GAME OVER

A patient who has just completed Step 2 (subgingival PMPR) therapy complains of new, sharp sensitivity to cold drinks. The sensitivity is localized to the upper premolars where there is now 2-3mm of recession that was not apparent before treatment. According to the guidance, what is the recommended first-line management for this post-PMPR dentine sensitivity?

A patient with a history of periodontitis has significant mid-buccal recession on their canine teeth due to historic traumatic toothbrushing. The areas are stable with no inflammation or pocketing, but the patient is concerned about the appearance. Which of the following is the most appropriate initial advice and management?

You are planning the supportive periodontal care (SPC) schedule for a patient who has just completed active therapy for Stage IV periodontitis. The treatment has been successful in stabilizing the disease, but there are residual 5mm pockets and significant risk factors remain (smoking, complex restorations). What is the most appropriate recall interval for this patient at the beginning of their SPC programmer?

A dentist is referring a patient with severe periodontitis to a specialist. They are writing the referral letter.

Which of the following pieces of information is LEAST critical to include in the referral letter, according to the checklist in the guidance?

Which toothbrushing instruction is most aligned with the advice in the guidance for preventing both periodontal disease and dental caries?

A patient with generalized, stable periodontitis asks if they should use a specific toothpaste to help their condition. They have seen advertisements for many "gum health" toothpastes containing agents like stannous fluoride or triclosan. Based on the key recommendations in the guidance, what is the most accurate advice to give this patient?

You are creating a treatment plan for a 50-year-old patient with generalized Stage III periodontitis. After Step 1 of therapy, the patient's oral hygiene is excellent (plaque score 15%), but multiple 5-6mm pockets remain. You plan to proceed with Step 2 (subgingival PMPR). The patient is anxious about the procedure and asks if there is a "best" way to do it. According to the evidence cited in the guidance, which of the following statements is most accurate regarding the instrumentation for subgingival PMPR?

A patient with peri-implantitis around tooth 11 is referred back to the specialist who placed it. The specialist performs surgical treatment and discharges the patient back to your care for maintenance. What is the most vital element for ensuring the long-term success of the treated implant?

A 68-year-old patient with a history of periodontitis presents with a mobile lower central incisor (tooth 41). The tooth has 70% bone loss, a 9mm pocket, and Grade 3 mobility. The patient is keen to save the tooth if possible. You are assessing the tooth's prognosis. Which of the following patient-related factors is most critical in determining whether this tooth can be retained, even in the short to medium term?

Give a BPE Score According to what you see?

A clinician is using a WHO BPE probe to screen a patient. What are the key features of this specific probe?

You are assessing a patient's risk of future periodontal disease progression. Which of the following is considered a non-modifiable risk factor?

A clinician is using the AUDIT-C screening tool to ask a patient about their alcohol consumption. The patient scores a total of 9. According to the "Advise and Act" flowchart in the guidance, what risk category does this score fall into and what is the appropriate advice?

A 40-year-old patient has a BPE score of 4 in the upper left sextant. According to the guidance, what is the immediate requirement for further examination before treatment begins for this sextant?

A 19-year-old male patient presents with intensely painful gums, bad breath, and a general feeling of malaise. He is a heavy smoker (20+ per day) and admits to high levels of stress due to university exams. Clinical examination reveals ulcerated and necrotic interdental papillae between his lower anterior teeth, covered by a greyish pseudo membrane. The affected gums bleed profusely on the slightest touch. There is no attachment loss. What is the most appropriate diagnosis and initial management?

A 38-year-old patient with generalized Stage III periodontitis is undergoing non-surgical therapy. He has a Grade I furcation involvement on tooth 16. The patient is concerned and asks if the tooth will need to be extracted. Based on the guidance, what is the most appropriate response and management plan for a tooth with Grade I furcation involvement?

A 58-year-old male patient presents for a routine check-up. His medical history reveals he has Type 2 diabetes, which he states is "fairly well-controlled," although he is unsure of his last HbA1c reading. He smokes 15 cigarettes per day and has done so for 25 years. His chief complaint is that his "gums bleed a bit when he brushes," but he is not in any pain. Clinical examination reveals generalized moderate gingival inflammation with significant plaque and calculus deposits. A Basic Periodontal Examination (BPE) is performed with the following scores

Radiographs show the most severe bone loss is approximately 40% of the root length on tooth 46, which also has a Grade II furcation involvement. The patient has crowded lower anterior teeth. Based on the information provided in the "Prevention and Treatment of Periodontal Diseases in Primary Care" guidance, what is the most appropriate initial step in this patient's management?

