Exam 1 Flashcards
Define the process of patient care
- Assessment
- Diagnosis
- Planning
- Implementation
- Evaluation
ADPIE
What are the objectives of a periodontal assessment?
- Provides a comprehensive picture of patients periodontal health status
- Determine health status
- Look for signs of inflammation and damage to periodontium
What are the fact gathering process?
- Baseline data for long term monitoring of periodontal disease activity
- Evaluate the success of periodontal treatment
- Accompanied by documentation of all clinical findings
- Needs to be performed on all patients
Reasons for periodontal documentation?
- Reference tool
- Record
- Educational resources
- Medical and legal document
What are the assessments in the clinical examination?
- Interview
- Extraoral/Intraoral
- Oral Hygiene
- Periodontal
- Dentition
- Radiographic
Describe the component of interview assessment
Medical History:
* Ensures safety of patient
* Aids clinician
* Verified with interview ans signature
Dental History:
* Chief complaint
* Acquire details necessary for diagnosis
* Past and present dental treatment
* Current oral hygiene practices
* Behavorial habits
* Attitude towards dentistry
Describe the component of Extra/Intra Oral assessment
Extroral
* Presence of pathology: Look, Feel, Listen, Smell
Intraoral
* Presence of Pathology: Oral mucosa, gingiva characterisitcs
Describe the component of Oral Hygiene assessment
- Plaque biofilm
- Calculus
- Tooth Surface topography
- Stain
Describe the component of Periodontal assessment
- Probe depth
- Clinical attachment level (CAL)
- Bleeding and suppuration
- Furcation detection and measurement
- Mucogingival considerations
- Tooth mobility and migration
- Fremitus
- Implications of implants
Describe the component of Dentition assessment
- Caries
- Restorations
- Overhanging margins
- Proximal contact relationships
- Tooth abnormalities
- Parafunctional habits
- Tooth wear
- Sensitivity or hypersensitivity
Describe the component of Radiographic assessment
- Interdental septa
- Bone destruction
- Furcation areas
- Dental implants
What are intrinsic stains
Fluorosis: too much fluoride over a period of time
Tetracycline: Medication
Minocycline: Medication
What are extrinsic stains and their associated causes?
Brown: Poor hygiene, Tannins and tobacco, Chlorhexidine, Stannous Fluoride
Green: Poor Hygiene, Enamel cuticle, Fluorescent bacteria and fungi
Black: Chromogenic bacteria, Ferric sulfide
Orange: Poor Hygiene, Chromogenic bacteria
What are the limitations of probing?
- Junctional Epithelium(JE) penetration/ puncture
- Probing Force
- Placement and Angulation variations
- Accuracy of depth
What are the etiology of recession?
- Multifactorial
- Anatomic variations
- Occlusal trauma
- Smoking or chewing tobacco
- Inflammatory periodontal disease
- Trauma induced by tooth brushing
- Ortho
- Crown margins
- RPD clasps
Describe normal and abnormal clinical presentation of the periodontium
Describe the normal and abnormal clinical presentation of the dentition.
How do you calculate Clinical attachment level (CAL)?
Overgrowth: Subtract overgrowth amount coronal to CEJ from probing depth
Recession: add the probe depth and recession measurement
How do you calculate attached ginigva?
1) record width of keratinized gingiva
2) Amount of keratinized gingiva minus probing depth
** You calculate on the outside*
How do you chart recession/FGM and Probing depth
How do you chart mobility
Mobility: Grade 0-3
0- Physiologic Mobility only (Not charted)
1- Slight pathology 1mm BL (Not charted)
2- Moderate pathology 1-2mm BL
3-Severe pathology greater than 2mm BL or MD vertical displacement
What type of instrument is specifically designed for measuring furcation involvement?
Nabers probe, curved with blunt tip and calibrated
List and describe the indices used to report furcation involvement
- Mandibular molars= bifurcated= Facial and Lingual involvements
- Maxillary Molars= Trifurcated= Facial Mesial and distal
- Maxillary 1st Premolars= Bifurcated= Mesial and distal
List and describe the indices used to report tooth mobility and dental caries.
