Perio 15 - Professional Dental Hygiene Therapy Phase I (Dr. Levi)

Phase I therapy

What phase of dental therapy is the following?

- Disease control therapy

Phase II therapy

What phase of dental therapy is the following?

- Corrective surgical therapy

Phase III therapy

What phase of dental therapy is the following?

- Corrective final restorative therapy

Phase IV therapy

What phase of dental therapy is the following?

- Professional Dental Hygiene Therapy (PDHT); Maintenance

Phase I therapy

What phase of dental therapy is the following?

- Patient plaque removal education

- Scaling and root planing

Phase I therapy

What phase of dental therapy is the following?

- Extraction of non-treatable and caries control

Phase I therapy

What phase of dental therapy is the following?

- Occlusal therapy (occlusal adjustment or an occlusal guard)

A complete examination (radiographs, periodontal chart, photos, diagnostic casts)

What is essential for treatment planning and must be periodically updated?

Always observe brushing and flossing techniques BEFORE charting

What should you do before you begin charting?

Because knowing your patient is essential for your success

Why do you want to take a comprehensive medical, dental, and social history?

B) After completing their intraoral exam (this enables them to practice before their Phase I therapy)

When can you offer patient advice about their oral habits?

A) Before completing their intraoral exam

B) After completing their intraoral exam

Diagnoses

Are all of the following diagnoses or classifications?

- Periodontal health

- Gingivitis

- Periodontitis

- Peri-implant health

- Peri-implant mucositis

- Peri-implantitis

Classifications

Are all of the following diagnoses or classifications?

- Pristine periodontal health

- Clinical periodontal health

- Stages I-IV periodontitis

- Grades A, B, C periodontitis

Emergency therapy (pain, infection)

What is the first step in the initial treatment sequence after an examination?

Phase I

What phase begins with Plaque Control Instruction review and Scaling and Root Planing?

- Plaque Control Instruction Review

- Scaling and Root Planing

Disease Control Therapy includes what two components?

- Emergency Therapy

- Medical Consultations

- Dental Consultations

- Disease Control Therapy

- Periodontal Re-evaluation

- Restorative Therapy

What is the correct order of the following treatments?

- Medical Consultations

- Restorative Therapy

- Emergency Therapy

- Dental Consultations

- Periodontal Re-evaluation

- Disease Control Therapy

Toxins from bacterial plaque

What is the primary etiological risk factor?

It contains toxins from bacterial plaque

Why does calculus contribute to periodontal disease?

Etiological risk factors

What are the following in relation to plaque?

- Systemic diseases or conditions (Lowers the immune system).

- Dental factors that cause plaque retention or the inability to remove dental plaque (malposed teeth, anatomical issues, open contacts, grooves, enamel projections, open contacts, etc)

Scrubbing brushing techniques

What is an example of physical trauma as a risk factor?

Parafunctional habits such as clenching or bruxism

What is an example of occlusal trauma as a risk factor?

Phase I therapy

What phase of dental therapy is the following?

- Plaque Control Instruction

- Scaling

- Root Planing

- Stain and biofilm removal

Phase I therapy

What phase of dental therapy is the following?

- Caries Control (Provisional restorations)

Phase I therapy

What phase of dental therapy is the following?

- Exodontia as needed (May include ridge preservation)

Phase I therapy

What phase of dental therapy is the following?

- Occlusal Adjustment

Phase I therapy

What phase of dental therapy is the following?

- Re-evaluation 6-8 (or more) weeks following initiation of therapy

Chemical therapy (antiseptics, antibiotics)

In addition to scaling and root planning, what therapy might also be indicated?

Sickle scaler

ID the type of periodontal instrument:

Universal curette

ID the type of periodontal instrument:

Gracey curette

ID the type of periodontal instrument:

NO!

Are scalers used subgingivally?

Scaling and root planing and may be used supra and subgingivally

What are curettes used for?

Scaler

ID the type of periodontal instrument:

Universal Curette

ID the type of periodontal instrument:

Gracey curette

ID the type of periodontal instrument:

Gracey curette

ID the type of periodontal instrument:

Gracey curette

ID the type of periodontal instrument:

Hand scaler

What periodontal instrument is used supragingivally?

Hand scaler

What periodontal instrument is good for heavy calculus deposits and particularly useful just under contact areas because the blade is triangular in cross section and tapers to a sharp point?

H 6/7

What is a curved sickle hand scaler?

34/35

What is a straight sickle hand scaler?

Shank

ID the part of the blade at 1:

Face

ID the part of the blade at 2:

Lateral edge

ID the part of the blade at 3 and 6:

Tip or toe

ID the part of the blade at 4:

Terminal (end) shank

ID the part of the blade at 5:

Blade

ID the part of the blade at 7:

Lateral surface

ID the part of the blade at 8:

Back of blade

ID the part of the blade at 9:

70°

What is the correct angle of the face of the blade to the tooth for efficient scaling or root planing?

