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BDS2 Periodontics > Basic Periodontal Examination, Disclosing and Oral Hygiene Instruction > Flashcards

Basic Periodontal Examination, Disclosing and Oral Hygiene Instruction Flashcards

1
Q

what is the etiological agent of gingivitis and periodontitis?

A

plaque

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2
Q

plaque induced gingivitis

A

an inflammatory response of the gingival tissues resulting from bacterial plaque accumulation located at and below the gingival margin

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3
Q

4 clinical signs of plaque induced gingivitis

A

Bleeding on probing

High plaque score

High Bleeding scores

Gingival swelling and rednes

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4
Q

what will the patient notice in plaque induced gingivitis?

A

Blood in saliva

Bleeding with toothbrushing and interdental cleaning

Bad breath (Halitosis)

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5
Q

Key features of plaque induced gingivitis

A

REVERSIBLE inflammation of the gingival tissues

Swelling and bleeding at the gingival margins

Risk Factor for Periodontitis

Probing depths ≤3mm

No attachment loss

No radiographic bone loss

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6
Q

definition of periodontitis

A

an inflammatory disease initiated by bacteria which, in susceptible people, cause severe inflammation and loss of bone around the teeth.

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7
Q

clinical signs of periodontitis

A

Bleeding on probing

Radiographic bone loss

Gingival recession

Probing depths ≥4mm (Clinical attachment loss)

similar to plaque induced gingivitis

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8
Q

what will a patient with periodontitis notice?

A

Blood in saliva

Bleeding with toothbrushing and interdental cleaning

Bad breath (Halitosis)

Black triangles

Tooth movement

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9
Q

key features of periodontitis

A

Inflammation of the supporting structures of the teeth (gingiva and bone)

Bleeding on probing in active disease

Probing depths ≥4mm

Radiographic bone loss

Susceptible patients most at risk for tooth loss – Can be modified by systemic disease

NOT REVERSIBLE - halt the progression to get patient stable

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10
Q

good questions to ask when taking a dental history

A

How often do you brush your teeth?
Do you use a manual or powered toothbrush?
What toothpaste do you use?
Do you clean in between your teeth with floss or interdental brushes
Do you use any mouth rinse?
Do you attend the dentist regularly?
Do you have your teeth cleaned by the dentist/hygienist?

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11
Q

reason for taking dental history

A

Identify the oral hygiene and regime the patient uses

- Risk assessing for periodontitis with straightforward Qs

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12
Q

what is the mouth divided into for the basic periodontal examination?

A

sextants

7-4, 3-3, 4-7
wisdom teeth not included

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13
Q

screening tool for periodontal disease

A

Basic Periodontal Examination (BPE)

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14
Q

what probe is used in the BPE

A

WHO CPITN probe

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15
Q

what is the height of the black band on the WHO CPITN probe?

A

3.5-5.5mm

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16
Q

how to carry out a BPE

A

insert probe down the long axis of the tooth

walk WHO CPITN probe around gingival line and will fall into pocket

ball end can catch calculus under gum

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17
Q

what does a BPE indicate

A

what further assessment and periodontal treatment the patient requires

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18
Q

BPE Score 0

A

No probing depths > 3.5mm, no calculus/overhangs, no bleeding after probing

Black band completely visible

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19
Q

BPE Score 1

A

No probing depths > 3.5mm, no calculus/overhangs, bleeding after probing

Black band completely visible

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20
Q

BPE Score 2

A

No probing depths > 3.5mm, supra- or sub-overhangs, bleeding after probing

Black band completely visible

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21
Q

BPE Score 3

A

Probing depth(s) of 3.5 – 5.5mm present

Black band partially visible

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22
Q

BPE Score 4

A

Probing depth(s) of 6mm or more present

Black band entirely within pocket

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23
Q

BPE Score *

A

Furcation involvement

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24
Q

fluoride content of toothpaste in adults with permanent dentition

A

1350-1500ppm fluoride

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25
Q

desensitising toothpaste

A

use of potassium-, stannous fluoride-, potassium and stannous fluoride-, calcium sodium phosphosilicate-, and arginine-containing desensitizing toothpastes for dentin hypersensitivity

block dentinal tubules

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26
Q

what does chlorohexidine mouth wash do

A

reduce plaque build up and gingivitis

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27
Q

manual toothbrush technique

A

modified bass

28
Q

toothbrushing duration

A

Almost universal recommendation that all people should brush their teeth twice a day for at least 2 min

Expert opinion is that for periodontitis patients 2 min is likely to be insufficient

29
Q

if have a BPE code 3

A

do a 6 point pocket chart for that particular sextant

30
Q

if have a BPE code 4

A

full mouth pocket chart of all dentition

31
Q

frequency of toothbrushing

A

few studies evaluating the association between tooth brushing frequency and periodontitis

infrequent tooth brushing was associated with severe forms of periodontal disease.

Further epidemiological studies are needed.

32
Q

interdental cleaning impact on gingivitis

A

Using floss or interdental brushes in addition to toothbrushing may reduce gingivitis or plaque, or both, more than toothbrushing alone.

