RSD

• What does RSD stand for in dental procedures?

  Root Surface Debridement
• What is the purpose of RSD?

  To remove deposits and microbes from tooth roots
• In which periodontal pockets is RSD indicated?

  Pockets of 4mm with bleeding or 5mm and above
• What are the complications that may occur during RSD?

  • Pain for the patient; LA can reduce it
  • Complications from LA: phobia, wrong angulation, accidental parotid injection
  • LA may wear off during treatment
  • Damage to root surface
  • Excessive bleeding affecting vision and causing panic
  • Graceys may perforate gingivae or go too deep
  • Iatrogenic damage
  • Patient tolerance issues with high-speed suction
  • Limited mouth opening
  • Risk of coughing/choking on water
  • USS may stop working
  • Gracey may break in the mouth
  • Gracey may scratch operator's skin
  • Patient may feel light-headed or dizzy
• What complications may occur after RSD?

  • Sensitivity once LA wears off
  • Risk of biting oral tissues or burning mouth
  • Gingival recession may occur
  • Excessive bleeding; contact GP/GDP if it occurs
  • Teeth may feel mobile; healing required
  • Poor healing may necessitate another RSD
  • Excessive pain at home
• What should be warned to the patient after RSD regarding sensitivity?

  They may experience sensitivity once LA wears off
• What is a potential risk when LA wears off during treatment?

  The patient may feel pain
• What should be done if a patient experiences excessive bleeding after RSD?

  Contact their GP/GDP immediately
• Why might a patient dislike gingival recession after RSD?

  It creates gaps between teeth
• What might happen to teeth after RSD?

  Teeth may feel mobile
• What is the first step in the RSD process?

  First round of RSD
• What occurs during Step 2 of the RSD process?

  Review assesses RSD and further treatment
• What might a patient experience at home after RSD?

  Excessive pain
• What is a potential complication of using Graceys during RSD?

  They may perforate the gingivae
• What is RSD?

  The removal of deposits and microbes from the root surface of a tooth
• When is RSD indicated?

  RSD is only indicated in perio pockets that are 4mm and bleeding or 5mm and above
• Why may RSD be painful for the patient?

  Local anesthesia can be used to reduce the pain of RSD
• What complications can occur during the administration of local anesthesia for RSD?

  Patient phobia, wrong angulation meaning more LA required, accidental injection into parotid gland leading to facial paralysis
• Why can the local anesthesia wear off during RSD?

  The procedure may take longer than the duration of the local anesthesia
• What damage can occur to the root surface during RSD?

  RSD can cause damage to the root surface
• What complications can occur due to excessive bleeding during RSD?

  Excessive bleeding may reduce vision, make treatment difficult, and cause the patient to panic
• What damage can be caused by the Gracey curettes during RSD?

  Graceys may perforate the gingivae or go too deep, causing damage
• What other complications can occur during RSD?


  Iatrogenic damage, patient unable to tolerate high speed suction, patient unable to open mouth wide enough, patient coughing/choking on water, ultrasonic scaler stopping working, Gracey breaking, Gracey scratching/perforating operator's skin, patient feeling light headed/dizzy/syncope
• Why may the patient experience sensitivity after RSD?

  The patient should be warned of sensitivity once the local anesthesia has worn off
• What other complications can occur after RSD?

  Recession of gingiva, teeth feeling mobile, poor healing, patient experiencing excessive bleeding, patient experiencing excessive pain at home
• Why may another round of RSD be required?

  If there is poor healing, another round of RSD will be required
• What are the steps in the RSD treatment process?

  Step 2 = first round RSD. Step 2 review assesses RSD, if further RSD indicated, progression into step 3 occurs
• What are the strengths and weaknesses of RSD?

  Strengths:

  • Effectively removes deposits and microbes from the root surface
  • Can improve periodontal health in indicated cases

  
  

  Weaknesses:

  • Can be painful for the patient
  • Risk of complications during and after the procedure
  • Requires careful administration of local anesthesia
  • Potential for iatrogenic damage to the root surface or gingiva
  • Possibility of poor healing and need for additional treatment
• If a patient experiences excessive bleeding after RSD, what should the clinician do?