Scaling

Define the following:

Instrumentation of the tooth surfaces exposed to the oral environment to remove accumulated plaque, calculus and stains

Scaling

What is being shown in this image?

Subgingivally

Root planning is done ONLY ____________ with curettes

Root planning

Define the following:

A treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with microorganisms and bacterial toxins (waste products).

Scaling and root planing

The following are objectives of what?

- Remove calculus, plaque and stain from the tooth surfaces.

- Achieve a smooth root surface to facilitate the patient's plaque removal.

- Remove cementum exposed to oral bacteria and oral fluids.

- Ensure that the patient is comfortable using local anesthesia.

True

T/F: When a patients presents with pockets of ≥ 5mm, and moderate to heavy calculus deposits and rough root surfaces, rarely can complete scaling and root planing be accomplished in a single visit

During active or maintenance therapy for patients with present or past periodontitis.

When is root planning done?

Root planning

What removes subgingival plaque, calculus, and cementum to assure smooth subgingival root surfaces regardless of the probing depths?

- To achieve a very smooth root surface removing the coronal cementum, 16-60 microns thick, about the thickness of a hair and apical cementum is 150-200 microns thick.

- Since Sharpey's fibers have vacated, there is a rough root surface now exposed to oral bacteria.

Why do we root plane?

Root planning

What is being shown in this image?

True

T/F: Hand curettes are designed to be used both supragingivally and subgingivally

Scaler

Does a scaler or curette have a pointed tip?

Curette

Does a scaler or curette have a rounded tip?

Scaler

Is this a scaler or curette?

Curette

Is this a scaler or curette?

Younger-good 7/8

What universal curette has the following characteristics?

- Can be adapted to most tooth surfaces

- Useful for gingival curettage

Three - two lateral edges and the toe

How many cutting surfaces do universal curettes have? What are they?

- Vertical stroke

- Oblique stroke

- Horizontal stroke (toe oriented apically)

When doing subgingival scaling and root planing, what strokes should be employed?

Vertical stroke

What type of stroke is shown?

Oblique stroke

What type of stroke is shown?

Horizontal stroke (toe oriented apically)

What type of stroke is shown?

Two - one lateral edge and the toe

How many cutting surfaces does the Gracey curettes have? What are they?

Hold the instrument vertically with the toe pointing towards you

How can you determine the cutting edge of the Gracey Curette?

The cutting edge slopes towards the floor

When the terminal shank of any Gracey curette is held perpendicular to the floor, how does the cutting edge appear?

70°

When the TERMINAL SHANK of any Gracey curette is maintained parallel to the tooth surface that is being scaled or root planed using any stroke (vertical, oblique, horizontal), then the blade will always be ______° to the tooth.

Parallel

Any Gracey may be used to scale or root plane any surface of any tooth as long as the terminal shank can be maintained ___________ to the tooth surface being treated

90°

The face of a universal curette is positioned at what angle to the terminal shank?

110°

The face of a Gracey curette is offset at what angle to the terminal shank?

D. Offset to form a cutting edge that is lower

Compared to a universal curette, the Gracey curette's face is:

A. Parallel to the shank

B. Perpendicular to the shank

C. Tilted away from the lower shank

D. Offset to form a cutting edge that is lower

Gauze

If you do not have an assistant while doing an SRP, what can help with blood control?

1. Dampen it and roll it tight like a cotton roll.

2. Place it in the vestibule facial and lingual of the mandible and facial of the maxilla.

3. Wipe your instrument blade.

4. Blot blood from gingival margin.

5. Provides a dry and comfortable non-skid finger rest.

6. Helps to keep tongue away from work area.

7. Retracts lip and cheek.

8. Provides access and more visibility.

How do you use a 2x2 gauze with hand scaling or root planning?

It must be done prior to using an instrument and when the instrument becomes dull during use

Hand instrumentation sharpening is vastly important! When must sharpening be done?

- Much more precise in cutting

- Less pressure against the tooth

- Good control of the instrument with optimum tactile sensitivity

- Less chance of the instrument slipping

- Less operator fatigue and frustration

Why must hand instrument sharpening must be done BEFORE every procedure?

True

T/F: The combination of ultrasonics and hand instrumentation is more effective than either technique alone.

1. Assess (Observe plaque control techniques, periodontal probing, calculus detection)

2. Disclose for instruction (Visualize supragingival plaque)

3. Motivate and educate: (Teach by explaining why)

4. Therapy:

4. Airflow® Supragingival

5. Perioflow® Subgingival

6. Ultrasonic scale PIEZON® PS tip

6. Hand instrumentation

7. Evaluate

8. Recall (Maintenance)

What is an excellent sequence for your PDHT?

False (it CAN be predictably achieved and maintained)

T/F: Dental health cannot be predictably achieved and maintained by the patient's daily hygiene therapy and regular professional dental hygiene therapy visits