ADC - Australian Dental Council Periodontal Disease Management Questions and Answers — Questions and Answers
Question 1: A 58-year-old male patient presents for a periodontal maintenance appointment. He completed non-surgical periodontal therapy 12 months ago for Stage III Grade B periodontitis. He is a former smoker, having quit 2 years ago, and has well-controlled Type 2 diabetes. Clinical examination reveals generalised probing depths of 3-4 mm, with bleeding on probing at 15% of sites. What is the most appropriate recall interval for his supportive periodontal therapy (SPT)?
- 12 months, as the probing depths are generally stable.
- 6 months, as he is a former smoker with controlled diabetes.
- 3 months, due to his history of advanced disease and presence of risk factors. (Correct answer)
- 9 months, as a step-down from the initial 3-monthly recall.
Correct answer: 3 months, due to his history of advanced disease and presence of risk factors.
Patients with a history of Stage III or IV periodontitis, especially with modifying factors like diabetes (even if controlled), require more frequent maintenance. The initial year post-therapy often involves a 3-month recall. Given his history of advanced disease and existing risk factors, a 3-monthly interval is crucial to monitor stability, prevent recurrence, and manage inflammation, as indicated by the 15% bleeding score. Extending the interval to 6 or 12 months would be inappropriate for this level of risk.
Question 2: A 28-year-old female patient is diagnosed with generalised Stage III Grade C (aggressive) periodontitis. Following initial non-surgical debridement (scaling and root planing), which of the following is the most appropriate next step in her management according to current Australian guidelines?
- Immediate referral for full mouth extraction and implant placement.
- Prescription of systemic antibiotics as an adjunct to the initial therapy. (Correct answer)
- A 12-month review to assess the healing response.
- Placement of localised antibiotic chips in all pockets deeper than 5mm.
Correct answer: Prescription of systemic antibiotics as an adjunct to the initial therapy.
For aggressive forms of periodontitis (now classified under the staging/grading system, often Grade C), systemic antibiotics are frequently used as an adjunct to mechanical debridement to target tissue-invasive bacteria that may not be eliminated by instrumentation alone. A common regimen is amoxicillin and metronidazole. The other options are either too extreme (extraction), too passive (12-month review), or not the primary approach for a generalised aggressive case (localised delivery as a sole adjunct).
Question 3: Which of the following is the primary goal of non-surgical periodontal therapy, such as scaling and root planing?
- To regenerate lost alveolar bone and cementum.
- To achieve a smooth root surface for patient comfort.
- To eliminate the need for any future dental treatment.
- To disrupt the subgingival biofilm and remove calculus deposits. (Correct answer)
Correct answer: To disrupt the subgingival biofilm and remove calculus deposits.
The fundamental objective of non-surgical periodontal therapy is to remove the primary etiological factors of periodontitis, which are the bacterial biofilm (plaque) and calculus (hardened plaque) from the root surfaces. This process aims to reduce the bacterial load, resolve inflammation, and create an environment conducive to healing, which may result in the reduction of probing depths. While regeneration is a goal of some surgical procedures, it is not the primary aim of non-surgical debridement.
Question 4: A patient with a multi-rooted molar exhibits a Class II furcation involvement. The area is difficult for the patient to clean, and there is persistent inflammation despite excellent overall oral hygiene and regular non-surgical debridement. Which of the following surgical interventions would be most appropriate to improve cleansibility and manage the defect?
- Gingivectomy.
- Root amputation of one of the roots.
- Tunnel preparation. (Correct answer)
- Free gingival graft.
Correct answer: Tunnel preparation.
Tunnel preparation is a surgical procedure specifically designed for mandibular molars with Class II or III furcation involvement where there is sufficient root divergence. It involves removing interradicular bone to create a space that is patent and cleansable with interdental aids like a proxy brush. This approach makes the previously inaccessible furcation area accessible for patient maintenance. Root amputation might be considered, but tunnel preparation specifically addresses cleansibility of the existing structure. A gingivectomy or free gingival graft would not address the bone defect within the furcation.
Question 5: According to the 2017 AAP/EFP classification system, which factor is a primary determinant for assigning the 'Grade' of periodontitis?
- The number of teeth lost due to periodontitis.
- The percentage of bone loss at the most affected site.
- The rate of disease progression over time. (Correct answer)
- The presence of probing depths greater than 5 mm.
Correct answer: The rate of disease progression over time.
The 'Grade' (A, B, or C) in the current classification system is designed to estimate the future risk and rate of progression of the disease. This is determined by assessing direct or indirect evidence of progression, such as longitudinal data (radiographs or probing depths over time) or by using metrics like the percentage of bone loss divided by the patient's age. The other factors, such as tooth loss and probing depths, are primarily used to determine the 'Stage' (I-IV) of the disease, which relates to severity and complexity.
Question 6: What is the most critical component of the long-term management and success of periodontal therapy?
- Initial prescription of systemic antibiotics.
- The complexity of the initial surgical procedures.
- Patient adherence to a regular supportive periodontal therapy (SPT) schedule. (Correct answer)
- Use of advanced ultrasonic scaling devices.
Correct answer: Patient adherence to a regular supportive periodontal therapy (SPT) schedule.
Periodontitis is a chronic disease that cannot be 'cured' but can be controlled. The long-term stability of periodontal health depends critically on preventing the recurrence of infection. This is achieved through a combination of the patient's diligent daily oral hygiene and consistent, lifelong participation in a professionally administered supportive periodontal therapy (SPT) program at individually determined intervals. While other factors contribute to initial success, long-term stability is most dependent on maintenance.
ADC - Australian Dental Council Periodontal Disease Management Questions and Answers
A 58-year-old male patient presents for a periodontal maintenance appointment.
He completed non-surgical periodontal therapy 12 months ago for Stage III Grade B periodontitis.
He is a former smoker, having quit 2 years ago, and has well-controlled Type 2 diabetes.
Clinical examination reveals generalised probing depths of 3-4 mm, with bleeding on probing at 15% of sites.
What is the most appropriate recall interval for his supportive periodontal therapy (SPT)?