05 The Final One: What have you learned about Perio?

Question 1

What are the objectives of Periodontal Therapy?

Answer 1

Maintain, improve and preserve natural dentition, dental implants, periodontium and peri- implant tissues.

• Summarizing this, we want to provide health, comfort, aesthetics and function .

Question 2

What are the portions of the collagen fibres (periodontal ligament) that penetrate into the root cementum and into the alveolar bone process called?

Answer 2

Sharpey fibres

Question 3

We use a periodontal probe to measure the depth of the sulcus or pocket. Where does the periodontal probe stop?

Answer 3

When a probe is introduced to measure the depth of the sulcus in health with a normal probing force it will stop coronal the junctional epithelium .

Stops at the end of sulcus, which is very close to the bone level (junctional epithelium). So, even if there is a pocket the probe will still stuck at the JE.

Question 4

Is periodontitis a consequence of gingivitis?

Answer 4

Patients with periodontitis tend to previously have gingivitis , but not all patients with gingivitis will have periodontitis .

Absence of gingival inflammation is a good indicator for long term periodontal health .

– not always, they are considered different diseases. They share the etiology (plaque) and risk factors, but they are still 2 different diseases. Periodontitis depends on the host .

Question 5

Is the progression of periodontitis linear? How would you describe it? (one sentence answer)

Answer 5

Not linear , there are periods of bursts and rests of the disease.

Question 6

If a group of people (let’s say the 5th year dental students of EUC) stopped brushing today, how long will it take to observe gingival inflammation in all of them?

Answer 6

21 days

after the 10th day most of them will have. But on the 21st day all of them will have.

Question 7

What does this demonstrate?

Answer 7

It demonstrates that in the presence of bacteria, host and food , after a certain period of time , everyone will get inflammation after brushing .

• gingivitis is a dental related disease and it can occur to everyone , it demonstrates the biofilm in gingival inflammation and progression. If you don’t brush you will have gingivitis, it’s not a matter of susceptibility .

Question 8

What do you observe in this clinical image?

Answer 8

1. Reddish, swollen interdental papilla and gingiva
2. Inflamed gingiva
3. Gingival recession on 34
4. No stippling of the gingiva - ideally, we want to see this
5. Reduced scalloped outline
   It is gingivitis.

Question 9

Name 3 categories of medications and name 1 in each category that might induce gingival enlargement:

Answer 9

1. Anti-seizure drugs – Phenytoin – not that common because it is not that often used
2. Immunosuppressant - Cyclosporine A – not that common
3. Calcium channel blockers - nifedipine – common

Question 10

What would be your initial diagnosis looking at this picture? Why?

Answer 10

Necrotizing ulcerative periodontitis due to the presence of interdental papillae loss , plaque , redness , swelling and bleeding .

Question 11

What would you ask the patient concerning the symptoms she/ he might be having?

Answer 11

Questions to ask:
1. When did it appear?
2. Do you have fever ?
3. Do you have a metallic flavor ?
4. Do you have lymphadenopathy

Question 12

In which situations would you typically observe a periodontal abscess occurring?

Answer 12

Localized factors:
1. Incomplete calculus removal and forcing calculus deeper in the pocket - left bacteria inside the pocket after supragingival debridement
2. After periodontal surgery
3. After periodontal treatment - didn’t remove a lot of calculus in the pocket, only superficially or you pushed the calculus inside
4. After systemic antibiotic therapy - antibiotics and perio – pocket margin closes
5. Due to recurrent disease
6. Foreign body impaction

Question 13

In which situation you would observe multiple periodontal abscesses occurring?

Answer 13

You start suspecting something systemic. You need to check their medical history and order blood tests, to check for problem with diabetic control.

1. Uncontrolled diabetes mellitus
2. Impairment of immune system

Question 14

Abscess

What would be your treatment plan?

Answer 14

Question 15

Which situation has a worse prognosis and why? Endo – perio lesion or perio – endo lesion?

Answer 15

Perio-endo lesion because it reaches the apex of the root, and the bacteria will infect the pulp .

• So, in this case the prognosis is doubtful .

Question 16

What are the steps for non-surgical periodontal therapy ?

Answer 16

1. OHI – they need to understand why it’s important
2. Plaque disclosing tablets
3. Smoking sensation if needed
4. Anesthesia
5. Scaling and root planning
6. Re-evaluation (3 weeks, then 6 weeks do a perio chart to check the response to the tx and check if they need surgery)

Major risk factor for periodontitis: smoking

Question 17

What are the steps you follow at the first evaluation appointment following non-surgical therapy ?

Answer 17

1. Check for plaque reduction using plaque disclosing tablet
2. Do periodontal chart : measurements: PPD, plaque score, BoP, recession, mobility, furcation
3. After that you need to give OHI

Question 18

Which are the red complex bacteria?

Answer 18

1. P. gingivalis,
2. t. forsythia,
3. t. denticola

• Red complex – most pathogenic bacteria
• Orange complex – most serious is the F nucleatum bc everything attaches to it

Question 19

What is the name of the bacteria A.a?

Answer 19

Aggregatibacter actinomycetemcomitans