PROJEK QA

DAERAH : Kuala Pilah

TAJUK : To assess the improvement of

periodontal parameter after non surgical
periodontal
KUMPULAN: UNIT PERIODONTIK

AHLI KUMPULAN ;

1. DR ZUHRAH BT MOHD SOOD

2. DR NIRMAL KUMAR
 PROBLEM ANALYSIS / LITERATURE REVIEW

 Poor oral hygiene even after dental counseling and

education regarding good oral hygiene care reduction.
 No much improvement in the plaque score and pocket
depth, after periodontal therapy (need data).
 Patient factor
 socioeconomic factor, low education
 diet, poor OH, low motivation and awareness
 not compliant patient
 Medical problem: uncontrol medical problem
 other risk factor: smoking
LITERATURE REVIEW
 Non Surgical Periodontal Therapy
 Scaling & Root Planing, OHI
 control the factors responsible for the periodontal
inflammation, the removal of subgingival bacterial
deposits and the subsequent control of plaque levels by
patients are particularly significant
 Many patients can have their periodontal disease
controlled with non surgical therapy and do not require
further surgical intervention (Newman, Takei et al.
2012)
 Oral Hygiene Practices
 single session of oral hygiene instruction describing the
correct use of a mechanical toothbrush in addition to a
single visit of professional session for oral prophylaxis
has a significant and positive effect on the decrease of
gingival inflammation ( Van der Weijden and Hioe
(2005))
 a meta-analysis of six-month studies of anti-plaque and
anti-gingivitis agents the largest body of studies
supported the efficacy of mouth-rinses with essential
oils and a smaller body supported a strong anti-plaque
and anti-gingivitis effect of 0.12%
chlorhexidine(Gunsolley 2006)
 routine instruction for daily flossing is not backed up by
scientific evidence and should be given only on a case by
case basis when high quality flossing could be
achievable(Berchier, Slot et al. 2008, Sambunjak,
Nickerson et al. 2011)
 Periodontal instrumentation
 aimed at the removal of plaque, endotoxin and calculus
but not cementum. (Smart, Wilson et al. 1990
 expected outcomes of nonsurgical periodontal treatment
in probing depth reduction and clinical attachment gain
at sites that initially were 4 to 6 mm in depth or greater
than 7mm. He reported mean pocket depth decrease of
1.29 mm and 2.16 mm respectively and mean gain of
clinical attachment of 0.55 and 1.29 mm respectively.
(Cobb 1996)
 Risk factor modification
 recognized risk factors such as smoking and diabetes
may aggravate the severity and advance of the disease
 Alteration of these risk factors needs to be integrated in
the non-surgical periodontal treatment to maximise the
outcome of the response( Irwin et al. 2007)
 A recent meta-analysis assessed the effect of smoking
cessation on the outcomes of periodontal therapy. From
the two studies included, it shows that smoking
cessation causes greater improvement in probing depth
reduction and clinical attachment gain (Chambrone,
Preshaw et al. 2013).
 type-2 diabetes can be considered a risk factor for
periodontitis (Chavarry, Vettore et al. 2009)
 Ryan, Carnu et al. (2003)found an increased prevalence
and severity of periodontitis in diabetics whilst Khader
et al. found that patients with diabetes show a
significantly higher severity
 Systemic antimicrobial therapy
 Systemic antimicrobials in simultaneity with scaling
and root planing offer an additional clinical advantage
in probing depth reduction and clinical attachment
gain(Herrera, Sanz et al. 2002, Haffajee, Socransky et
al. 2003).
 combined systemic administration of amoxicillin and
metronidazole adjunctively to scaling and root planning
(Sgolastra, Petrucci et al. 2012).
 Local adjunts
 Subbgingival pocket irrigation with povidone iodine
demonstrated a small but statistically significant effect
in probing depth reduction (Sahrmann et al, 2010)
 Bonito et al.showed a statistical significant advantage
in pocket depth reduction of 0.1 to 0.5 mm for four
agents, these include tetracycline fibers, doxycycline gel,
minocycline microspheres, and metronidazole gel
 significant benefit in probing depth reduction (between
0.5 and 0.7 mm) with subgingival application of
tetracycline fibers, sustained released doxycycline and
minocycline but a minimal effect of chlorhexidine and
metronidazole (0.1 and 0.4mm respectively) (Matesanz-
Perez et al, 2013).
 GENERAL OBJECTIVE
 Toassess the effectiveness of non surgical
periodontal treatment in Periodontic
Department, Kuala Pilah
 SPECIFIC OBJECTIVES
1) To assess the plaque score during
baseline and reassessment
2) To assess the BOP during baseline and
reassessment
3) To assess the pocket depth during
baseline and reassessment
 PROBLEM STATEMENT/OPPORTUNITY STATEMENT
 One of the major limitations of the nonsurgical periodontal therapy is the management of
multi-rooted teeth with furcation involvement. Huyuan et al. .
 in a systematic review assessing the 5-year survival rate of multi-rooted teeth concluded that
nonsurgical conservative furcation therapy is effective in preventing degree I furcation
involved teeth from further intrerradicular disease progression.
 as the lesion advances leading to increased attachment loss, this treatment presents some
limitations including incomplete calculus removal and inability of the patient to access and
optimally clean the area (Huynh-Ba G, et al in 2009)
 Root sensitivity occurs in approximately one-half of the patients following subgingival scaling
and root planing. The sensitivity increases for a few weeks after therapy, after which it
decreases (Von Troil, Needleman et al. 2002).
 The successfulness of the nonsurgical periodontal therapy is restricted when patient is non-
compliant, a smoker and inpatients with uncontrolled diabetes.
 The damaging effect of smoking in the therapeutic outcome of mechanical therapy is well
established. A systematic review demonstrated that smokers does not respond as well as non-
smokers with less favourable outcomes and less reduction in probing depths (Labriola,
Needleman et al. 2005).
 FLOW CHART/CARTA ALIRAN KERJA
Chronic periodontitis patients

