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Periodontics > Exam 3 - Tx & Diagnosis > Flashcards

Exam 3 - Tx & Diagnosis Flashcards

1
Q

T or F, Only in emergencies can you treat a patient before a treatment plan has been established and accepted by the patient.

A

True

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2
Q

What must occur first before the treatment and sequence is planned?

A

A diagnosis and prognosis has been determined

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3
Q

Describe the Urgent phase of care

A

Begins with a thorough review of the patient’s medical condition and history. This initial emergency appointment is to establish patient’s comfort and it may include:

  • eliminate pain and/or abscess
  • Address emergency concern
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4
Q

Describe things that may occur during the Control Phase of care

A
  1. Control active pathological lesions
  2. Control general caries and initial tooth preparation and provisional for diagnostic purposes
  3. Provisional restoration for esthetic and/or functional reason
  4. Control plaque and initial periodontal therapy
  5. Oral surgery procedures
  6. Initiation of endodontic treatment
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5
Q

What is the Re-evaluation phase

A

Phase of treatment plan is to determine the response to our initial therapy before our definitive phase begins.

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6
Q

Describe the Definitive phase of treatment

A

After reassessing the initial treatment, the patient enters the corrective or definitive phase of treatment.
This phase includes all therapies that restore function after the patient’s disease has been controlled.
- Orthodontics
- Implant restoration
- Fixed and removable prosthodontics

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7
Q

Describe Maintenance phase

A

Includes regular re-care examinations such as reassessment of occlusion, etc.

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8
Q

Clinical Presentation for Gingivitis

A
  1. Inflammation is soft tissue only (superficial)
  2. Bleeding on provocation
  3. Probing depth may range from 1-4 mm and present as pseudo pockets
  4. No loss of attachment or radiographic evidence of bone loss
  5. No tooth mobility
  6. No furcation involvement
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9
Q

Initial therapy (Phase I) of Gingivitis

A
  1. Medical consult if indicated
  2. Oral Hygiene instructions
  3. Full-mouth scale and polish
  4. Re-evaluation in 4-6 weeks
  5. Prophylaxis every 6 months if disease is resolved.
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10
Q

Clinical Presentation of Mild Chronic Periodontitis

A
  1. Inflammation extending to bone
  2. Bleeding on provocation
  3. Attachment loss of 1-2 mm from CEJ
  4. Probing depths of 3-4 mm
  5. Radiographic bone loss of
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11
Q

Initial therapy (Phase I) of Mild Chronic Periodontitis

A
  1. Medical consult if indicated
  2. Oral Hygiene Instructions
  3. Quadrant or half-mouth scaling and root planing with anesthesia
  4. Requires 2-4 appointments
  5. Re-evaluation (4-6 weeks)
  6. 3-4 month maintenance interval (depending on OH)
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12
Q

Clinical presentation of Moderate Chronic Periodontitis

A
  1. Inflammation extending to bone
  2. Bleeding on provocation
  3. Attachment loss of 3-4 mm from CEJ
  4. Probing depths 5-6 mm
  5. Radiographic bone loss of 20%-40%
  6. Class I and II furcation involvement
  7. Class I and II tooth mobility
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13
Q

Initial therapy (Phase I) of Moderate Chronic Periodontitis

A
  1. Medical consult if indicated
  2. Oral Hygiene Instructions
  3. Quadrant or half-mouth scaling and root planing with anesthesia
  4. Requires 2-4 appointments
  5. Re-evaluation (4-6 weeks)
  6. Locally delivered antimicrobials in 5-6 mm residual pockets
  7. Referral to periodontist
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14
Q

Clinical Presentation of Advanced Chronic Periodontitis

A
  1. Inflammation extending to bone
  2. Bleeding on provocation
  3. Attachment loss of >5 mm from CEJ
  4. Probing Depths of >7mm
  5. Radiographic bone loss > 40%
  6. Class I, II or III furcation involvement
  7. Class I, II or III tooth mobility
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15
Q

Initial Therapy (Phase I) of Advanced Chronic Periodontitis

A
  • **Same as Moderate Chronic Periodontitis
    1. Medical consult if indicated
    2. Oral Hygiene Instructions
    3. Quadrant or half-mouth scaling and root planing with anesthesia
    4. Requires 2-4 appointments
    5. Re-evaluation (4-6 weeks)
    6. Locally delivered antimicrobials in 5-6 mm residual pockets
    7. Referral to periodontist
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16
Q

Diagnostic Prognosis

A

Prognosis without treatment

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17
Q

Therapeutic Prognosis

A

What effect will periodontal treatment have on the course of the disease?

