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Perio > Diagnosis and Microbiology > Flashcards

Diagnosis and Microbiology Flashcards

0
Q

How can you classification the severity of bone loss?

A

Mild: 25% of root length (1-2mm CAL)
Moderate: 25-50%(3-4mm CAL)
Severe: more than 50% (6+mm CAL)

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1
Q

How can you categorise distribution?

A

Generalised : PPD or more than 3mm in more than 30% of sites
Localised : PPD. Of less than 3mm in less than 30% of sites

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2
Q

How can you assess the shape of bone loss?

A

Horizontal or vertical

Horizontal is entire width of interdental bone loss
Vertical : adjacent to tooth surface

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3
Q

What is the host response to perio antigens?

A

PMN complement and in Late stages you see T cels B cells and very late is plasma infiltrate

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4
Q

What is the purpose of neutrophil in pDl?

A

They act as surveillance and maintains integrity of PDL

Adhere, chemo taxis, phagocytosis, generate super oxide

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5
Q

What is the PDL like in health?

A

Very little plaque

Minimal GCF
Few PMN

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6
Q

What happens in the initial gingival lesion?

A

2-14 days
Early plaque: gram pos bacteria
Increases PMN

Vasculitis with appearance of IGs and complement

JE begins to proliferate and FEW Plasma cels

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7
Q

Wat happens in the established gingival lesion?

A

Grame neg and pos bactera

PLASMA CELLS. IGs predominate

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8
Q

What happens in the advanced gingival lesion?

A

Connective tissue attachment loss

> 50% PLASMA cells

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9
Q

What is he microbial aetiology of perio?

A

Non specific vs specific vs ecological plaque

Non specific : caused by mixed microbial bass of bactera

Specific: one group or a single organism causes perio

Ecological: changes in environmental conditions lead to an ecological shift favouring pathogenic organisms

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10
Q

How does tissue destruction occur in perio?

A

Directly by bacteria eg collagenases,muster oxide, toxins

Indirectly via host response; humoral immunity and cellular

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11
Q

Which interleukin is key in perio destruction for bone manage?

A

IL1 released by macrophages and CT cell

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12
Q

Which factors make you a susceptible host?

A

Smoking:
Syestmic condition eg HIV, diabetes have four fold increased risk since they have decreased neutrophils
Genetic familial
Stress
Leukaemia
Overhangs, crowding, dentures, weak contacts, enamel pearls

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13
Q

Which OH indices are there?

A

Greene and Vermillion

Quigley and Hein 1962 mod Turesky 1970

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14
Q

What does the Green and vermillion show?

A

Soft and hard depsotos

0: nothing
1: soft debris 2/3 band of calculus sub

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15
Q

What did the Turesky show?

A

0: nothing
1: flecks
2: continuous band of 1mm
3: less than 1/3
4. Less than 2/3
5: >2/3

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16
Q

Which gingival index is there?

A

Loe 1967

0: no inflam
1: change in colour and texture
2: inflam and bleeding from probing
3: overt inflam and spon bleeding

Muhlemann and Son 1971

1: no bleeding on probing
2: bleeding within 15seconds

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17
Q

How can we screen for perio?

A

BPE

3: 6PPC that sextand
4: whole mouth
Each sextand must have 2 teeth or add to next sextant

  • furcation but must be added to score
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18
Q

What are the scores for BPE?

A

1: healthy
2: BOP/calculus/overhand : OHI and scale
3: part black band gone 3.5-5.5 pocket depth :.OHI scale, RSD
4: black band gone: OHI Scale, consider surgery

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19
Q

What factors will affect picket depth?

A 
Size of probe
Force applied
Contour of tooth
Angulation of probe
Presence of calcius
Presence of inflammation
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20
Q

Which mobility is normal?

A

<0.2mm

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21
Q

What are mobility indices?

A

Grace and smales

Miller

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22
Q

What is the grace and smales mobility index?

A

0: no apparent mobility
1: single tooth where mobility is les than 1
2: mobility 1-2
3: >2 horizontal /vertical movement

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23
Q

What is the miller index?

A

1: 1mm
3: >1 and axial

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24
Q

How can we measure furcation?

A

Used curved nabers probe

1: 1/3 but not total width: cul de sac
3: through

25
Q

What is the picket probing deoth?

A

Gingiva margin to base of pocket

26
Q

How much force do you use for probing?

A

25g
0.25N

0.5mm diameter

27
Q

How do you measure recession?

A

CEJ to gingival margin

28
Q

What is the clinical attachment loss?

