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ICS - PERIODONTOLOGY > 1: Periodontal Examination & Diagnosis > Flashcards

1: Periodontal Examination & Diagnosis Flashcards

1
Q

6 components of history taking?

A 
reason for attendance (complaint)
history of complaint
past medical history
past dental history
family history 
social history
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2
Q

medical history: uses?

A
  • partially help to explain the perio disease seen
  • alert precautions needed to ensure patient safety
  • alert precautions for clinician to safeguard themselves, staff and other patients
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3
Q

past dental history: uses?

A 
previous perio disease/treatment
attendance pattern
OH habits
presence and care of appliances
problems with latex, LA/GA, bleeding
other dental treatment
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4
Q

family history: uses?

A

genetic link in some forms of perio disease: aggressive periodontitis
positive family history: increase monitoring frequency, may prompt more aggressive treatment if required
screening of siblings/children of affected patients is recommended

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5
Q

social history: uses?

A

occupation, family: availability for treatment

reveal risk factors: smoking, alcohol habits, stress

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6
Q

what does stress to do periodontal health?

A

reduces immune function
reduces saliva flow
increases salivary viscosity, acidity, glycoprotein content
- favoring plaque accumulation

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7
Q

how to assess periodontal disease?

A

must be done thoroughly and carefully, disease varies from site to site within mouth
- each periodontal site/micro-environment is assessed

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8
Q

components of the 5 point periodontal examination?

A
  1. lack of BOP
  2. probing depth
  3. loss of attachment: ACJ-base of pocket
  4. tooth mobility
  5. furcation involvement
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9
Q

lack of BOP - indicates what?

A

lack of disease activity, at that site and at that time
30% of BOP sites -> LOA
no BOP - almost 100% no LOA

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10
Q

why are pockets >3mm significant?

what does periodontal treatment aim to do?

A
  • they cannot be reliably cleaned by patients. probing depths will influence treatment plan.
  • perio treatment aims to reduce pocket depths
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11
Q

what index is used to measure tooth mobility?

A

miller’s index

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12
Q

miller’s index - describe the different degrees?

A

0 - horizontal movement up to and including 0.2mm
1 - horizontal movement of >0.2mm but =1mm
2 - horizontal movement of >1mm
3 - movement in both horizontal and vertical planes

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13
Q

causes of mobility: 3 main dental causes?

A
  • periodontal disease, leading to loss of support
  • peri-radicular disease
  • occlusal trauma
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14
Q

what is furcation involvement?

what is the prognosis for teeth with furcation involvement?

A
  • area between roots of multi-rooted teeth can be probed in horizontal plane (probe goes between tooth)
  • reduced prognosis
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15
Q

diagnosis: should be in place before ____?

A

diagnosis should be in place before treatment planning

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16
Q

diagnosis is based on which 2 things? where to find other clues?

A
  • BOP
  • LOA
    + in medical/family history
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17
Q

what does diagnosis have NOTHING to do with? why?

A

probing depths, as pockets could be true or false

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18
Q

systematic diagnosis of periodontium? for periodontitis and gingivitis

A

1) distribution, severity, type, periodontitis
2) distribution, type, gingivitis
3) alternatively, periodontal stability

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19
Q

patient with BOP - diagnosis

generalized disease vs localized disease?

A

> 30% sites bleeding - generalized disease

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20
Q

most cases of gingivitis are chronic or acute?

A

chronic gingivitis

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21
Q

examples of acute gingival conditions?

describe them

A

ANUG, abscesses

- they are more specific, less common, and usually associated with pain

22
Q

diagnosis of gingivitis: what to write in notes for diagnosis of localized disease?

A

localized chronic gingivitis affecting e.g. lower anteriors

23
Q

describe in DETAIL the four parts used to describe a case of periodontitis

A

i. distribution: localized/generalized
ii. severity: slight/moderate/severe
iii. type: chronic/aggressive
iv. periodontitis

24
Q

periodontitis: how does LOA vary with the severity of the condition?

