Ch 17 perio Flashcards
What is the fundamental importance for the success of periodontal therapy
preventing recurrent disease and maintaining oral health
this is “the continuing periodic assessment and prophylactic tx of the perio structures that permit early detection and tx of new or recurring abnormalities or disease”
periodontal maintenance
perio maintenance is commonly referred to as
recall, supportive perio therapy, or the maintenance phase of perio tx
what is the overall goal of dentistry is to
attain and maintain healthy and functional dentitions and oral tissues for a lifetime
what is the primary objective of periodontal maintenance
is to preserve the stable state achieved during the active phase of perio therapy
what are the issues that are relevant to maintenance
- effectiveness of perio therapy in arresting the progression of periodontitis and preventing tooth loss
- Objectives of perio maintenance
- Importance of pt compliance with recommended recall schedules and plaque biofilm control regimens
- Components of the maintenance appointment
- Recurrence of perio disease
- Significance of caries in the perio maintenance population and the appropriate use of fluorides in caries prevention
- Sensitivity of dentin after perio therapy and recommended tx
Periodontal therapy consists of a series of three phases of tx
Initial or hygienic, phase including the reevaluation phase (Phase 1) Surgical phase (Phase 2) Maintenance phase (Phase IV 4)
which phase consists of individualized oral hygiene instruction and supragingival and subgingival debridement of bacterial plaque biofilm and calculus
Initial phase
what happen during reevaluation
a second assessment of the perio condition is performed to determine the results of initial therapy and whether additional perio intervention is required
The _____ is initiated immediately after reevaluation to ensure the stability of results attained in the initial phase
Maintenance program
arrest the progression of perio disease by eliminating or reducing the local microbial etiologic factors: that is removal of the pathogens that illicit the inflammatory response in the host
This is a major objective of perio therapy
successful prevention of gingivitis and periodontitis begins with
good personal oral hygiene and periodic professional maintenance care to minimize or eliminate the etiologic factors that lead to the pathogenic state
what is associated with the occurrence of periodontal disease
gingivitis
gingivitis does not always proceed to periodontitis; however
periodontitis is always preceded by gingivitis
what nonsurgical periodontal therapy also called
Phase 1 therapy or the hygienic phase
this is recognized as an effective tx to arrest or retard the progression of early periodontal disease
phase 1 therapy or the hygienic phase
it is the responsibility of the dental hygienist to
help maintenance pts understand the benefits of reg. professional care and daily personal plaque biofilm control
periodontal maintenance care must begin soon after active therapy and must occur in
3-4 month intervals
the success of perio tx relies on what
surgical and nonsurgical procedures for through root debridement and long-term maintenance through periodic professional therapy and daily personal oral hygiene
the overall objective of periodontal maintenance is to what?
Prevent the development of new or recurrent periodontal disease through supervised care and to preserve a functional and comfortable dentition for life
what are the five underlying objectives
- Preservation of clinical attachment levels
- Maintenance of alveolar bone height
- Control of inflammation
- Evaluation and reinforcement of personal oral hygiene
- Maintenance of optimal oral health
what is necessary to asses periodontal health
monitoring the gain or loss of clinical attachment levels and probing depths
A gain of clinical attachment and improved probe depth measurement are common findings after
periodontal therapy
The reductions in probe depths after periodontal therapy results from what
healing at the epithelial attachment and reduction of gingival swelling
what is the most valuable and practical measurement to predict clinical attachment loss during maintenance therapy
increasing probe depths
Increasing probe depths are more predictable than
increasing biofilm scores, bleeding sites or amount of suppuration
evaluation of the stability of perio health requires through
documentation of probing depths and clinical attachment levels
probing depths and clinical attachment level measurements are essential for monitoring pt perio status during what phase
maintenance phase
every recall appointment must include a _____, regardless of weather it is a comprehensive or a monitoring assessment
periodontal evaluation
what is the most reliable means of determining the current health of the periodontium for maintenance pts.
regular periodontal probing and assessment of clinical attachment loss
what is characterized by the progression of gingival inflammation into deeper periodontal structures, resulting in the loss of alveolar bone support for teeth
perio disease
what is required to compare bone changes over time
periodic radiographs examinations
what provides important data that can be used to evaluate the long term stability of alveolar bone height during maintenance therapy
radiographs
radiographic images records of alveolar crestal height reflect only historical bone loss not ____
active bone destruction
what is one of the most important aspects of periodontal maintenance
personal oral hygiene
what is never finished, it is ongoing throughout the pts lifetime
periodontal tx
the reason why pt do not comply with maintenance is
schedules are complex, because each individual has different needs and experiences
noncompliance is seen more commonly in pts who what?
who do not perceive chronic disease to be life-threatening
what is the primary etiologic agent of gingivitis and perio disease
bacterial plaque biofilm
it is well established that ____ can prevent both dental caries and perio disease
meticulous oral hygiene
reason for noncompliance with maintenance schedules
- Fear
- Economic concerns
- Socioeconomic levels
- influence from family and friends
- perceived indifference from the dental hygienist
- Failure to understand the significance of periodontal maintenance
Daily mechanical plaque biofilm control with a variety of cleaning aids is the responsibility of the pt, however what is the dental hygienist responsible for?
to educating pt and motivating the, to perform these task
strategies to increase compliance start with what
increasing the pts knowledge
research suggests that the highest dropout rate occurs during the ___years of maintenance therapy
1
are a common source of concern about suggested maintenance intervals
economic
is often a primary determinant of pt compliance
the cost of maintenance appointments
Regular professional maintenance visit are the cornerstone of perio maintenance. What are the principal aims of the maintenance appt.