Interdental brushes may be more effective than floss.

Available evidence for tooth cleaning sticks and oral irrigators is limited and inconsistent.

33
Q

what happens when you rinse with cholorhexidine for 4 weeks or more

A

extrinsic tooth staining
calculus build up
transient taste disturbance

  • not recommended for routine use
34
Q

fluoride mouth rinse function

A

under supervision results in a large reduction in tooth decay in children’s permanent teeth.

little information about potential adverse effects and acceptability.

  • recommended for routine daily use if high caries risk
35
Q

TIPPS oral hygiene instruction tools

A

Talk
- About the causes of dental disease and discuss any barriers to effective plaque removal;

Instruct
- the patient on the best ways to perform effective plaque removal;
Practise

Plan
- put in place a plan which specifies how the patient will incorporate oral hygiene into daily life;

Support
- support the patient by following up at subsequent visits

36
Q

what is the hardest element in oral hygiene of a patient to change

A

their behaviour

  • habits take months

Offering assistance, and seeking permission to give knowledge or teach skills facilitates patient ownership of the task.
- The natural response to force is resistance

Motivation is not static
- Varies with individuals life factors and stresses

37
Q

3 reasons why a clinician discloses teeth

A

Highlights to the patient where they are missing when cleaning their teeth

Shows the clinician where they need to concentrate the patients efforts

Gives the opportunity to learn effective toothbrushing skills

38
Q

what % of people have some form of dental disease?

A

90%

39
Q

what is oral biolfilm

A

a.k.a plaque

After teeth cleaning, bacterial species colonise tooth surfaces and at the gingival margin

40
Q

what does poor oral biofilm maintenance lead to

A

colonisation of pathogenic bacteria
results in oral biofilm dysbiosis
- can lead to hard and soft tissue disease

41
Q

what can be done to control oral biofilm

A

Mechanical and chemical

42
Q

properties of plaque

A

adhesive and cohesive

  • sticks to itself and other things (like honey)
43
Q

how much of plaque biofilm can be left behind after brushing with a manual brush

A

50%

44
Q

what brushes are technique sensitive

A

manual

sonic

45
Q

sonic brush

A

sound waves, vibrates at high speed, disrupts the pellicle, not moving at a wide enough angle to bend and straighten to come back again.

Technique sensitive (side to side)

46
Q

oscillating rotating brush movement

A

3D action

left right turn (45 degree oscillating-rotating) and pulsation,

47
Q

how is plaque measured? (2)

A
  • rustogi modified plaque index (RMNPI)

- turesky modified quigley hein index (TMGHI)

48
Q

how is gingivitis measured? (2)

A
  • probing (gingival bleeding index)

- amount of inflammation (modified gingival index)

49
Q

pros of OR over other brushed

A

OR demonstrated more effective plaque removal and reduced gingival bleeding long term use Vs manual and sonic

not technique sensitive

400-600 directional changes with manual brush - technique sensitive whereas Oscillating rotating 9,900 directional changes and 45,000 pulsations
- So 55000 total

50
Q

3 things that can happen if brush too aggressively

A

gum abrasion

gum recession

tooth structure loss

51
Q

3 areas assess for OR brushes

A

effectiveness

gentleness

safety

52
Q

when is a bristle not able to remove plaque?

A

when it is bent

53
Q

oral b test drive

A

innovative demonstrative model)

Let’s patients experience the benefits of Oral B

Showing improves patient compliance

Increasing patient confidence and trust in you

54
Q

what is the primary cause of gingivitis

A

poor biofilm control

55
Q

why is a power toothbrush more efficacious at preventing gingivitis than manual toothbrush

A

it physically removes more plaque

56
Q

what % of toothpaste is the active component

A

0.2-10%

rest is a complex formula humectants, water, abrasives, binders and buffers, surfactants

57
Q

what does fluoride need to enter the oral cavity

A

a carrier (dissociates from)

Complex carrier longer delivery time

58
Q

fluoride carriers

A

Sodium fluoride
stannous fluoride
ammine fluoride
sodium monoflurosuplphate

59
Q

why has dental erosion been identified and increased since 2004?

A

diets have changed

more dietary acid

60
Q

what does acid expose

A

dentinal tubules

61
Q

how does stannous fluoride help prevent caries and tooth eroision

A

its ability to effectively deliver fluoride

62
Q

properties of stannous

A

Stable
Antimicrobial

Bactericidal - kills bacteria

Bacteriostatic - inhibits metabolic rate of bacteria (inhibits metabolic processes in biofilm), manage bacteria in mouth

63
Q

bactericidal

A

kills bacteria

64
Q

bacteriostatic

A

inhibits metabolic rate of bacteria (inhibits metabolic processes in biofilm), manage bacteria in mouth

65
Q

how is plaque kept soft by toothpaste

A

Effective calculus and staining ingredients bind to calcium in tooth enamel which inhibits mineralisation of plaque, which keeps it soft for mechanical removal and blocks chromagen molecules from interacting with the tooth surfaces to reduce staining

BDS2 Periodontics (2 decks)

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