Clinical measurement including plaque score, PD

and BOP

Group 1 (5 pt) - Group 2 (5 pt) -

Pre-completion Post-completion

Clinical measurement at 6 months after baseline

Statistical Analysis
QA STUDY METHODOLOGY
METODOLOGI KAJIAN
 Jenis kajian - Retrospective & Prospective
 Tempoh kajian - 6 bulan
 Sumber Data – Patient records
 Teknik persampelan – Randomised
 Pengumpulan Data
 Analisa Data - SPSS
 INCLUSION & EXCLUSION CRITERIA
 Inclusion Criteria
 Good general health and controlled medical problem
 Not pregnant or lactating
 At least two adjacent posterior teeth with ≥ 5mm interproximal pocket that bleeds on
probing

 Exclusion Criteria
 Uncontrolled medical problem
 Pregnant and lactating
 INDICATOR & STANDARD
INDIKATOR :

STANDARD :
 PLAN FOR DATA COLLECTION
Data yang di kehendaki Cara maklumat di perolehi Siapa yang di tugaskan
 PLAN FOR DATA ANALYSIS
What/How/Whom/Where/When ( with proposed dummy tables )

• What • Whom • Where • When

How
 Dummy Tables
ANALYSIS AND INTEPRETATION
GANTT CHART
PROJECT ACTIVITIES 2017

JUN JULAI OGOS SEPT OCT

QA Activities APRIL MEI NOV DEC

Subjects
Recruitment

Data Collection

Data Analysis /
Interpretation

Presentation &
Submission of
Reports

Report Writing

Project Completed

Submission of QA
Papers
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 STATUS TERKINI PROJEK
Tajuk Tarikh Projek Status Projek Sasaran Projek
/Senarai Projek Dimulakan terkini diselesaikan
QA (Bulan)
Improving February 2017 April 2018
Percentage of
Gingivitis- Free
Students in
Rembau Primary
School
THANK YOU