy aims to address the immediate causes of inflammation and infection.

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Corrective Periodontal Therapy

Corrective periodontal therapy involves more specialized procedures.

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Supportive Periodontal Therapy

Supportive periodontal therapy focuses on long-term maintenance.

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Key Steps in Initial Therapy

This phase involves plaque control, OHI, smoking cessation advice, managing risk factors and RSD.

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Operator Factors

Factors related to the clinician's skill, equipment, and time management that can lead to unsuccessful treatment outcomes.

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Patient Factors

Aspects of a patient's health, habits, and adherence to recommendations that may hinder treatment effectiveness.

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Site Factors

Characteristics of the specific location in the mouth (like deep pockets or tooth shape) that make treatment more challenging.

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Poor operator technique

Inadequate skills, poor instrument maintenance, lack of experience, or insufficient time allocated for the procedure.

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Patient-related obstacles

Inadequate oral hygiene, smoking, systemic diseases, or issues with patient cooperation.

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Site-specific complicating factors

Deep pockets, infra-bony pockets, or unusual tooth/root shapes.

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Addressing Operator Factors

Practice consistently, seek advice from experienced colleagues, use sharp and well-maintained instruments, and allocate sufficient time.

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Managing Non-Responding Patients

Investigate reasons for non-response (motivation, compounding factors), reinforce oral hygiene instructions, and maintain regular review appointments.

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Addressing Non-Responding Sites

Referral to a specialist, further non-surgical treatment, periodontal surgery, extraction, or accepting the site and moving to supportive therapy.

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Supportive Periodontal Therapy Components

Pocket probing depths, bleeding on probing, motivation assessment, oral hygiene reinforcement, and biofilm disruption.

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Study Notes

  • Non-surgical periodontal treatment addresses the non-responding patient

GDC Learning Outcomes

  • Oral diseases and their significance to prevention, diagnosis, and treatment should be described
  • Psychological and sociological factors that contribute to poor oral health, disease progression, and treatment success must be recognized
  • The importance of recording a comprehensive and contemporaneous patient history needs to be recognised
  • Changes in a patient's reported oral health status need to be recognised, and appropriate action taken
  • Delivery of care must be planned and carried out in the patient's best interests
  • The need to monitor and review treatment outcomes needs to be recognised
  • The need for and arrangements for appropriate follow-up care must be recognised
  • Treatment results must be assessed and appropriate aftercare with ongoing preventive advice is needed
  • The health of periodontal and soft tissues must be assessed and managed, taking into consideration risk and lifestyle factors
  • The impact of a patient's periodontal and general health on the overall treatment plan and outcomes must be accounted for
  • Non-surgical treatments should be undertaken to remove hard and soft deposits and stains using various methods
  • Changes in periodontal health should monitored and recorded using appropriate indexes
  • Complications associated with periodontal therapy should be recognised and appropriately managed
  • The role of surgical management of periodontal diseases should be recognised, antimicrobials applied, and appropriate patient care provided

Learning Outcomes

  • The aims of non-surgical periodontal treatment should be explained
  • Clinical indications that treatment has been unsuccessful need to be identified
  • The common reasons why treatment may fail require a list
  • Possible future treatment options to address non-responding sites should be described
  • The factors to be included in a supportive periodontal therapy appointment need a list

Primary Objective

  • The primary objective of periodontal treatment is to slow down or halt the disease's progression and minimize tooth loss

Treatment Aims

  • Bleeding on probing should be less than 10%
  • Plaque Score should be less than 15%
  • Periodontal Probing Depths should be less than 4mm
  • No furcations should be probable
  • Function needs to be maintained
  • Aesthetics need to be maintained
  • These aims as defined by the British Society of Periodontology

Clinical Indications of Unsuccessful Treatment

  • High Plaque Score (PS)
  • High Bleeding on Probing (BOP)
  • Pockets greater than 5mm
  • A "mixed response" can occur in a patient.

Phases of Periodontal Treatment

  • Initial periodontal therapy
  • Corrective periodontal therapy
  • Supportive periodontal therapy

Initial Periodontal Therapy

  • Plaque and bleeding indices following Basic Periodontal Examination (BPE)
  • Oral Hygiene Instructions (OHI)
  • Advice on smoking cessation
  • Managing other risk factors
  • Instrumentation/Root Surface Debridement (RSD)/removal of overhangs
  • Extracting hopeless teeth, other dental work
  • Monitoring response to initial therapy
  • If pockets over 4mm with BOP remain, switch to corrective therapy
  • If there are no pockets over 4mm or no bleeding, continue to supportive therapy

Corrective Periodontal Therapy

  • Includes More Non-Surgical Periodontal Treatment (NSPT)
  • +/- adjunctive antimicrobials
  • Periodontal surgery may be required
  • Restore function or aesthetics- definitive restorative treatment
  • Implant options
  • Orthodontics

Supportive Periodontal Therapy

  • Supportive Periodontal Therapy embraces the philosophy that both the patient and dental professional maintain the patient's periodontal health
  • It is weighted heavily towards contribution from the patient

Reasons for Treatment Failure

  • Operator Factors
  • Patient Factors
  • Site Factors

Operator Factors

  • Poor instrumentation technique
  • Poor instruments
  • Inexperience
  • Time constraints

Patient Factors

  • Poor Oral Hygiene (OH)
  • Smoking
  • Systemic disease/impaired host response like stress or nutrition
  • Cooperation for treatment, example, Local Anaesthetic(LA) use or access

Site Factors

  • Very deep pockets
  • Infra-bony pockets
  • Tooth and root morphology
  • Failure of treatment might be due to the case's severity/complexity rather than inadequacy.

Addressing Operator Factors

  • Practice is needed
  • Advice from more experienced clinicians help
  • Use appropriate instruments like sharp and good condition instruments.
  • Time management is paramount

Addressing Non-Responding Patients

  • Investigate reasons for non-response
  • Address motivation, like any compounding factor, need reviewing
  • Reinforce Oral Hygiene(OH)
  • Review progress and treatment

Addressing Non-Responding Sites

  • Corrective periodontal therapy comes into play
  • Refer to specialists like periodontists
  • Further Non-Surgical Periodontal Treatment (NSPT) with antimicrobials +/-
  • Periodontal surgery is an option
  • Extractions in some cases
  • Acceptance and move to supportive periodontal therapy:
  • Pockets 4-5 mm with good OH and no BOP can usually be maintained
  • Pockets greater than 6mm have an increased risk of progression and tooth loss

Supportive Periodontal Therapy Appointment Factors

  • Check Plaque Score (PS)
  • Bleeding On Probing (BOP) check
  • Motivation levels needs to be checked
  • Oral Hygiene (OH) should be reinforced
  • Intervention/disruption of biofilm is necessary

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Failure of Non-Surgical Periodontal Treatment PDF

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