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D2 - Perio > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is the rational for perio treatment?

A
  • Control etiology
  • Control inflammation
  • Control pain & discomfort
  • Restore periodontal health
  • Maintain long-term function of dentition
  • Regeneration of lost bone and soft tissue
  • Maintain/restore to esthetic level
  • Control local inflammatory response = control of systemic inflammation = good general health
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2
Q

Why do we treat perio?

A
  • Disease is an infection
  • Disease is chronic
  • Cannot remove all plaque and calculus
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3
Q

What are the legal requirements we are obligated to fulfill?

A

We must:

  • Diagnose disease
  • Inform pt of disease
  • Offer appropriate treatment
  • Treat to standard of care
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4
Q

What are the variables of probing?

A
  • Inflammation
  • Probe diameter
  • Tapered vs parallel
  • Force (.15 - .75 N)
  • Band width (.7 - 1mm)
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5
Q

How is probing done?

A
  • 6 measurements/tooth
  • Measure oral sulcular epithelium pocket
  • Its a measure of free gingiva
  • Attached gingiva = margin to MGJ - depth of gingival sulcus
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6
Q

What is a healthy probing depth?

A

0-3 mm

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7
Q

What are the characteristics of severe chronic perio?

A
  • Localized < 30% teeth
  • Generalized > 30% teeth
  • Slight/Moderate/Advanced
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8
Q

What are the characteristics of an Initial Lesion?

A
  • 2-4 days
  • Inflammatory infiltrate - PMN
  • Vasculitis
  • Loss of perivascular CT = collagen
  • Increased GCF
  • No CAL or bone loss
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9
Q

What are the characteristics of an Early Lesion?

A
  • Bleeding on probing (1st sign)
  • 4-7 days
  • Acute inflammation - PMNs
  • Chronic inflammation begins - lymphocytes/macrophages
  • 70% loss of collagen in lamina propria
  • Fibroblasts show damage
  • Pseudopocket formation begins
  • Edema and erythema of marginal gingiva
  • Increased GCF
  • Loss of gingical stippling
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10
Q

What are the characteristics of an Established Lesion?

A
  • 2-3 weeks
  • Edema & erythema
  • Bleeding upon probing,
  • Gingival changes (color, contour, consistency
  • No bone loss
  • Soft tissue retraction
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11
Q

What are the characteristics of Advanced Lesion?

A
  • AKA “Periodontitis”
  • Activation of osteoclasts - bone loss
  • Bleeding on probing
  • Apical margination of JE
  • Mobility
  • Cytokines, MMPs, Prostaglandins, Leukotrines
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12
Q

How do you calculate Clinical Attachment Loss?

A
  • Probing depth - Gingival margin
  • If gingival margin is coronal to CEJ, PD - GM
  • If gingival margin is apical to CEJ, PD + GM
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13
Q

What is the biological width and how wide is it usually?

A
  • Dimension that exists naturally around all teeth
  • About 2mm
  • Junctional epithelium + Connective tissue attachment
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14
Q

How do you measure mobility and how is it classified?

A
  • Measured with 2 instruments
  • Class 1 - .2 > x < 1 mm
  • Class 2 - > 1 mm (buccal to lingual)
  • Class 3 - > 1 mm + axial displacement (apical margination)
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15
Q

What does bleeding upon probing indicate?

A

Active disease, presence of micobial biofilm/plaque, ulcerative sulcus/pocket epithelium

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16
Q

What does probing depth show with BOP, along with recorded data over time?

A
  • Probing depth (BOP) - active disease
  • Recorded data - disease progression or stability
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17
Q

What is the normal distance between the CEJ and alveolar bone?

A

1.5 - 2 mm (accomodates biological width)

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18
Q

What is the average PDL width?

A

.17 mm

19
Q

What probe do you use to measure furcations and what does it measure?

A

Nabors probe - horizontal bone loss

20
Q

What is the difference between gingivitis and periodontitis?

A
  • Clinical presentations
  • Plaque is necessary for both
  • May not have signs of inflammation with perio
  • No bone loss or PDL loss with gingivitis
  • Apical margination of JE with periodontitis
  • Gingivitis may never develop into periodontitis (pt immunology plays role in pathogenesis)
21
Q

What are the characteristics of healthy gingiva?

A
  • Color: coral pink, melanin is variable
  • Contour: anterior - papillae pyramidal, posterior - papillae are slightly pyramidal
  • Consistency: firm & resilient
  • Texture: stippling
  • Some PMN, macrophages present, no collagen destruction, some GCF, intact epithelial barrier
22
Q

What data do we collect to diagnose perio?

