Exam 3 Lecture 1

Question 1

What 3 things must we do first before we treat a patient?

Answer 1

Diagnosis
Prognosis
Get permission for Treatment

Question 2

What phase is non-surgical in nature?

Answer 2

Phase I

Question 3

What phase is surgical in nature?

Answer 3

Phase II

Question 4

Patient with superficial inflammation, BOP, PD 1-4 mm, but no CAL, no bone loss, no tooth mobility or furcation involvement? What’s the diagnosis?

Answer 4

Gingivitis

Question 5

Patient presents with superficial inflammation, BOP, PD 1-4 mm, but no CAL, no radiographic bone loss, no tooth mobility or furcation involvement? What’s the prognosis?

Answer 5

Medical consult
OHI
Full-mouth scale and polish
Re-Evaluation in 4-6 weeks
Prophylaxis every 6 months

Question 6

What phase is for emergencies where we review their medical condition and history?

Answer 6

Urgent Phase

Question 7

What’s the initial phase called?

Answer 7

Control Phase

Question 8

What the phase when they come back?

Answer 8

Re-evaluation Phase

Question 9

What’s the corrective phase called?

Answer 9

Definitive Phase

Question 10

What do we do in the corrective phase?

Answer 10

restore function if disease controlled

Question 11

What’s the most critical phase in treatment?

Answer 11

Maintenance phase

Question 12

When performing SRP, what instrument do we use first?

Answer 12

cavitron

Question 13

With mild chronic periodontitis and treating with SRP, what might we prescribe for smokers?

Answer 13

Doxycycline

Question 14

What does Doxycycline inhibit and why do we prescribe it?

Answer 14

Host Immuno-Inflammatory response for limiting connective tissue and bone metabolism

Question 15

What’s the goal for SRP?

Answer 15

Decrease PD and change CAL

Question 16

What’s the average PD and change in CAL with SRP?

Answer 16

PD = 1.23 mm
CAL = 0.81 mm

Question 17

SRP is most likely a prognosis when PD is how large?

Answer 17

PD greater than 5 mm

Question 18

What are some problems we may encounter with SRP depth?

Answer 18

PD > 5mm, can’t reach bottom of pocket

Question 19

What are some problems with SRP when it comes to tooth roots?

Answer 19

Root Proximity
Root Furcations
Root Flutings

Question 20

What are 2 other problems we may encounter with SRP that don’t have to do with pocket depth or roots?

Answer 20

Irregular CEJ

Restorations

Question 21

What are limitations to SRP?

Answer 21

Intrabony lesions (SRP can’t get rid of these on its own)

Question 22

Patient presents with inflammation extending to bone, BOP, CAL 3-4 mm from CEJ, PD of 5-6 mm, bone loss 20-40%, Class I and II furcation involvement, and Class I and II tooth mobility? What’s the prognosis?

Answer 22

Medical consult (Seeing a pattern yet)
OHI
Quadrant or half-mouth SRP w/anesthesia
Requires 2-4 appointments
Re-Evaluation 4-6 weeks
Local antimicrobial in 5-6 mm RESIDUAL pockets
Refer to Periodontist

Question 23

So when do we use SRP + local delivery of antimicrobials in PD?

Answer 23

residual > 5 mm PD

Maintenance Pt’s with ISOLATED PD’s of 5-6 mm

Question 24

What are some other reasons to use SRP + local antimicrobials besides PD?

Answer 24

For Moderate Chronic Periodontitis
EARLY period abscesses
Extracted 3rd molars
Ailing implants
Furcations

Question 25

Where do we place local antimicrobials in Pt's that have lost 3rd molars?

Answer 25

DF line angle of 2nd molars

Question 26

Name the 3 medications used in local antimicrobial prescriptions?

Answer 26

PerioChip Atradox Arestin

Question 27

PerioChip is AKA?

Answer 27

CHX

Question 28

Atradox is AKA?

Answer 28

Doxycycline

Question 29

Arestin is AKA?

