02 Recognition of Periodontal Disease Flashcards
Why are universal precautions and infection control important?
- Prevent transmission of diseases between dental offices, commercial labs, and families/general public
- Protect yourself and loved ones
What are the components of PPE?
- Cap
- Eye goggles
- Mask
- Gown
- Gloves
What are the 5 moments of hand hygiene?
- Before an aseptic task
- Before patient contact
- After patient contact
- After contact with patient’s surroundings
- After risk of body fluid exposure
How and why should the dental tray be arranged?
- Instruments in order and stable in slots, the operator has an easy view and easy to pick up
- Open free ends facing away from clinician and patient
- Table top is flat, stable, and clean
- Sterile paper neatly folded and covers the underlying tray
- Safety
- Efficiency
- Patient has a positive perception of the operator
What to do when patient first comes into your clinic?
- Be nice and greet the patient
- Introduce yourself
- Check-in with the patient
- Ask about the chief complaint
- Take note of non-verbal cues (e.g. body language, tone)
- Take medical history (need to know if medically fit for dental tx, current medications and allergies)
- Take dental and social history (e.g. oral hygiene habits, reasons for tooth loss, past experiences, diet history, job and smoker)
- Fill up E&D form
What poses as occupational hazards to dentists?
- MSK disorders
2. Infectious diseases
Why is good posture important?
- See oral cavity clearly and deliver proper treatment
- Work more efficiently
- Suffer less muscle aches
What is a neutral seated position?
- Sit up straight, neck slightly forward (20 deg)
- Feet firmly on the floor
- Thighs and forearms parallel to the floor
- Elbows close to the body
- Weight evenly balanced
- Shoulders relaxed
- Patient’s mouth at clinician’s elbow level
- Clinician’s eyes 20-30cm away from patient’s mouth, and eyes directed downwards
How to position the patient?
- Supine with chin up, feet same level as the head (unless medical conditions e.g. vertigo, hypotension, inner ear problems)
- Reclined 45 deg with chin down to work on mandibular teeth or take impressions
What is the definition of periodontal diseases?
Periodontal diseases are complex diseases of multifactorial nature involving an intricate interplay between subgingival microbiota, host immune response and inflammatory responses, and environmental modifying factors.
What is the key aetiological factor of periodontal diseases?
Bacteria
Describe the contemporary model of host-microbe interactions in pathogenesis of periodontitis.
Clinical health:
- Symbiosis (health-promoting biofilm)
- Proportionate host response
- Acute resolution of inflammation
Gingivitis:
- Incipient dysbiosis (imbalance between health-promoting bacteria and perio-pathogens)
- Proportionate host response
- Chronic resolution of inflammation
Periodontitis:
- Frank dysbiosis
- Disproportionate host response (hyper-inflammatory)
- Failed resolution of inflammation > chronic non-resolving inflammation > CT and bone damage
Other risk factors:
- Behavioural
- Environmental
- Genetic
- Epigenetic
Describe the clinical appearance of healthy gingival tissues.
- Coral pink (but might have racial pigmentation)
- Firm and resilient
- Knife edge, scalloped margins
- Complete papilla fill, with gingival margins above CEJ
- Keratinised gingiva with stippling
- Keratinised gingiva with stippling
What are the characteristic features of healthy gingiva?
- No radiographic bone loss
- Most apical cell of JE attachment is on enamel (above or at CEJ)
Describe the clinical appearance of gingivitis.
- Erythematosus / gingival redness
- Edematous / spongy
- Rolled margins (swollen/hyperplastic/enlarged)
- Shiny, loss of stippling, and possible ulcerations
Describe the clinical appearance of periodontitis.
- Increased intensity of gingivitis characteristics
- Erythematosus / gingival redness (more cyanotic and extends towards MGJ)
- Edematous / spongy
- Rolled margins (enlarged/swollen/hyperplastic)
- Shiny, loss of stippling, and possible ulcerations
What symptoms do patients with periodontitis experience?
- Pain
- Spontaneous bleeding when brushing
- Suppuration
- Loss of function
- Gingival recession accompanied by sensitivity
- Drifting of teeth
- Shaky teeth
What are the clinical parameters used to determine presence of periodontal disease?
- PDs
- GRec
- CAL
- Furcation involvement
- BOP
- Suppuration
- PS
- Mobility
How to measure probing depth?
- Ramfjord 1959
- Measure PPD and CAL with a manual probe
- Probes used: UNC-15, Michigan ‘O’ probe with Williams markings
- Locate, measure and determine the course of a pocket on the tooth surface
How does a deep PD contribute to periodontal disease?
- Anaerobic environment
- Promotes periopathogens
- Increases breakdown of periodontal tissues
What are the key things to take note when measuring PDs?
- Parallelism
- Adaptation at proximal sites
- Record at line angles
- Let the probe drop to the base of the sulcus = 0.25g of force
- Walk the probe and record the deepest point
- Slightly tilt to detect deep pockets under the contact point with probe parallel to the long axis of the tooth
What are the factors that influence probing depth?
Larsen et al. 2009
- Probing force
- Probe diameter
- Probing pressure
- Shape of probe
- Angulation of probe
- Recording position (under at contact area)
- Shape of tooth
- Presence of subgingival calculus (under)
- Presence of inflammation of periodontal tissue (over)
- Cooperation from the patient (under)
How to measure Grec?
- Measure the vertical distance between the CEJ and FGM
- Probe is kept parallel to the long axis of the tooth
How is CAL measured and what is its significance?
- Clinical attachment loss around a tooth = tissue damage
- CAL = PD + GRec
- Measured from GRec to the base of the sulcus
- Fixed reference point to measure against all the time = reproducible
- Can be used to monitor patients over time
- Measure of accumulated past disease, not representative of current disease activity level