A
  • Probing depths
  • Bleeding upon probing
  • Clinical attachment levels
  • Width of attached gingiva
  • Gingival recession
  • Furcation involvement
  • Mobility
  • Radiographic evidence of bone loss
  • Plaque/calculus
23
Q

What are the characteristics of chronic periodontitis?

A
  • Most prevalent in adults
  • Loss of furcation bone, gingival recession, gingival appearance can be consistent with acute or chronic inflammation
  • BOP, exudate from pockets, not amenable to treatment with systemic antibiotics
  • Tooth mobility, Suprabony & Intrabony pocket formation (≥ probing depth), loss of alveolar bone, periodontal abscess
  • Painless except abscess
24
Q

The average rate of CAL in patients with untreated chronic periodontitis ranges from ______ per year for facial and lingual surfaces, and _____ per year for interproximal areas.

A
  • 0.1 to 0.3 mm
  • 0.3 mm
25
Q

During the same time period, untreated periodontal patients will lose ______ more teeth than those patients who receive treatment, or in a 10 year period, untreated periodontal patients will lose ________ teeth while those patients who receive treatment will lose ___ tooth.

A
  • 3.5 times
  • 3.5 – 4.0
  • 1
26
Q

What is the Continuous Model of periodontal progression?

A
  • All sites show continuous progession of clinical attachment loss
27
Q

What is the Random Burst Model of periodontal progression?

A
  • All sites exhibit loss over time, but with random bursts of activity
28
Q

What is the Asynchronous Burst Model of periodontal progression?

A
  • Several sites have one or more bursts of activity
  • Prolonged period of inactivity
  • Cumulative extent of destruction varies over time
  • Some sites don’t have attachment loss
29
Q

How do we diagnose slight/moderate/advanced?

A
  • Slight - 1-2 mm CAL
  • Moderate - 3-4 mm CAL
  • Advanced - >5 mm CAL
30
Q

How are intrabony pockets classified?

A

By the number of remaining walls:

1,2 or 3

Circumferential or Interdental Craters

31
Q

What are the percentages of mandibular vs maxillary occurences of interdental craters?

A
  • 63% - mandibular intrabony defects
  • 35% - maxillary intrabony defects
32
Q

How is a well-controlled diabetic treated?

A

Just like a non-diabetic patient

33
Q

What are some signs of diabetes and periodontal disease?

A
  • Rapid alveolar bone loss
  • Poor response to treatment
  • Oral signs/symptoms
    • Xerostomia, burning mouth, periodontal abscesses, multiple abscesses, caries, candidiasis
  • Periodontal considerations:
    • Impaired wound healing, increased plaque & bone resportion, altered PMN chemotaxis, abscesses
34
Q

With type 2 diabetes, obesity has been associated with increased what?

A

Susceptibility to periodontal disease

35
Q

What is a common perio problem for pregnant women and why?

A

Pyogenic granulomas - P. intermedia growth is facilitated by progesterone (menadione = napthoquinone)

Hormones - decreased estrogen, increased progesterone

36
Q

What are some of the adverse outcomes of perio disease in pregnant women?

A
  • Pre-term birth < 37 weeks gestation
  • Low birth weigh < 2500g
  • Preeclampsia - hypertension b/w week 20-41
  • Fetal growth restriction and development, CNS involving hippocampus (emotions/memory)
37
Q

When can you treat pregnant women?

A
  • 1st trimester - emergencies only, no radiology
  • 2nd trimeseter - good
  • 3rd trimester - selective treatment
38
Q

What medications are safe/not safe during pregnancy?

A
  • Avoid (D) – Clarithromycin & Tetracyclin, Metronidazole (B)
  • Caution (C) – Ciprofloxacin, Gentamicin, Vanocomycin
  • OK (B) – Penicillins, Erythomycin, Clindamycin, Cephalosporins
  • Avoid aspirin during breastfeeding
39
Q

What are medications that affect gingivitis?

A
  • Pheytoin (Dilantin) - anti-seizure
  • Cyclosporine (Sandimmune) - immunosuppressant
  • Ca Channel Blockers (Nifedipine) - hypertension
40
Q

How long must you wait to treat a patient after he or she has had an MI?

A

6 months

41
Q

What are the Red Complex bugs?

A
  • Prevotella gingivalis
  • Tannerella forsythia
  • Treponema denticola
42
Q

What is A.A. associated with?

A

Aggressive chronic perio

43
Q

What is Prevotella intermedia associated with?

A

Pregnancy

44
Q

What’s the difference between suprabony and intrabony bone loss?

A
  • Suprabony - horizontal bone loss
  • Intrabony - vertical bone loss

D2 - Perio (5 decks)

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