A 30-year-old patient with a history of generalized Stage IV, Grade C periodontitis is considering dental implants to replace her missing lower molars. She has completed non-surgical periodontal therapy and her disease is now stable, with no pockets >4mm and BoP <10%. She has successfully quit smoking. According to the guidance, what is the most important information to convey to this patient before she proceeds with implant treatment?

A 70-year-old patient with a history of treated Stage III periodontitis is on a 4-monthly supportive periodontal care (SPC) program. At his last review, his condition was stable, with no pockets >4mm and a bleeding on probing (BoP) score of 8%. Today, you note his BoP score has increased to 25%, and there are now two sites on tooth 36 with probing depths of 5mm that bleed on probing. The patient mentions he has recently been diagnosed with Type 2 diabetes by his GP. His oral hygiene appears to have deteriorated slightly. According to the guidance on managing disease recurrence during supportive care, what is the most appropriate next step?

A 24-year-old patient who is 20 weeks pregnant presents for her first dental examination in three years. She reports that her gums have become swollen and bleed easily when she brushes. She is a non-smoker and has no other relevant medical history. Clinical examination shows generalized gingival erythema and oedema, particularly in the anterior regions. Her BPE scores are 2 in all sextants. There is no evidence of interdental recession, and a review of bitewing radiographs taken three years prior shows no bone loss. Her oral hygiene is fair, with visible plaque along the gingival margins. What is the most appropriate management for this patient according to the guidance?

A patient presents for an examination and treatment planning for their lower right quadrant. You are presented with the following radiograph

Tooth 47 is affected by periodontitis extending into the furcation, is heavily restored and has an inadequate root filling. Tooth 46 has Stage III periodontitis with a Grade III furcation lesion, extensive caries beneath a full coverage crown and a mesial periapical radiolucency.

what is the most appropriate initial treatment plan for these two teeth?

A 35-year-old patient taking phenytoin for epilepsy presents with significant gingival enlargement. His BPE scores are 2s and 3s throughout. The enlarged tissue is firm, fibrotic, and covers a significant portion of the clinical crowns, making oral hygiene extremely difficult. After Step 1 therapy, including intensive oral hygiene instruction and supragingival PMPR, there is some reduction in inflammation, but the bulk of the enlarged tissue remains. What is the most appropriate next step in managing this patient's gingival enlargement?

You are conducting a risk assessment for a new patient. Which of the following combinations of factors would place a patient in the HIGHEST risk category for periodontitis progression according to the principles in the guidance?

A patient with excellent oral hygiene and no gingivitis attends for a routine check-up. Her BPE is 0 in all sextants. She asks if she still needs a "scale and polish" at every visit.

What is the key recommendation from the guidance regarding PMPR for patients with periodontal health?

A 65-year-old female patient with a history of generalized Stage III, Grade B periodontitis attends for a maintenance appointment. Her periodontal condition has been stable for the last 3 years. She has a dental implant at position 21, which was placed 5 years ago. Today, she reports no pain but has noticed some redness around the implant. Clinical examination of the implant at 21 reveals localized soft tissue swelling and bleeding on gentle probing at three sites around the implant. Probing depths around the implant have increased by 2mm since her last visit one year ago, with the deepest reading now being 6mm. There is no suppuration. A new periapical radiograph of the 21 implant shows no evidence of progressive bone loss when compared to the baseline radiograph taken one year after placement. According to the "Prevention and Treatment of Periodontal Diseases in Primary Care" guidance, what is the most appropriate diagnosis and immediate management plan for the implant at 21?

A 45-year-old patient presents with a chief complaint of a painful, swollen gum around his lower right molar. He has a history of periodontitis but has not attended for several years. Clinical examination reveals a localized, tender, erythematous swelling on the buccal aspect of tooth 47. A 7mm pocket is present on the buccal aspect, from which pus can be expressed upon gentle pressure. The tooth is tender to percussion and gives a positive response to sensibility testing with cold. What is the most appropriate immediate management for this patient?

A dental hygienist is providing supportive periodontal care for a patient with stable periodontitis. Which of the following tasks is a core component of every SPC visit?

