EXAM Flashcards
what is FMD and what are the advantages and disadvantages of it?
Full mouth disinfaction is intensive treatment that is carried out over two appointments within 24 hours, we carry out full mouth disinfection as bacteria is able to reenter areas in which have already been infected via instruments, blood and saliva, full mouth disinfection consists of root surface instrumentation which we would carry out first using an ultrasonic scaler to oxygenate the periodontal pocket removing the bacteria and endotoxins and subgingival calculus, we would then use hand instruments for tactile sensation and to smooth the root surface, we would use 0.2% chlorhexadine for 1 min to irrigate as an adjunct in ecological areas to flush out any bacteria and endotoxins. I would then take a plaque sample if possible and send off to a lab to see what bacteria was present this would help with getting an antibiotic prescribed, gold standard is metronidazole as this kills broad spectrum bacteria, or amoxicillin. The advantages of full mouth disinfectant is reduction in pocket depth, less oedema, less erythema, more attachment gain, less malodour, the disadvantages of full mouth disinfection is operator fatigue due to ongoing appointment times, recession and sensitivity due to the deep cleaning taking places would get the patient back in back in 1 to 2 weeks to check patient is engaging on oral hygiene routine and check for signs of inflammation’s would then get patient back in around 3 months to check everything has healed nicely.
what anaesthetic would you give for an IDB why? what does IDB numb up & what are the complications of giving an IDB?
For an iDB you would administer Lidocaine as it works effectively, fast acting and a safe local anaesthetic with a moderate duration of action that numbs a significant portion of the lower jaw such as
Buccal
Inferior
Alveolar
Nerve
Lingual
surrounding gingive and bone
pain from rapid injection
Facial paralysis.
Trismus
Self inflicted trauma.
Bleeding at site of injection.
Needle fracture.
Haematoma.
Doesn’t work.
what is a periodontal abscess how would you manage a periodontal abscesses?
A periodontal abcess is a purulent infection within the periodontal pocket it causes rapid damage to the periodontal ligament, surrounding gingiva and alveolar bone, there are two types acute and chronic. an acute periodontal abcess can be caused by inaqudate scalling, forigen object such as a fish bone or toothbrush bristle, clinical sings and symptoms would be sudden onset, pain when biting down, swelling and tenderness of overlying gingiva, pus draining from pocket or sinus, extra oral swellig isnt common, you wouldnt notice any defects on radiographs however horizontal or vertical bone loss may appear. i would manage an acute periodontal abscess by draining to releave pressure and pain, gentle supra snd sub PMPR to remove irritation, advise the patient to use chlorhexadine mouthwash and get metronidaxole or amoxicillin prescribed het them back in 2 months to monitor. a chronic periodontal abcess is more common and less severe than an acute can be common in patients with chronic periodntal disease, and deep pocketing, it is commonly detected when taking a BPE, if chronic abscess keep reappearing may be signs of a systemic disease. the clinical sings and symptoms would be dull pain or symptomless, pus comes within the pocket through the sulcus, patient may notice a bad smell or taste, extra oral swelling may appear, radiograph may show angular defects, i would manage this by supra & sub PMPR and chlorhexadine irrigation to rmove any bacteria witin the pocket, may require an extraction, allow healing 8-12 weeks the get the patient back to monitor.
what are some of the bacteria in Necrotising Gingivitis?
AA
Fusospirochetal complex
Porphyomonas Gingivalis
Treponema Vincenti
Borelli Vincenti
Fusiform Bacilli
Prevotella Intermedium
what is periimplantitis and how would you manage this?
Periimplantitis is an inflammatory condition which occurs round the dental implant and supporting bone, it starts off as periimplant mucositis which is bleeding and inflammation around the dental implant and if that is not addressed it develops into periimplantitis witch involves the supporting bone of the implant similar to periodontitis although it occurs around the dental implant if left untreated can result in implant failure, the clinical picture of periimplntit is is erythema, oedema, suppuration, hallitosis, can be painful, you would detect periimplantitis by radiographs would show horizontal and vertical bone loss around the dental implant, the probe would penetrate through the junctional epitheliam into the connective tissue through to the periodontal ligament and alveolar bone ,mobility. It is caused by unaqedate oral hygine routine, poor implant placement, history of gum disease ,excess cement from the implant, smoking, genetics, the bacteria present in periimplantitis is porphymonas gingavallis and AA, I would manage this by non surgical mechanical therapy using carbon fibre, titanium instruments or plastic inserts so that we don’t damage the implant surface, you would get the patient back every 3 months to monitor and refer if necessary.
what is denture stomatitis and how would you manage this?
Denture stomatitis is an inflammatory condition in the mouth that occurs in sites where the denture sits, the clinical picture of denture stomatitis is swelling, redness, burning sensation, white or red patches in the mouth, hallitosis, tissue bleeding, denture stomatitis is caused by a fungi called Candida albicans that drives in warm conditions, due to not taking dentures out at night to let soft tissues breathe, not cleaning dentures or tissues properly, ill fitting dentures that are causing friction and trauma to the soft tissues, dry mouth, smoking, underlying health conditions. I would manage denture stomatitis by advising the patient to take dentures out at night to let soft tissues breathe, a good oral hygiene routine for dentures such as a toothbrush and tooth paste and cold water to clean dentures, soaking dentures at night in steradent solution, avoiding foods that will stain or sticky foods that are harder to clean, advising an antibiotic from the dentist such as an anti fungal such as anviclovir. Getting dentures adjusted if they are ill fitting to avoid friction or trauma in the mouth that could lead to denture stomatitis.
you treat a patient who is post 2 months periodontal therapy, with some remaining pockets of above 4mm and dentine sensitivity. what is the treatment and how would you manage this patient longterm ?
I would reevaluate the patient by checking medical history social history I would check for any medical conditions or medications that could be causing slower healing such as immunocompromised as this attacks the bodys immune system leading to inflammation, slower tissue repair, therefore longer healing process, the body also may struggle to fight of bacteria as the immune system is weakened, i would review radiographs to check for any further bone loss or anything else that looks abnormal or infection, I would check for bleeding on probing which would indicate if the disease was active or not, check for mobility, furcation involvement or recession, I would then decide to retarget pockets above 4mm supra and subgingival PMPR to ensure complete root surface debridement, I would then irrigate targeted pockets with 0.2% chlorhexadine or use local antimicrobials which are placed into the site of infection to decrease bacteria load in the periodontal pocket such as periochip which is a 2.5mg chlorhexadine chip it biodegradable and controlled release for 7 days placed into the pocket with an instrument the chip slowly releases chlorhexadine only used in pockets 5mm or above advise the patient not to floss for 10 days, elyzol which is is metronidazole gel is 25% metronidazole in a lipid matrix its a sustained release delivery over 24 hours bio absorbable in 3 days to kill gram-ive bacteria. Dentomycin is 2% minocycline bioabsorable gel is restorable in 1 day kills bacteria such as porphymonas gingavallis and AA. for dentine sensitivity I would apply fluoride varnish, and advise patient to use sensitive tooth paste with potassium nitrite or strontium chloride to decrease dentine sensitivity, or possibly apply Glass ionomer on areas of recession as it releases fluoride. I would then advise the patient to come back in 3 months time to monitor them.
