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
2
Q
Why do we treat perio?
A
- Disease is an infection
- Disease is chronic
- Cannot remove all plaque and calculus
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
4
Q
What are the variables of probing?
A
- Inflammation
- Probe diameter
- Tapered vs parallel
- Force (.15 - .75 N)
- Band width (.7 - 1mm)
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
6
Q
What is a healthy probing depth?
A
0-3 mm
7
Q
What are the characteristics of severe chronic perio?
A
- Localized < 30% teeth
- Generalized > 30% teeth
- Slight/Moderate/Advanced
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
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
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
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
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
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
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)
15
Q
What does bleeding upon probing indicate?
A
Active disease, presence of micobial biofilm/plaque, ulcerative sulcus/pocket epithelium
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
17
Q
What is the normal distance between the CEJ and alveolar bone?
A
1.5 - 2 mm (accomodates biological width)
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
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.
* 3.5 times
* 3.5 – 4.0
* 1
26
What is the Continuous Model of periodontal progression?
* All sites show continuous progession of clinical attachment loss
27
What is the Random Burst Model of periodontal progression?
* All sites exhibit loss over time, but with random bursts of activity
28
What is the Asynchronous Burst Model of periodontal progression?
* 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
How do we diagnose slight/moderate/advanced?
* Slight - 1-2 mm CAL
* Moderate - 3-4 mm CAL
* Advanced - \>5 mm CAL
30
How are intrabony pockets classified?
By the number of remaining walls:
1,2 or 3
Circumferential or Interdental Craters
31
What are the percentages of mandibular vs maxillary occurences of interdental craters?
* 63% - mandibular intrabony defects
* 35% - maxillary intrabony defects
32
How is a well-controlled diabetic treated?
Just like a non-diabetic patient
33
What are some signs of diabetes and periodontal disease?
* 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
With type 2 diabetes, obesity has been associated with increased what?
Susceptibility to periodontal disease
35
What is a common perio problem for pregnant women and why?
Pyogenic granulomas - P. intermedia growth is facilitated by progesterone (menadione = napthoquinone)
Hormones - decreased estrogen, increased progesterone
36
What are some of the adverse outcomes of perio disease in pregnant women?
* 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
When can you treat pregnant women?
* 1st trimester - emergencies only, no radiology
* 2nd trimeseter - good
* 3rd trimester - selective treatment
38
What medications are safe/not safe during pregnancy?
* Avoid (D) – Clarithromycin & Tetracyclin, Metronidazole (B)
* Caution (C) – Ciprofloxacin, Gentamicin, Vanocomycin
* OK (B) – Penicillins, Erythomycin, Clindamycin, Cephalosporins
* Avoid aspirin during breastfeeding
39
What are medications that affect gingivitis?
* Pheytoin (Dilantin) - anti-seizure
* Cyclosporine (Sandimmune) - immunosuppressant
* Ca Channel Blockers (Nifedipine) - hypertension
40
How long must you wait to treat a patient after he or she has had an MI?
6 months
41
What are the Red Complex bugs?
* Prevotella gingivalis
* Tannerella forsythia
* Treponema denticola
42
What is A.A. associated with?
Aggressive chronic perio
43
What is Prevotella intermedia associated with?
Pregnancy
44
What's the difference between suprabony and intrabony bone loss?
* Suprabony - horizontal bone loss
* Intrabony - vertical bone loss