  The clinician should contact the patient's GP/GDP as it could be an undiagnosed bleeding disorder, and the patient should not leave the surgery until the bleeding stops
• How does the RSD procedure differ from a regular dental cleaning?

  RSD is a more intensive procedure focused on removing deposits and microbes from the root surface, while a regular cleaning is a less invasive procedure focused on removing plaque and tartar from the tooth surfaces
• What factors should a clinician consider when deciding if RSD is the appropriate treatment for a patient?

  • Depth of periodontal pockets (4mm and bleeding or 5mm and above)
  • Presence and severity of periodontal disease
  • Patient's pain tolerance and ability to undergo the procedure
  • Risk of complications based on patient's medical history
  • Likelihood of successful healing and improved periodontal health
  • Patient's willingness to undergo the procedure and follow post-op instructions
• If a patient experiences excessive pain at home after RSD, what should the clinician do?

  The clinician should contact the patient and assess the situation, and potentially schedule another appointment to address the pain
• How does the RSD procedure fit into the overall treatment plan for a patient with periodontal disease?

  • RSD is typically the first step in the treatment of moderate to severe periodontal disease
  • It aims to remove deposits and microbes from the root surface to create a clean environment for healing
  • After RSD, the clinician will assess the patient's response and determine if further treatment is needed, such as:
  • Additional rounds of RSD
  • Periodontal surgery
  • Ongoing maintenance and monitoring
  • RSD is an important part of a comprehensive periodontal treatment plan to improve the patient's oral health
• If a patient experiences gingival recession after RSD, how should the clinician manage this?

  The clinician should warn the patient about the possibility of gingival recession before the RSD procedure, so the patient is prepared for this potential outcome
• How does the use of local anesthesia during RSD impact the overall procedure and patient experience?

  Local anesthesia is critical to reduce the pain of RSD for the patient, but its administration can also lead to complications like patient phobia, wrong angulation, and accidental injection into the parotid gland
• What are the key factors that influence the success of the RSD procedure?

  • Proper administration of local anesthesia to manage patient pain
  • Careful and controlled use of instruments to avoid iatrogenic damage
  • Effective removal of deposits and microbes from the root surface
  • Promotion of optimal healing and reduction of post-op complications
  • Patient compliance with post-op instructions and maintenance of good oral hygiene
  • Clinician's skill and experience in performing the RSD procedure
• If a patient's teeth feel mobile after RSD, what should the clinician advise the patient?

  The clinician should advise the patient that the teeth may feel mobile after RSD, and that the patient will have to wait for the gingiva to heal around the teeth
• How does the RSD procedure differ from scaling and root planing (SRP)?

  • RSD is a more intensive procedure focused on removing deposits and microbes from the root surface
  • SRP is a less invasive procedure that aims to remove plaque and calculus from the tooth surfaces
  • RSD is indicated for deeper periodontal pockets (4mm and bleeding or 5mm and above)
  • SRP is often the first-line treatment for mild to moderate periodontal disease
  • RSD carries a higher risk of complications compared to SRP
  • The healing process and patient experience may differ between the two procedures
• If a patient's ultrasonic scaler stops working during RSD, what should the clinician do?

  The clinician should troubleshoot the issue with the ultrasonic scaler and, if unable to resolve it, continue the RSD procedure manually using hand instruments
• What are the key considerations for patient selection and preparation for the RSD procedure?

  • Assess the depth of periodontal pockets and severity of periodontal disease
  • Evaluate the patient's pain tolerance and ability to undergo the procedure
  • Review the patient's medical history for any conditions that may increase the risk of complications
  • Ensure the patient understands the procedure, potential complications, and post-op instructions
  • Administer local anesthesia effectively to manage pain and discomfort
  • Prepare the patient's oral cavity and ensure they can maintain an open mouth position
  • Provide clear instructions on post-op care and follow-up appointments