A

slight: 1-2mm LOA, bone loss up to 1/3rd of root length
moderate: 3-4mm LOA, bone loss >1/3rd, 1/2 root length and/or furcation involvement

25
Q

what does loss of attachment represent?

A

the sum of all the episodes of disease which have taken place at the site since the tooth erupted

26
Q

what is the best indicator of future periodontal disease?

A

past periodontal disease experience

27
Q

once periodontitis is identified, what factors to study to determine the type of peridontitis present? what is the most common type?

A
  • OH, LOA, age, family history, social history, medical history
  • chronic periodontitis
28
Q

what if a patient is young, has excellent OH and no risk factors eg. smoking BUT has a positive family history of periodontitis? what is the likely diagnosis?

A

check for aggressive periodontitis

29
Q

generalized bleeding, no LOA at BOP sites - what disease does the pt have?

A

generalized chronic gingivitis

30
Q

generalized bleeding, LOA of 3-4mm at those bleeding sites - what disease does the pt have?

A

generalized moderate chronic periodontitis

31
Q

what constitutes a stable periodontium?

A

when there is no BOP, pockets are maintainable by the patient (

32
Q

radiographic examination - must be preceded by?

A

clinical examination and examination of previous radiographs, to decide whether radiographs are required or which views are required

33
Q

what are 3 things useful to aid periodontal diagnosis, in addition to clinical findings?

A
  • bone loss/support
  • pathology
  • prognosis of teeth
34
Q

what are the advantages of taking radiographs in periodontology?

A
  • shows teeth present
  • shows bone loss/levels
  • suggestion of furcation involvement
  • calculus “wings”
  • caries
  • overhangs
  • periradicular pathology
  • unerupted/impacted teeth
  • retained roots
35
Q

what are the disadvantages of taking radiographs in periodontology?

A
  • superimposition of structures
  • radiation exposure (ALARA principle)
  • does not show disease activity
  • no indication of timescale of periodontal disease
  • does not show periodontal pockets/soft tissue
  • underestimates bone loss
  • interpretation of small changes difficult (digital subtraction radiography)
36
Q

superimposition can occur in which 3 forms?

A
  • bone on bone
  • tooth on tooth
  • tooth on bone
37
Q

name 2 methods of intraoral radiography

A

bitewing (horizontal/vertical)

paralleling periapicals

38
Q

full mouth periapicals

  • how many intraoral films?
  • radiation?
A
  • 14 intraoral films

- high dose radiation

39
Q

bitewings - used for what type of teeth?

A

posterior teeth only

40
Q

horizontal bitewing - used when?

A

used where loss of attachment is slight

41
Q

vertical bitewing - used when?

how many films needed?

A

where loss of attachment is moderate

may need 2 films of LHS and 2 of LHS

42
Q

extraoral radiography - DPT: advantages? equivalent to?

A
  • fast, simple, shows whole dentition and supporting structures on film
  • equivalent to around 4-6 periapicals
43
Q

what is the mechanism of digital subtraction radiography?

A

2 images of same object taken, image intensities substracted, producing a uniform difference image

44
Q

advantages of digital subtraction radiography?

A
  • more accurate

- far greater diagnostic yield than conventional films

45
Q

disadvantages of digital subtraction radiography?

A

need to standardise image for serial radiographs

46
Q

3 headings to describe bone loss?

A

distribution
pattern
severity

47
Q

bone loss: difference between localized and generalized?

A

localized: 30% sites affected

48
Q

what are the two patterns of bone loss? what is each associated with?

A

horizontal: associated with suprabony pockets
vertical: associated with infrabony pockets

49
Q

bone loss: measuring severity

  • measured as?
  • radiograph: true representation of object or not? why?
A
  • measured as ratio %

- not a true representation, due to distortion via magnification and foreshortening

50
Q

how is severity of bone loss calculated?

A

( acj to bone crest / acj to root apex ) x 100%

51
Q

bone loss severity percentage: how does it determine severity?

A

mild/slight: up to and including 1/3rd root length (33%)

moderate: >1/3rd, 1/2 root length (>50%), OR suggestion of furcation involvement

ICS - PERIODONTOLOGY (10 decks)

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