A

CEJ to base of pocket

29
Q

What are the changes from the 1989 to 199 classification?

A

1999 has: perio endo , periodontal abscess, development conditions, gingival diseases

Adult perio: chronic perio
Early onset: aggressive
Necrotising ulcerative perio: necrotising perio

30
Q

Why does smoking cause perio?

A

Reduced blood flow to gingiva
Impaired WBC
Imparted owing healing
Increased inflam cytokines

31
Q

Why does diabetes cause perio?

A

Imparted healing and poor response to therapy

Thickening of lumen of blood vessel

32
Q

What are the FGDP guidelines re radiograph?

A

Pocketing of less than 6mm horizontals
Pocketing or more then 6mm vertical BW (PA)
Irregular pockets : BW horizontal or vertical (PA)
Concurrent problems: DP/PA
Perio endo: PA

33
Q

Pocketing can be true or false, what does this mean?

A

True: apical migration of JE

False; gingival enlargements and no apical migration

34
Q

How long does it take the Aquired pellicle to form?

A

Within minutes and made from salivary glycoproteins

35
Q

What are the early colonisers of plaque?

A

0-7 days they form and are mainly gram pos

3/4 hours see strep and actinomycosis
These bind to saliva and provide anaerobic environment

36
Q

How long does it take the late colonisers?

A

After 7 days of plaque they come

37
Q

Which study showed the relationship between plaque and gingivitis?

A

Loe et al 1965

38
Q

Which study showed the chronology between plaque and gingivitis?

A

Lang et al 1973

39
Q

Which teeth mainly become affected with increasing age by perio?

A

Posterior teeth

40
Q

What are the sublingual plaque retentive factors?

A 
Calculus
Furcation
Rough cementum
Iatrogenic: overhangs, defective margins
Root grooves
Resorption 
Boney pockets
41
Q

What are the supragival factors that affect plaque?

A

Caries
Overhangs
Exposed root surface
Unpolished fillings

42
Q

How long does it take gingivitis to set in?

A

48 hours

43
Q

Which are the strong association organisms?

A

Aa PG Tanerella forsythia

Red

44
Q

What are the moderate association,

A

Treponema denticola
Fusoform nuclear up
Peptostreptococcus micros

Orange

45
Q

How do you mange boney defects?

A

Non surgical debridement or surgical

46
Q

What are the types of bone loss you can have?

A

Horizontal
Vertical
Interdental

47
Q

How can vertical be classified?

A

1/2/3/4 wall defects
4 is known as Circumfrential

By the number of remaining walls

48
Q

What are the surgical treatment options for vertices bone defects?

A

Conventional flap and curettage
Obturate defects eg bone graft or synthetics
GTR

49
Q

What are the type of bone grafts available?

A

Autogenous self
Homogenous same species
Isogenous twin
Heterogenous: freeze dried/diff species

50
Q

Where are the sources for Autogenous bone grafts?

A

Adjacent bone
Edentulous ridge
Iliac crest

51
Q

What are the options for artificial bone?

A 
Biodegradable ceramics
HAP
Acrylic 
PLaster of Paris
Metals
Epoxy resin
52
Q

When are synthetic bone grafts used?

A

1 operation site
It is cosly and cannot always predict outcome

+ little tissue reaction

53
Q

What is GTR?

A

Placing a barrier to epilthlil migration prior to completion of sugery allowing new CT attachment

It is more effective in reducing probing depths than open flap debridement improves CA and reduced PPD, less recession

54
Q

Which materials can be used in GTR?

A

Gortex
Collagen eg Biomend
PLA (poly lactic acid) eg resolut
Growth factors eg Emdogain

55
Q

What is the difference between first generation and second generation bio absorbable membranes?

A

First generations : no second surgery, requires stablisstion sutures,better than Gortex
Second : no second surgery, no stablisstion sutures, free flow or custom made by operator

56
Q

What is the advantage of using collagen?

A

Natrual haemostat since promotes platelet plugging
Promotes early wound stabilisation, matriation, chemo tactic for fibroblasts

BIOMEND

57
Q

What is Emdogain?

A

Improves PPD compared to flap surgery

It is an enamel matrix protein
Place onto exposed root surface
2 compoantsn: Emdogain and perio Glas

58
Q

How do you use Emdogain?

A

Raise flap
Curettage area
Apply pre gel EDTA conditioner which removed smear later on exposed root for 2mins
Rinse and apply Emdogain from apical region and work up
Close flap
No robing 6 months

59
Q

What is GCF?

A

In health it is a transudate

In disease becomes an exudate

Perio (6 decks)

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