BDS4 Periodontology PPs Flashcards
What are the clinical signs of improved health following periodontal treatment?
- reduction in probing depths
- no BoP
- decreased mobility
- plaque <15%
- bleeding <10%
- PPD </= 4mm
Why might oral antibiotics not be effective in treating chronic periodontal disease?
- microbial complexity
- antibiotic resistance
- biofilm resistance
- ABs not mediating the host immune response
- ABs inactivated by first pass metabolism
- poor pt adherence to regime
- poor OH
- smoking
How do you manage a periodontal abscess with systemic involvement?
- administer LA
- drainage via incision or via pocket
- give some subgingival PMPR of pocket (try to avoid excessive trauma)
- if tooth poor prognosis consider XLA
- advise analgesia
- give OHI
- prescribe Chlorhexidine 0.2%, 1 min gargle tih 10ml, 2x per day
- PenV 250mg 2 tablets 4x a day for 5 days
- review
What is SIRS?
Any 2 or more of:
- temp >38 or <36
- tachycardia >90bpm
- tachypnea >20 breaths per min
- WCC >12,000/mm^3 OR <4000/mm^3
What is a periodontal abscess?
Acute infection of an existing periodontal pocket
What are the signs and symptoms of a periodontal abscess?
- pain on biting
- TTP
- pt complains tooth feels high
- increased mobility
- swelling
- deep pocketing at swelling
- BoP and potential purulent exudate on probing
- bad taste/smell from area
How can a periodontal abscess be differentiated from a periapical abscess?
Sensibility testing in a periodontal abscess = normally POSITIVE
Sensibility testing in a periapical abscess = NEGATIVE
Mobility less likely in a PA abscess
How is a periapical abscess managed?
- drainage of abscess [via pocket if present or via incision]
- consider PMPR if pocketing present
- RCT of tooth / XLA if poor prognosis
- CHX 0.2% prescribed
- only prescribe antibiotics if signs of spreading infection
How do you manage traumatic occlusion in a patient with periodontal disease?
- PMPR
- bite raising appliance when sleeping
What factors can influence localised mobility of teeth?
- existing periodontal disease
- traumatic/heavy occlusion
- morphology/length of roots
- PA bone loss
- resorption of roots
When might splinting be advised for a patient with mobile teeth?
- pt has loss of function
- pt has discomfort
- OH is good
- pt doesn’t want teeth XLA
Why is there a reduction in tooth mobility after periodontal treatment?
- long junctional epithelial attachment [reduction in perio pocketing]
- increased tissue tone
What can you do if the PDL of a tooth is still widened after successful periodontal treatment?
- reduce contact of tooth in occlusion
- consider splinting too?
What bacteria are involved in necrotising gingivitis?
fusiform & spirochetes bacteria (anaerobic gram negative bacteria)
- treponema denticola
- prevotella intermedia
- p gingivalis
What are the clinical signs and symptoms of necrotising gingivitis?
- pain
- bleeding
- grey sloughing of gingiva
- punched out/crater appearance
- pseudomembranous formation over top
- blunted papillae
- halitosis/foetus oris
Give 5 risk factors for development of necrotising gingivitis?
- smoking
- stress
- immunocompromised (eg HIV)
- malnourished
- young age
- poor OH
What is the management of necrotising gingivitis?
- PMPR to remove plaque/deposits under LA for next 2-3 days
- advise pt SOFT TOOTHBRUSH to clean teeth
- 0.2% Chlorhexidine MW (minimum twice a day BUT can use it 3 times a day, warn pt they might get a lot of stinging due to sore gums, advise pt should hold it in their mouth for 1 min) OR Hydrogen peroxide 0.3% MW (hold in mouth for 2 mins, dilute if necessary, use minimum twice a day)
- if systemic involvement/no improvement 400mg Metronidazole TID for 3 days (avoid alcohol)
- then assess risk factors & pre-existing gingivitis & smoking cessation
Define localised and generalised bone loss:
- Localised <30%
- Generalised >30%
List the 2017 classification of periodontal diseases:
- Health
- Plaque induced Gingivitis [intact / non-intact periodontium]
- Non plaque induced Gingival Diseases and Conditions
- Periodontitis
- Necrotising Periodontal Diseases
- Periodontitis as a manifestation of Systemic Disease
- Systemic Diseases or Conditions Affecting the Periodontal Tissues
- Periodontal Abscesses
- Periodontal-endodontic lesions
- Mucogingival deformities and conditions
Why might someone with gingival health have a reduced periodontium?
- previous periodontal patient that has responded to treatment
- trauma from toothbrushing etc.
How does a healthy periodontium react to traumatic occlusion?
PDL widening that can increase mobility
- this reverses once tooth is taken out of occlusion/occlusion sorted
- no LOA or inflammation
How does a healthy but reduced periodontium react to traumatic occlusion?
PDL widening HOWEVER mobility is increased more due to already lessened PDL attachment/bone
- again reverses once occlusion fixed
What is Chlorhexidine?
Bisbiguanide digluconate antiseptic
What is the mode of action of Chlorhexidine?
Dicationic
- 1 cation adheres to pellicle
- 1 cation disrupts bacterial membrane
Works against gram +ve and -ve bacteria, fungi, viruses and candida!