- Evaluate the stability of results after active therapy
- to remove bacterial plaque biofilm accumulations on the tooth surface thoroughly
- to eliminate all factors that favor the persistence of pathogenic bacteria
- to evaluate and reinforce plaque biofilm control
on average the maintenance appointment last how long
1 hour and generally provides sufficient time for thorough and proper care
the perio maintenance apt must begin with what
a verbal and written update of the pts medical and dental history, current meds and vital signs
what are the parameters that evaluated in the pts current perio status
- probing pocket depths
- clinical attachment loss
- gingival recession
- Bleeding on probing
- Suppuration
- tooth mobility
- furcations
- mocogingival involvement
what is used to measure the normal sulcus and perio pocket depths from the base of the sulcus to the gingival margin
perio probe
what are the six measurements taken when while probing on each tooth
- distobuccal
- buccal
- mesiobuccal
- Distolingual
- lingual
- mesiolingual
you must complete a new perio chart at least
once a year
what is apparent when the root surface is clinically exposed as a result of apical migration of the JCE and loss of marginal gingiva
gingival recession
recession is measured from the
cementoenamel junction to the gingival margin
what is added to probing depths to provide an estimate of total clinical attachment loss
recession
the exposed root surface in the areas of recession are of special concern bec of the increased risk of what?
dentin sensitivity or hypersensitivity and carious lesions
Bleeding on probing is a reliable indicator of what
pocket inflammation and is a good but not prefect predictor of active disease
what is the formation of pus that is visible at the entrance of the pocket what light pressure is place on the external gingival surface
suppuration
what is suppuration also referred to as
exudate or purulent
what is an accumulation of inflammatory cells and serum proteins
pus
the presence of pus indicates that the site requires
treatment
sites with bleeding or suppuration show some or all of the characteristic signs of inflammation must be what
treated during the maintenance visit and the pt possibly rescheduled for further tx
what are the signs of inflammation
redness, swelling, heat and pain
what are the causes of mobility
- inflammation of the perio ligaments
- loss of perio support
- trauma from occlusion
what is defined as loss of clinical attachment and supporting bone to a multirooted tooth beyond the division of the roots.
furcation involvement
the status of furcations is evaluated with what
a periodontal probe or a curved Nabers probe and must ne assessed at every maintenance appointment
The dental hygienist must spend more time treating the furcation areas bec
they are less accessible to debridement techniques and teaching the pt specific home care techniques
what are some things a pt can use to clean a furcaton
toothpicks or interproximal brushes
This extension of the pocket beyond the mucogingival junction and into the alveolar mucosa represents what
mucogingival involvement
The frequency of x-ray imaging varies on what
the basis of age, risk of disease and signs and symptoms
indications for radiographs include
- caries activity
- increased perio destruction
- suspected pathology
it has been suggested that a full mouth series of x-rays should be taken
every 2 to 4 years during maintenance care for comparison with previous films
full mouth x-rays permits the detection of changes in
alveolar bone height, repair of osseous defects, signs of trauma from occlusion, periapical conditions, and caries
Vertical posterior bitewings images are often preferred in
periodontics to provide both caries detection and a better image of alveolar bone levels.
