Perio Ch. 24

Front 1

Nonsurgical Periodontal Therapy

Back 1

includes self-care measures, periodontal instrumentation, and use of chemical agents to prevent or control plaque-induced gingivitis or chronic periodontitis

Front 2

What is the objective of NSPT?

Back 2

to eliminate inflammatory disease in the periodontium and return the periodontium to a health state that can be maintained through both professional and patient self-care

Front 3

T/F

All patients with chronic periodontitis should undergo nonsurgical therapy prior to periodontal surgical intervention

Back 3

true

Front 4

NSPT is frequently successful in __________________ the extent of any surgery subsequently needed and can improve the outcomes of that periodontal therapy

Back 4

minimizing

Front 5

Is NSPT the treatment of choice for all patients with periodontitis?

Back 5

no

Front 6

What type of periodontitis is NSPT not the best therapy for?

Back 6

aggressive periodontitis

Front 7

T/F

Patients with types of periodontitis other than chronic periodontitis should be referred to a periodontist for treatment

Back 7

true

Front 8

List the 4 goals of NSPT

Back 8

1) to minimize the bacterial challenge to the patient

2) to eliminate or control local contributing factors for periodontal disease

3) to minimize the impact of systemic factors for periodontal disease

***4) to stabilize the clinical attachment level

Front 9

What is one important aspect of NSPT?

Back 9

patient self-care

Front 10

List examples of NSPT procedures

Back 10

1) customized self-care instructions

a) mechanical plaque biofilm control

b) chemical plaque biofilm control

2) periodontal debridement (instrumentation) or tooth surfaces and pocket space

3) correction of systemic risk factors

4) correction of local contributing factors

5) modulation of host defenses

Front 11

T/F

Because of the structure of biofilms, physical removal of bacterial plaque biofilm is the most effective mechanism of control

Back 11

true

Front 12

T/F

Most subgingival plaque biofilm within pockets can be reached by brushes, floss, and mouth rinses.

Back 12

FALSE

they cannot be reached, that's why patients need to come to the hygienist so we can remove it for them

Front 13

Rationale for periodontal instrumentation

Back 13

1) to arrest the progress of periodontal disease

2) to induce positive changes in the subgingival bacterial flora (count and content)

3) to eliminate inflammation in the periodontium

4) to increase the effectiveness of patient self-care

5) to prevent recurrence of disease during periodontal maintenance

Front 14

T/F

Electronically powered devices are as effective as hand instrumentation

Back 14

true

Front 15

T/F

Electronically powered devices also have some advantages over hand instrumentation when used for periodontal debridement

Back 15

true

Front 16

List the advantages of electronically powered devices

Back 16

1) effective in deplaquing tooth surfaces

2) small tips can reach into furcations

3) less damage to root surfaces

4) can penetrate deeper into periodontal pockets

5) washes toxic products and free-floating bacteria from pockets (removes blood)

6) instrumentation time is reduced after use of ultrasonic

Front 17

Scaling

Back 17

instrumentation of the crown and root surfaces of the teeth to remove plaque biofilm, calculus, and stains

Front 18

Root planing

Back 18

a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms

Front 19

_________ ____________ is a fundamental treatment procedure for patients with chronic periodontitis

Back 19

root planing

Front 20

What is the new term that is used to replace the term "scaling and root planing"?

Back 20

periodontal debridement

Front 21

Periodontal debridement

Back 21

the removal or disruption of bacterial plaque biofilm, its byproducts, and plaque biofilm retentive calculus deposits from coronal tooth surfaces and tooth root surfaces to the extent needed to reestablish periodontal health and restore a balance between the bacterial flora and the host's immune responses

Front 22

T/F

Periodontal debridement includes deliberate, aggressive removal of cementum

Back 22

FALSE

Front 23

During the healing process after disease, _____________ is thought to contribute to repair of the periodontium

Back 23

cementum

Front 24

Deplaquing

Back 24

the disruption or removal of subgingival microbial plaque biofilm and its byproducts from cemental surfaces and the pocket space

Front 25

The primary type of healing after periodontal debridement is through the formation of a ________ _______________ _______________

Back 25

long junctional epithelium

Front 26

Dentinal hypersensitivity

Back 26

a short, sharp painful reaction that occurs when some areas of exposed dentin are subjected to mechanical, thermal, or chemical stimuli

Front 27

What is an example of mechanical stimuli?

Back 27

touch of toothbrush bristles

Front 28

What is an example of thermal stimuli?