What is the substantivity of Chlorhexidine Diglugonate?
12 hours [how long it stays in oral cavity]
Give 2 common doses of chlorhexidine:
- 0.2% 10ml 2x daily for 1 minute
- 0.12 15ml 2x daily for 1 minute
Give 4 side effects of using Chlorhexidine Mouthwash:
- tooth staining if excessive use
- taste disturbance
- anaphylaxis
- burning/stinging sensation
Give 8 uses of chlorhexidine:
- endodontic irrigant
- irrigation under peri-coronitis operculum
- post-surgery disinfection
- pre-surgery disinfection
- irrigation of dry socket
- necrotising periodontitis/gingivitis
- periodontal abscess
- ulceration
What 7 things are recorded on a periodontal full mouth pocket chart?
- teeth missing
- gingival margin
- pocket depth
- loss of attachment
- BoP
- mobility
- furcation involvement
What are some disadvantages of a 6PPC?
- assumes all pts have same root length so may appear worse than they actually are
- probing depths are subjective to operator
What are some local factors that cause gingival recession?
- periodontal disease
- habits [nail/pen biting]
- traumatic OB
- traumatic toothbrushing
- crowding
- orthodontics
- frenal attachments
- abrasive toothpaste
How can you measure/classify gingival recession
- Miller’s Classification
- photos
- study models
- pocket charting
How is localised gingival recession managed?
- dentine desensitising agents placed on root
- monitor for worsening/improvement
- gingival veneer
- free gingival graft [from palate]
- minimise other risk factors [eg improve OH, treat traumatic occlusion]
- atraumatic toothbrushing advice
How can bony defects be classified?
Horizontal bone loss
Vertical bone loss
- 1 wall
- 2 wall
- 3 wall (heal better)
A patient is deemed to be suitable for regenerative periodontal surgery. What are the indications of this?
- 2 & 3 walled defects
- grade 2 furcation in mandibular teeth
- grade 2 buccal furcation in maxillary molars
*pt OH and motivation is good
If regenerative periodontal surgery of a molar tooth fails, how else can this tooth be managed?
- XLA
- hemisection
- tunneling procedure
- monitor & leave
Why is diabetes a risk factor for development of periodontal disease?
- altered host response to infection [impaired immune response]
- chronic hyperglycaemia can cause dysfunction of immune cells [neutrophils and macrophages] & impair their ability to fight off bacterial pathogens
- diabetes affects the blood vessels and causes microvascular changes
- impaired wound healing [polymorphonuclear leukocyte function]
- chronic hyperglycaemia leads to glycation of proteins [ECM components of perio tissues] and leads to formation of AGEs which exacerbate perio disease and tissue destruction
Explain the mechanism of development of a vertical bone defect vs horizontal:
- plaque deposition and radius determines this
- if there is larger deposits of bone adjacent to site of bone loss [eg >2mm interproximal bone] then the defect pattern is vertical
Give 2 ways to test for diabetes:
- Fasting Plasma Glucose
- Random Plasma Glucose
Give the normal values and diabetic values for a random plasma glucose test:
Normal = <11.1mmol/L
Diabetic = >11.1mmol/L
Give the normal values and diabetic values for a fasting plasma glucose test:
Normal = <7mmol/L
Diabetic = >7mmol/L
How does smoking affect the periodontal tissues?
- restricted blood flow [reduction in delivery of oxygen + nutrients]
- impaired chemotaxis [ability of immune cells to detect & migrate towards chemical signals released by pathogens/injured tissues]
- impaired phagocytosis
- upregulation of proinflammatory cytokines, chemokines and MMPs
What is interleukin-1?
A pro-inflammatory cytokine
- stimulates release of enzymes
- stimulates RANKL to bind to RANK and induces osteoclast formation & recruitment
Give some reasons as to why non-surgical management of periodontal disease may be unsuccessful?
- inadequate PMPR
- furcation/angular defects that are difficult to access
- patient poor OH
- patient immunocompromised
- patient is a smoker
- motile anaerobes penetrate deep into periodontal tissues
A patient attends with inflammation of the gingiva extending beyond the mucogingival junction. Give a clinical description:
Desquamative gingivitis
Name 3 oral conditions associated with desquamative gingivitis:
- lichen planus
- pemphigoid
- pemphigus
What are 2 local factors that may exacerbate desquamative gingivitis:
- sodium lauryl sulphate (SLS)
- plaque
Give 2 topical treatments for desquamative gingivitis:
- betamethasone tablets 1mg dissolved in 10ml of water
- beclomethasone inhaler 1mg puff 2/4x daily
- tacrolimus in gingival retainer
What is TIPPS?
OHI:
- talk
- instruct
- practise
- plan
- support
How is mobility graded?
Grade 1 = <1mm horizontal movement
Grade 2 = 1-2mm horizontal movement
Grade 3 = >2mm horizontal movement and/or depression/rotation
What is PSD?
Patient Specific Direction
- Written instruction for a specific pt allowing a healthcare professional to administer medication like LA
When prescribing local anaesthetic, what four details should be included in PSD?
- Method and site of administration
- Specific type of LA & Dosage
- Concentration of LA
- Maximum number of cartridges