a plaque biofilm evaluation is necessary to determine what
the pts effectiveness in maintaining a clean oral environment
what is the two purpose of disclosing agent
- plaque biofilm score can be calculated, which can be recorded in the pt chart and compared at subsequent maintenance visits to help movtivate compliance with home care regimens
- pt can be shown existing plaque biofilm as an educational tool to demonstrate oral hygiene techniques
In areas with deeper pockets or furcations involvement that cannot be maintained in health, what may be required
surgical therapy
what is the purpose of polishing
remove acquired pellicle, bacterial plaque biofilm and extrinsic stains completely form the clinical crowns of the teeth, providing smooth and shiny tooth surfaces
the therapeutic value of polishing is limited bec
pellicle begins to form with mins
plaque biofilm accumulates again in about __ to __ hours later
1 to 2 hours
what is not considered an etiologic factor in gingivitis or perio disease
extrinsic stain
Factors for determining the interval between perio maintenance visits
- Probing depths
- Bleeding on probing
- Effectiveness of pt plaque biofilm control
- Age
- Med history
- Dental history
- Perio history
- History of compliance with maintenance
- Compliance with oral home care regimen
What are the serval factors that may contribute to recurrence of perio disease
- Insufficient pt plaque biofilm control
- Incomplete removal of bacterial plaque biofilm and calculus during therapy
- Presence of faulty restorations
- Prostheses that favor the reestablishment of disease
- lack of pt compliance with recommended maintenance procedures
- Systemic conditions that negatively affect the oral cavity
aggressive periodontitis affects about what % of the adult population with periodontitis
8% to 13%
signs of recurrent disease are
- Increasing probing pocket depths, which are indicative of clinical attachment loss
- Recurrent bleeding on probing
- Chronic gingival inflammation
- Gradual increase in x-ray bone loss
- gradual increases in tooth mobility
approximately how many weeks after re-tx is a complete perio reevaluation os necessary to determine the results, prognosis, and tx recommendations
4-6 weeks
what is fundamental concern in the perio population
root surface caries
what is a soft progressive lesion of the root surface that involves bacterial plaque biofilm and microbial invasion
root caries
where does the caries lesion usually begin at
on the cemental surfaces of the root, at or near the CEJ and proceeds to invade the underlying the peripheral dentin
what is the predominant organism in bacterial plaque biofilm samples covering carious root surfaces
Actinomyces viscous
Predisposing Conditions for root surfaces exposure
- Perio disease
- Perio surgery
- Malocclusion
- Orthodontic tx
- Mechanical trauma
In periodontal health
the cemental root surface is covered by gingival tissues and functions as a major component of the perio attachment apparatus
In perio disease and other conditions that lead to gingival recession
the cementum becomes exposed as the junctional epithelium migrates apically and the gingival margin recedes.
_% to _% with men having more root caries than women
7 to 56
what are risk indicators of root caries
loss of gingival attachment is considered a significant risk factor along with age, number of teeth, presence of coronal caries, level of oral hygiene, water fluoridation, and years of education
Pt st high risk for caries can be aggressively treated with
chlorhexidine rinses to reduce the amount of cariogenic bacteria and then encouraged to use appropriate fluoride therapy and diet modifications
the functions of this include antimicrobial activity, control of pH, and removal of food debris from the oral cavity
Saliva
this can lead to difficulties with speaking, eating, swallowing an wearing dentures, candida infection, dental caries, and perio disese
Xerostomia (dry mouth)
xerostomia is a relatively common finding that may be related to numerous conditions including
- systemic disease
- Diabetes
- Sjogren’s syndrome
- immunocompromised states
- head and neck radiation therapy
- during therapy
- dehydration
- stress and anxiety
the oral mucosa of xerostomic pt may appear
red, dry, and sticky and angular cheilitis
Temporary relief of xerostomia may be achieved with the use of
water, glycerin preparations, or artificial saliva as salivary substitutes
Stimulation of natural salivary flow are
surgarless gum, candy or medications is ueful for individuals with limited functional salivary glands
clinically what does early root caries appear as
multiple discolored areas that are tan or brown
arrested root caries is characterized by a
dark brown to black discoloration and a hard texture
what can lead to difficulties with speaking, eating, swallowing, and wearing dentures
Xerostomia
Xerostomic individuals have an increase risk of
Candida infections, dental caries, and perio disease
Prevention of ____ is extremely important in xerostomic individuals bec of their reduced salivary flow
Dental caries
Whats feel soft and appear shallow (2mm deep) and are usually covered with bacterial plaque biofilm
Active caries lesions
because root caries can develop on any root surface which types of examination are essential for caries assessment
Clinical and radiographic
What are the principal strategies to prevent the development of root caries
- Increasing the remineralization of teeth through fluoride
- Reducing the # of micros
- Modifying caries risk by selecting noncariogenic foods
- Limit intake of fermentable carbs
- Improving salivary flow
This works by inhibiting demineralization of the tooth surface, enhancing remineralization and inhibiting bacterial activity
Fluoride
Fluoride solutions and gels must be applied directly to the teeth using a cotton pellets or a gel tray system for how long
4 mins
What is one of the primary etiologic agents for all dental caries
Oral microorganisms
This is characterized by sharp intermittent pain of short duration or by dull chronic pain. It can effect any number of teeth, and its occurrence is difficult to predict on susceptible surfaces
Dentin sensitivity
What is the pain of dentin sensitivity caused by
various stimuli, such as cold, heat, sweet, or sour foods, oral hygiene practices, or dental instruments
What terms are often used interchangeably to describe the pain evoked on stimulation of exposed dentinal surfaces
dentin sensitivity and dentin hypersensitivity
This refers to excessive sensitivity
hypersensitivity
What theory is the most commonly accepted explanation of sensitivity of the dentinal surface to external stimuli
Hydrodynamic
Common therapeutic measures for treating hypersensitive dentin are the use of
specific toothpaste, gels, or oral rinses at home and the application of chemical agent in the dental office
What are the 4 classified chemical desensitizing agents
- Anti-inflammatory agent
- Protein-precipitating agent
- Tubule-occluding agent
- Tubule sealants