Back 28

ice cream

Front 29

What is an example of chemical stimuli?

Back 29

acidic grapefruit

Front 30

T/F

Dentinal hypersensitivity is associated with exposed dentin

Back 30

true

Front 31

Exposed dentin

Back 31

dentin that is visible to the oral cavity due to the recession of the gingiva that normally covers the dentin or to an absence of the enamel due to damage to the tooth crown

Front 32

Smear layer

Back 32

crystalline debris from the tooth surface that covers or plugs the dentinal tubules and inhibits fluid flow, thus preventing the dentinal sensitivity

Front 33

What active ingredients, that are in toothpastes, help patients with dentinal hypersensitivity?

Back 33

- potassium nitrate

- strontium chloride

- sodium citrate

- fluoride

Front 34

What are some professional applied ingredients that help patients with dentinal hypersensitivity?

Back 34

- potassium oxalate

- ferric oxalate

- fluoride solutions

- fluoride varnishes

Front 35

Should you warn your patients about dentinal hygpersensitivity before NSPT?

Back 35

yes

Front 36

When should you schedule a reevaluation appointment for someone who has chronic periodontitis?

Back 36

4 to 6 weeks after completion of NSPT

Front 37

What are the steps in a reevaluation?

Back 37

1) medical status update

2) thorough periodontal assessment

3) compare results from initial assessment with the reevaluation assessment

4) make appropriate decisions related to the next step in therapy

Front 38

What are some examples of what the next step would be after the reevaluation?

Back 38

1) additional NSPT may be needed

2) need for periodontal maintenance may be identified

3) the need for periodontal surgery may be evident

Front 39

Nonresponsive disease sites

Back 39

areas in the periodontium that show deeper probing depths, continuing loss of attachment, or continuing clinical signs of inflammation in spite of thorough NSPT

Front 40

T/F

If calculus is found at a nonresponsive site, additional periodontal debridement should be performed

Back 40

true

Front 41

T/F

When nonresponsive sites are encountered, the dental team members should also consider the possibility that other factors might be contributing to the disease process (such as undiagnosed diabetes or smoking)

Back 41

true

Front 42

What can we do as hygienists to help patients get better through NSPT?

Back 42

-customized self-care instruction/education

-periodontal debridement

-antimicrobial therapy

-correction of local risk factors/systemic factors

-fluoride therapy

-nutritional counseling

-minor ortho treatment

-caries control/temp restorations

-modulation of host defenses

Front 43

What are some examples of anitmicrobial therapies?

Back 43

-chlorhexadine

-arestin

-subgingival irrigation

Front 44

What are some of the local risk factors/systemic factors that we can help correct?

Back 44

-oral hygiene

-food impaction

-smoking cessation counseling

-undiagnosed diabetes

-occlusal therapy

Front 45

T/F

No matter how advanced they are in their disease, most patients with chronic periodontitis can benefit from undergoing NSPT prior to seeing a periodontist

Back 45

true

Front 46

The horizontal stroke helps to get the ___________ ____________ line angle when cleaning

Back 46

distal buccal

Front 47

**What are the benefits of ultrasonic instrumentation?

Back 47

1) water stream produces cavitation and acoustic turbulence, which disrupt bacterial cell walls and may even dislodge plaque biofilms slightly beyond the reach of the power instrument tip

2) water irrigation washes toxic products and free-floating bacteria from pockets and can provide better vision by removing blood from tx site

3) hand instrument time is reduced when powered device is used

Front 48

What are the post-op instructions for NSPT?

Back 48

-tenderness is normal

-tylenol or ibuprofen

-warm salt water rinses

-avoid food with nuts, spices, sticky, crunchy

-sensitivity is normal...sensodyne

-avoid brushing or flossing till the next day

Front 49

Is it common to have residual calculus at the re-evaluation appointment?

Back 49

yes

Front 50

Usually 3 things are what's happening when you get non-responsive sites, what are they?

Back 50

1) residual calculus

2) plaque accumulation

3) other systemic risk factors

Front 51

T/F

Success is measured by your ability to halt the progression of the disease

Back 51

true

Front 52

What is co-management?

Back 52

alternate/trade off between the dentist and periodontist

Front 53

Which type of patient would need to use co-management?

Back 53

patients with moderate periodontitis

Front 54

How frequently does the patient visit the dentist and periodontist?

Back 54

1 x 3 months

dentist will be 2 x a year

periodontist will be 2 x a year