Tooth mobility:
-Loss of support
-Rotation
-Elongation/extrusion
Dental Caries
G.V Black Cavity Classification:
Class 1- Pits and Fissures
Class 2- Proximal Spaces on Posterior teeth
Class 3- Proximal Spaces on Anterior teeth (no angle)
Class 4- Proximal Spaces on Anterior teeth with angle
Class 5- Cervical Third
Class 6- Edge and cusp
List and describe the indices used to report tooth wear
Attrition- parafunction, reduced salivary
Erosion- chemical, gastric, diet
Abrasion- excessive abrasion by foreign object
Abfraction- occlusal stress
Identify radiographic changes seen in periodontal diseases
Interdental Septa- break down of the lamina dura, loss of radiopacity, breaks in the crestal plate
Bone loss- Horizontal or vertical , Furcations
State the characteristics of ginigval epithelium
- Protection of underlying structures
- Selective interchange with oral environment (absorption of drugs)
- Avascular (relies on lamina propria for blood supply and nutrients
- has serveral layers
What are the 4 layers of ginigival epithelium?
Stratum Corneum (cornified)
Stratum Granulosum (Granular)
Stratum Spinosum (Spinous/prickle)
Stratum Germinativum/basale (Basal)
What are the different characteristics of the 4 layers of ginigval epithelium ?
Stratum Corneum (cornified) (TOP)
- Keratinized, para and non
- barrier membrane
Stratum Granulosum (Granular)
-Keratin Formation
-Flatten cells
-Shrinking nuclei
Stratum Spinosum (Spinous/prickle)
- 8-12 layers thick
- Langerhans cells
Stratum Germinativum/basale (Basal)
- Mitotic
- Keratinocytes (Touch cell)
- Melanocytes (Touch Cell)
- Merkel Cells (Touch Cell)
Differentitate among the three types of gingival epithelium:
Oral
Sulcular
Junctional
Oral (OE):
- Covers=crest of gingiva, outer surface of the free ginigva and attached gingiva.
- Keratinized or parakeratinized stratified squamous epithelium (masticatory mucosa)
- Keratinized Tissue: hard palate and dorsum of tongue
Sulcuar (SE):
- lines the gingival sulcus, thin and non keratinized
- DOES NOT have rete pegs
- Maybe parakeratinized near oral cavity opening
- goes from the coronal area of JE to crest of MG
- It forms the gingival wall of sulcus
- DOESNOT have granulosum or corneum
- Acts as a semipermeable membrane
Junctional (JE):
- nonkeratinized
- Two cell layers: basale and spinosum
- Thickness from coronal to apically
- Length ranges from .71 to 1.35mm
- Attaches to tooth by epithelial attachment (basement lamina and hemidesmosomes from enamel or cementum
Explain the renewal of gingival epithelium and its keratinization process
GE renews constantly - Thickness maintained by the balance between cell formation and shedding of old surfcae cells
During the keratinization process
- process by epithelial cells differentiating or mature
- Different types of differentiating reflects functional demand and stimulus placed on tissue
- Entire thickness is replaced
Define Fenestrations
A window of bone loss on the facial of the mandible
Bone defect
Define Dehiscences
V shaped defects apical to the cementoenamel junctions extending through marginal bone
Bone defect
What is the difference between fenestrations and dehiscences?
Fenestration is not commonly associated with ginigval recession, unlike dehiscence.
Both can affect either a natural tooth or dental implant
How do you chart Furcation grade
by grade I-IV (FITS)
I- early involvement=bone is intact (Feel It)
II- Moderate= bone is destroyed but probe cannot pass through it (In it)
III-Severe= Probe can pass through the roots (Through it)
IV- Severe severe= Visible due to recession (See It)
How do you chart bleeding on probe?
during probing- presence or absence on chart
Detailed description to include amount and rate
Ex: Gen light BOP, loc mod molars
Light= delayed
Mod= @ the time of probing
Severe=@ time and excessive
Where is the fremitus tested?
Only maxillary anterior teeth
Cell turn over time
- Palate, tongue and cheek is 5-6 days
- Ginigiva is 10-12 days
- JE is 4-7 days