Answer 29

Minocycline

Question 30

Patient presents with inflammation extending to bone, BOP, CAL >5 mm from CEJ, PD >7 mm, bone loss >40%, Class I, II, or III furcation involvement, and Class I, II, or III tooth mobility? What is the diagnosis?

Answer 30

Advanced Chronic Periodontitis

Question 31

Patient presents with inflammation extending to bone, BOP, CAL >5 mm from CEJ, PD >7 mm, bone loss >40%, Class I, II, or III furcation involvement, and Class I, II, or III tooth mobility? What is the prognosis?

Answer 31

``` Medical consult OHI Quadrant or half-mouth SRP w/anesthesia Requires 2-4 appointments Re-evaluation in 4-6 weeks Local antimicrobials in 5-6 mm RESIDUAL pockets Refer to Periodontist ```

Question 32

Name the prognosis without treatment?

Answer 32

diagnostic prognosis

Question 33

Name the prognosis when determining the effect perio treatment will have on the course of the disease?

Answer 33

therapeutic prognosis

Question 34

Name the prognosis when given the anticipated results of periodontal treatment, you determine what the forecast is for the success of the prosthetic restoration?

Answer 34

prosthetic prognosis

Question 35

Name the prognosis given prior initial phase of treatment, it may change according to the patient/tooth response?

Answer 35

provisional prognosis

Question 36

Name the 5 factors of substantivity when prescribing local antimicrobials?

Answer 36

1) Kill 2) Reach 3) Appropriate concentration 4) Adequate duration 5) no harm

Question 37

When do we prescribe systemic antibiotics?

Answer 37

Aggressive Periodontitis | Severe & Progressive Chronic Periodontitis

Question 38

How long do we prescribe systemic antibiotics for?

Answer 38

7 day window

Question 39

What medications do we prescribe for systemic antibiotics?

Answer 39

``` Amoxicillin Metronidazole (don't if will consume alcohol) ```

Question 40

What can we prescribe if allergic to Amoxicillin?

Answer 40

Clindamycin

Question 41

What is so overly prescribed that we won't prescribe it anymore?

Answer 41

Azithromycin

Question 42

What else can we prescribe for systemic antibiotics?

Answer 42

Tetracycline HCl | Doxycycline

Question 43

Name some advantages for using systemic antibiotics for chronic periodontitis?

Answer 43

``` affects bacterial reservoirs targets multiple sites reduces Pt chair time absorbs in adjacent soft tissue sites penetrates base of pocket wide choice of antibiotics ```

Question 44

Name some disadvantages for using systemic antibiotics for chronic periodontitis?

Answer 44

``` Allergy GI intolerance Pt compliance Drug interactions Pt cost inability to penetrate intact biofilm ```

Question 45

Name some reasons systemic antibiotics fail for use with chronic periodontitis?

Answer 45

Pt compliance Pt cost can't penetrate infection and intact biofilm can't eradicate infection

Question 46

What is the average improvement in change of CAL for prescribing systemic antibiotics in aggressive and chronic periodontitis?

Answer 46

0.4 mm

Question 47

Patient presents with inflammation extending to bone, BOP, CAL 3-4 mm from CEJ, PD of 5-6 mm, bone loss 20-40%, Class I and II furcation involvement, and Class I and II tooth mobility? What's the diagnosis?

Answer 47

Moderate Chronic Periodontitis?

Question 48

Patient presents with inflammation extending to bone, BOP, CAL 1-2 mm from CEJ, PD 3-4 mm, bone loss less than 20%, Class I or no furcation involvement, Class I or no tooth mobility. What's the diagnosis?

Answer 48

mild chronic periodontitis

Question 49

Patient presents with inflammation extending to bone, BOP, CAL 1-2 mm from CEJ, PD 3-4 mm, bone loss less than 20%, Class I or no furcation involvement, Class I or no tooth mobility. What's the prognosis?

Answer 49

``` medical consult OHI quadrant or half-mouth SRP w/anesthesia requires 2-4 appointments re-evaluation 4-6 weeks 3-4 month maintenance interval ```