ADC - Australian Dental Council Periodontal Disease Management 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)?

Accepted Answer

3 months, due to his history of advanced disease and presence of risk factors.

Answer

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?

Accepted Answer

Prescription of systemic antibiotics as an adjunct to the initial therapy.

Answer

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?

Accepted Answer

To disrupt the subgingival biofilm and remove calculus deposits.

Answer

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?

Accepted Answer

Tunnel preparation.

Answer

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?

Accepted Answer

The rate of disease progression over time.

Answer

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.

ADC - Australian Dental Council Practice Test

ADC - Australian Dental Council Practice Test

ADC - Australian Dental Council Periodontal Disease Management Questions and Answers