A 28-year-old female patient is referred to your practice. She is medically fit and well and is a non-smoker. She has a family history of her mother losing teeth at a young age. Clinical examination reveals generalized deep periodontal pockets, with several sites probing at 8-9mm. There is significant bleeding on probing (>50% of sites) and Grade 2 mobility affecting the upper incisors. Radiographic assessment shows generalized bone loss, with the most severe site at tooth 11 showing approximately 60% bone loss. Based on the 2018 Classification system as described in the guidance, what is the correct diagnosis for this patient?

A practice is reviewing its environmental sustainability. Which of the following principles, advocated by the guidance, contributes most to sustainable healthcare?

A patient with generalized gingivitis (BoP 40%, no pockets >3mm) is reviewed 6 weeks after receiving oral hygiene instruction based on the Oral Hygiene TIPPS model and a full mouth PMPR. Her plaque score has improved from 60% to 25%, and her BoP score has reduced to 15%. According to the 2018 Classification, what is her current periodontal diagnosis?

A 55-year-old patient with well-controlled Type 2 diabetes (last HbA1c 49 mmol/mol) and a diagnosis of generalized Stage II periodontitis asks for your advice on interdental cleaning. He has a mix of tight anterior contacts and larger posterior spaces where food gets trapped. What is the most appropriate advice according to the key recommendations in the guidance?

A patient with periodontitis has sub-optimally controlled diabetes. You have provided non-surgical periodontal treatment. What is the key potential systemic benefit for the patient, which should be explained to them and communicated to their medical team?

A 14-year-old patient attends for a routine examination. He is in the permanent dentition stage. You perform a simplified BPE on the six index teeth (16, 11, 26, 36, 31, 46). The scores are as follows: 16-2, 11-1, 26-2, 36-3, 31-1, 46-2. What is the most appropriate action based on these BPE findings?

A 48-year-old patient has a tooth with an endo-perio lesion. Tooth 36 has a deep mesial pocket of 8mm that communicates with a periapical radiolucency. The tooth is non-vital. There is no evidence of root fracture. The patient has generalized Stage II periodontitis elsewhere in the mouth. According to the 2018 classification and management principles in the guidance, what is the correct classification of the lesion and the first treatment step?

A patient with a history of poorly controlled periodontitis is found to have a new diagnosis of rheumatoid arthritis. According to the guidance, what is the current understanding of the relationship between these two conditions?

During a full periodontal examination, you are assessing tooth mobility on tooth 16. You place two rigid instrument handles on the buccal and palatal aspects of the tooth and can displace the crown approximately 1.5mm in a horizontal direction. There is no discernible vertical movement. How would you grade and record this mobility according to the guidance?

A patient is diagnosed with Generalised Periodontitis; Stage III, Grade B; Stable. What do these terms mean clinically?

A dental therapist is treating a patient under a prescription from a dentist for non-surgical periodontal therapy. The patient requires local anaesthesia for subgingival PMPR. There is no Patient Group Direction (PGD) in place at the practice. What must be present in the patient's record for the therapist to legally administer the local anaesthetic?

A clinician is preparing to perform a full periodontal examination to record 6-point pocket depths. Based on the image provided and the guidance document, what is the specific name of this type of probe?

A 60-year-old patient is undergoing Step 1 therapy for periodontitis. You are providing oral hygiene instruction using the Oral Hygiene TIPPS model. After you have TALKED about the disease and INSTRUCTED the patient on technique, what is the next crucial step in the process?

When recording a BPE, you find a Grade I furcation on tooth 36 in a sextant where the highest pocket depth score is a 2. How should this be recorded in the BPE chart for that sextant?

A patient presents with generalized gingival recession. Which of the following is NOT listed in the guidance as a potential cause?

A 50-year-old patient has a BPE score of 3 in the upper right sextant. Radiographs are not currently available. What is the minimum requirement for periodontal charting for this sextant according to the guidance?

What is the primary reason the BPE is not considered suitable for the reassessment of a patient following periodontal treatment?

A patient with a history of periodontitis is scheduled for implant placement at tooth 46. You have completed non-surgical therapy, and their periodontal condition is now considered stable. According to the guidance, what is the recommended protocol for radiographic monitoring of this new implant?

A new patient presents to your practice with a full-arch, screw-retained implant bridge in the upper arch, which was placed abroad 10 years ago. He has no records or radiographs. You observe significant plaque accumulation and inflamed, bleeding tissues around the prosthesis. You suspect peri-implant disease.

What is the most critical first step in the examination and assessment of his peri-implant tissues?