Chapter 5 - periodontal diseases and general health

Question 1

what are the two main general health issues associated with having periodontitis?

Answer 1

• premature low birth weight babies

- coronary heart disease

Question 2

studies show what about periodontitis and pregnancy outcomes?

Answer 2

that if an expectant mothers periodontal health is improved then there is a reduced incidence of adverse pregnancy outcomes

Question 3

what is the association between cardiovasuclar disease?

Answer 3

the association is thought to be mediated by inflammatory markers (in particular C-reactive protein)

Question 4

periodontitis can do what to cholesterol?

Answer 4

raise the level of serum cholesterol (more evidence required)

Question 5

give 8 local risk factors for periodontitis?

Answer 5

• calculus
• enamel pearls
• root grooves/concavties
• malpositioned teeth
• overhanging/poorly fitting or contoured restorations
• removable partial dentures
• weak/malpositioned contact points
• a deep overbite causing direct gingival trauma

Question 6

when does gingivitis become periodontitis?

Answer 6

when the junctional epithelium becomes damaged and migrates apically

Question 7

what is the clinical presentation of an apically migrated junctional epithelium?

Answer 7

the gingival crevice now becoming a periodontal pocket (>3mm probing depth)

Question 8

apical progression of the junctional epilthelium is allowed to continue how? what will happen at the same time as this

Answer 8

because the patient can no longer remove plaque from the base of the pocket

there will be inflammation of the connective tissue between the PDL and the junctional epithelium

Question 9

what are the clinical features of periodontitis?

Answer 9

• the exact same as gingivitis
  (erythmatous, odema, disoloured papilla and margins, BOP)
• > 4mm probing depth
• detachment of the ID papilla
• Swelling of the papilla
• gingival sinuses
• hyperplasia of the papila
• extradition of pus when digit pressure or probing
• Mobility
• Furcation
• gingival recession

Question 10

how to probe a periodontal pocket?

Answer 10

• place the probe at the gingival margin parallel to the long axis of the tooth and proceed to the base of the pocket until resistance is felt

Question 11

if you probe a periodontal pocket and there is bleeding what does this indicate?

Answer 11

inflammation of the subgingival tissues

Question 12

if you get no bleeding when probing of the periodontal pocket this can indicate..?

Answer 12

• that the subgingival tissues are not inflamed

or

• that the ginigval tissues are not recieving adequate blood supply due to smoking for example (ischaemia)

Question 13

what causes gingival recession?

Answer 13

• destructive periodontitis
  (because the gingiva relies heavily on underlying periosteum for blood supply)
• bone destruction
  (the gingival tissues will follow the bone crest - the thinner the gingivae the more likely this is to happen)

Question 14

where do you need to probe to find the furcation?

Answer 14

the inter-radicular space

Question 15

how to measure tooth mobility?

Answer 15

you want to place 2 ends of a probe and move the tooth in a bucco-lingual direction

Question 16

what are the grades of mobility? what index is used?

Answer 16

grade 0 - physiological movement of 0.1-0.2 mm

grade 1 - horizontal movement of 0.3-1mm

grade 2 - horizontal movement of >1mm

grade 3 - horizontal and vertical mobility

MILLERS index

Question 17

what is the issue with millers index of mobility?

Answer 17

it is very subjective but remains the only index universally used

Question 18

what can be used that would eliminate this issue with millers mobility index?

Answer 18

periotest (electronic device for testing tooth mobility)

• more reproducible and comparable

Question 19

what is aggressive periodontitis?

Answer 19

a group of extremely susceptible patients who suffer from rapid bone destruction so that by the age of 35 they have lost >50% of bone - this can be clearly seen on a radiograph.

A highly destructive form of periodontitis that is characterised by
- rapid attachment loss
- destruction of the pdl
- destruction of the supporting bone
in an otherwise healthy young adult usually below the age of 35 (older patients may be affected too)

Question 20

what are the subcategories of aggressiive periodontitis?

Answer 20

localised or generalised

affecting all or just some teeth

Question 21

what is vital to do with patients who have aggressive periodontitis?

Answer 21

to recognise that they have the condition early on in order to prevent disease progression

Question 22

mild periodontitis classification is done how?

Answer 22

1-2mm LOA

Question 23

moderate periodontitis classification is discovered how?

Answer 23

3-4mm LOA

Question 24

severe periodontitis classification is if there is?

Answer 24

> 5mm LOA

Question 25

classifying something as generalised =

Answer 25

> 30% of sites affected

Question 26

classification is localised if =

Answer 26

there is <30% of sites affected

Question 27

what bacteria is associated with aggressive periodontitis?

Answer 27

• aggregatibacter actinomycetamcomitans

- phorphyromonas gingivalis

Question 28

what other cell changes are in aggressive periodontitis compared to normal periodotnitis?

Answer 28

• altered leucocyte function

- increased production of immune system mediators (cytokines)

Question 29

what are the CLINICAL features of aggressive periodontitis?

Answer 29

• lack of overt gingival inflammation

- relatively good OH (not in line with the level of disease present)

Question 30

what is it called when periodontitis occurs in children? how common is this?

Answer 30

prepubertal periodontitis

rare

Question 31

What is the treatment of aggressive periodontitis?

Answer 31

mechanical plaque removal
RSD
systemic antibiotics

usually gives equally as successful outcome for controlling the disease as periodontitis