initial therapy, pt 2

lecture given 9/17/2026

is gingival inflammation (measured by BOP) a reliable indicator for future breakdown?

no!

but absence of BOP is a somewhat reliable indicator of health

does SRP reduce the levels of motile microbes and spirochetes?

yes, but for a limited period of time

is SRP alone a realistic technique to remove all plaque and calculus?

no! it is rarely attained

in initial pocket depths of 5mm or greater, clinicians have been shown to inadequately debride roots ____% of the time

65

is SRP a definitive or inital treatment?

it depends on the re-evaluation

scaling

removal of soft and hard deposits adhering to the tooth surface

root planing

removal of diseased root surfaces to create a smooth non-contaminated root surface

do sharp or dull instruments reflect light?

dull edge

what are the parts of effective instrumentation?

adaptation, angulation, motion activation, handle roll

adaptation

placing the leading third of the cutting edge in contact with the tooth surface

in this position, the cutting edge is correctly adapted to the tooth surface

what is the correct angulation of a gracey currette?

the angle formed between the instrument face and the tooth surface should be between 60-85

use a 45 angle to bring the gracey into the pocket

motion activation?

moving the instrument in order to produce an instrumentation stroke

what instrument do you used to detect calculus?

11/12 after five explorer

what is the most common location for calculus?

at or just below the CEJ and in pockets over 5mm

how long should you let topical anesthetic sit?

5 minutes

how should you inject local anesthetic for SRP?

initial injection into mucosal tissue (mepivicaine 3%)

subsequent injection in keratinized tissue (lidocaine 2% with 1:00k epi)

overlap injection points with blanched tissue

move thru the interproximal

continue on to the palate

oraqix

non-injectable local anesthetic for periodontal use

2.5% lidocaine and 2.5% prilocaine gel

how should you use oraqix?

place on the gingival margin, wait for 30 sec

place in the pocket and fill until the gel is visible, wait 30 sec

how long does oraqix last?

14-31 minutes, average 20 minutes

what characteristics does ONLY stannous fluoride have?

reduce plaque buildup

reduce inflammation associated bleeding and gingivitis

reduce tooth sensitivity

what characteristics do stannous fluoride AND have?

protect against cavities

strengthen tooth enamel

provide corrective action from acid damage

reduce complication related to dry mouth

what were the historic problems with stannous fluoride?

staining and metallic taste

recent reformulation with zinc phosphate has greatly reduced those problems

systemic administration chemotherapeutic agents

tetracycline

metronidazole

penicillin

clindamycin

erythromycin

augmentin

periostat

20mg doxycycline

2x a day

doesn’t kill bacteria, suppresses enzymes (MMPs)

periostat + SRP

SPR removes the bacterial component

periostat suppresses MMPs from the host response

is periostat effective?

yes, SRP + periostat is more effective than just SRP

in tooth sites with severe disease (baseline PD>7mm) improvements in attachment were demonstrated for both treatment groups at all points

however the perio pts attachment gains were significantly greated with subjunctive SDD than with adjunctive placebo

improvements from baseline were 33 to 52% greater

HOWEVER, scientifically, does that make sense? NO

gingival health

pink, healthy tissue

no clinical signs of disease

good oral hygiene

low susceptibility

no systemic risk factors

periodontal disease

chronic overproduction of tissue destructive enzyme

bone loss, deeper pockets

smoking and perio

25% of the adult population smokes

53% of periodontitis is attributable to smoking

smoking is the major preventable risk factor for periodontitis in the US

current smoking increases periodontal disease severity ____ greater risk

former smoking increases periodontal disease severity ____ greater risk

4

2

<9 cigarettes smoked, ____x greater risk of perio

>31 cigarettes smoked, ____x greater risk of perio

3

6

0-2 years post smoking, ___x greater risk than nonsmoker

>11 years post smoking, ___x greater risk than nonsmoker

3

same

who should use periostat?

those resistant to treatment

those who cannot afford to lose any more attachment

those starting to show signs of new breakdown after being stable for a time

smokers