Nonsurgical Periodontal Therapy MCQ

Nonsurgical therapy is the foundation of periodontal treatment and the first phase for almost every patient. Its core is scaling and root planing: mechanically disrupting and removing the biofilm and calculus that drive inflammation. But the dentist's instrumentation is only half the work; the patient's daily plaque control is what makes any treatment last, and without it therapy fails. Antimicrobials (local, systemic, or host-modulating) are adjuncts, never substitutes for debridement. After healing, the case is reevaluated to decide who is stable and who needs more, and every periodontitis patient then enters lifelong supportive periodontal therapy (maintenance), because the disease recurs without it.

Scaling and Root Planing

• Scaling removes plaque and calculus from the crown and root surfaces; root planing additionally smooths the root surface and removes contaminated deposits to leave a biologically acceptable surface.
• Instrumentation uses hand instruments (scalers and area-specific Gracey curettes for subgingival work) and powered ultrasonic or sonic scalers, which are efficient and provide irrigation; the two approaches are often combined.
• The realistic goal of SRP is to reduce the bacterial load and inflammation so the tissues heal: pockets shrink through tissue shrinkage and the formation of a long junctional epithelium (repair), not true regeneration of lost attachment.
• Most patients with gingivitis and mild-to-moderate periodontitis respond well to thorough SRP plus good home care, which is why nonsurgical therapy is the first phase.

Oral Hygiene and Plaque Control

• Daily plaque control by the patient (effective brushing and interdental cleaning) is the single most important determinant of long-term success.
• No amount of professional instrumentation compensates for ongoing poor home care; the biofilm simply re-forms and the disease recurs.
• Oral hygiene instruction and behavior change are therefore part of therapy, not an afterthought, and adherence is monitored at every visit.
• Interdental cleaning (floss, interdental brushes) matters because interproximal sites are where periodontitis is often most active and hardest to reach with a toothbrush.

Antimicrobial Adjuncts

• Locally delivered antimicrobials (a chlorhexidine chip, minocycline microspheres, or doxycycline gel placed into a pocket) can help selected localized sites that do not respond to SRP alone.
• Systemic antibiotics are reserved for specific situations such as aggressive or refractory periodontitis (a commonly cited combination is amoxicillin plus metronidazole), not for routine chronic periodontitis.
• Host modulation therapy uses sub-antimicrobial-dose doxycycline (a low dose that inhibits host matrix metalloproteinases rather than acting as an antibiotic) as an adjunct to reduce tissue breakdown.
• Chlorhexidine mouthrinse is an effective antiplaque and antigingivitis adjunct, though it can cause tooth staining and altered taste with prolonged use; all of these are adjuncts to, not replacements for, mechanical debridement.

Reevaluation

• After SRP, the periodontium is reevaluated, usually at about 4 to 6 weeks, to allow healing before the tissues are reassessed.
• Reevaluation re-measures probing depth, bleeding on probing, and attachment levels to judge the response to nonsurgical therapy.
• Sites that have responded (reduced probing depth, no bleeding) move into maintenance, while residual deep pockets that still bleed are candidates for surgical therapy or referral.
• Reevaluation is the decision point that separates the patients who are controlled by nonsurgical care from those who need more.

Supportive Periodontal Therapy (Maintenance)

• Supportive periodontal therapy (SPT), also called periodontal maintenance, is the lifelong program of recall visits with re-instrumentation, monitoring, and reinforcement of home care that follows active treatment.
• The recall interval is set by the patient's risk, with about every 3 months being common for treated periodontitis patients.
• Maintenance matters because periodontitis recurs without ongoing professional care and plaque control; it is the recurrence-control program, not an optional extra.
• Patient adherence to both home care and the recall schedule is a major determinant of long-term tooth retention.