Chapter 5 - periodontal diseases and general health Flashcards
what are the two main general health issues associated with having periodontitis?
- premature low birth weight babies
- coronary heart disease
studies show what about periodontitis and pregnancy outcomes?
that if an expectant mothers periodontal health is improved then there is a reduced incidence of adverse pregnancy outcomes
what is the association between cardiovasuclar disease?
the association is thought to be mediated by inflammatory markers (in particular C-reactive protein)
periodontitis can do what to cholesterol?
raise the level of serum cholesterol (more evidence required)
give 8 local risk factors for periodontitis?
- 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
when does gingivitis become periodontitis?
when the junctional epithelium becomes damaged and migrates apically
what is the clinical presentation of an apically migrated junctional epithelium?
the gingival crevice now becoming a periodontal pocket (>3mm probing depth)
apical progression of the junctional epilthelium is allowed to continue how? what will happen at the same time as this
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
what are the clinical features of periodontitis?
- 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
how to probe a periodontal pocket?
- 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
if you probe a periodontal pocket and there is bleeding what does this indicate?
inflammation of the subgingival tissues
if you get no bleeding when probing of the periodontal pocket this can indicate..?
- that the subgingival tissues are not inflamed
or
- that the ginigval tissues are not recieving adequate blood supply due to smoking for example (ischaemia)
what causes gingival recession?
- 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)
where do you need to probe to find the furcation?
the inter-radicular space
how to measure tooth mobility?
you want to place 2 ends of a probe and move the tooth in a bucco-lingual direction
what are the grades of mobility? what index is used?
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
what is the issue with millers index of mobility?
it is very subjective but remains the only index universally used
what can be used that would eliminate this issue with millers mobility index?
periotest (electronic device for testing tooth mobility)
- more reproducible and comparable
what is aggressive periodontitis?
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)
what are the subcategories of aggressiive periodontitis?
localised or generalised
affecting all or just some teeth
what is vital to do with patients who have aggressive periodontitis?
to recognise that they have the condition early on in order to prevent disease progression
mild periodontitis classification is done how?
1-2mm LOA
moderate periodontitis classification is discovered how?
3-4mm LOA
severe periodontitis classification is if there is?
> 5mm LOA