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18
Q

Prosthetic Prognosis

A

Given the anticipated results of periodontal treatment, what is the forecast for the success of the prosthetic restoration?

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19
Q

Provisional Prognosis

A

The prognosis given prior initial phase of treatment

May change according to the patient/tooth response

20
Q

Prognosis is divided into what 2 areas

A

Overal prognosis

Individual tooth

21
Q

What systemic habits affect prognosis

A

Smoking
High refined sugar intake
Methamphetamine abuse

22
Q

What factors may be involved in Overall Prognosis

A
  1. Systemic background (smoking, AIDS, Diabetes)
  2. Patient attitude toward treatment
  3. Availability of maintenance care
  4. Vertical or horizontal bone loss
  5. Furcation involvements (access for OH)
  6. Patient history (caries history, rate of periodontal disease progression, past perio destruction )
  7. Skill and interest of the operator
  8. Finances
23
Q

Single most important risk factor in overall prognosis/systemic background

A

smoking.

Cigarette smokers are 5-8 times more likely than non-smokers to develop severe periodontitis

24
Q

In what ways does smoking contribute to periodontal disease and diminish the overall prognosis

A
  1. Inhibits wound healing following periodontal therapy
  2. Alters the quality of microbiota in shallow and deep pockets
  3. Decreases neutrophils, chemotaxis, phagocytosis and oxidative burst
  4. Increases collagenase production
  5. Constricts gingival venules, arterials and capillaries
  6. Decreases GCF flow
25
Q

Name the positive benefits related to smoking cessation from 20 minutes to 24 hours

A

20 min.

  • BP drops to normal
  • Pulse rate drops to normal
  • Peripheral body temperature increases to normal

8 hours
- CO in blood drops to normal

24 hours
- Chance of heart attack decreases

26
Q

Name the positive benefits related to smoking cessation from 2 weeks to 9 months

A

2 - 3 weeks

  • Circulation improves
  • lung function increases up to 30 %

1 to 9 months

  • Coughing, sinus congestion, shortness of breath decreases
  • Cilia re-grow in lungs thereby enhancing host defense against respiratory infections
27
Q

Name the positive benefits related to smoking cessation from 1 year to 5 years to 10-15 yrs

A

1 year:
- Risk of coronary heart disease is 50% less than that of a smoker

5 years:

  • Lung cancer death rate for average smoker decreases by almost 50%
  • Stroke risk is reduced to that of non-smoker in 5-15 year quit range
  • Risk of oral, pharynx and esophageal cancer is 50% less than that of a smoker’s

10-15 yrs

  • Lung cancer death similar to nonsmoker
  • Risk coronary heart disease is that of nonsmokers
28
Q

Type I diabetes and Type II diabetes can alter or increase the oral microbial flora. What microbes are altered?

A

Type I diabetes: Captocytophaga sp.

Type II diabetes: Porphyromonas gingivalis

29
Q

Diabetes can have what systemic background effects of altered host defense mechanism

A
  1. Decreased PMN function
    • Chemotaxis & Phagocytosis
  2. Increase glucose in GCF
    • May allow growth of different sub gingival bacteria
30
Q

Describe the vascular changes associated with diabetes

A

Increased thickness of basement membrane and vessel walls

- Decreased O2 diffusion and elimination of wastes

31
Q

Diabetes and collagen breakdown association

A
  • Stimulation of collagenous activity
  • Altered collagen metabolism
  • Limited production of growth factors
  • Impaired wound healing & increased severity of periodontitis
32
Q

Comparison of untreated/treated periodontitis:

  • Untreated moderate to advanced periodontitis
  • Treated moderate to advanced periodontitis with no maintenance
  • Treated moderate to advanced periodontitis with regular maintenance
A

Untreated: 0.36 teeth lost per patient per year

No maintenance: 0.22 teeth lost per patient per year

Treated: 0.11 teeth lost per patient per year

33
Q

Aggregate study of untreated/treated chronic periodontitis

  • Untreated
  • Treated
A 
Untreated = 0.28 teeth per year
Treated = 0.08 teeth per year

-*** Difference of 3.5x
Thus over a ten year period the untreated patient can expect to lose 3-4 teeth and treated patient 0-1

34
Q

T or F, Average tooth loss can be misleading as all patients do not respond the same

35
Q

In a long-term survey of tooth loss in 600 treated periodontal patients, what percentage of patients are:

  • well-maintained
  • downhill
  • extreme downhill
A
  • Well-mainted: 83.2% of patients lost 0-3 teeth
  • Downhill: 12.6% of patients lost 4-9 teeth
  • Extreme downhill: 4.2% lost 10-23 teeth
36
Q

Example of worst prognosis:

  • Type of periodontitis
  • Inflammation
  • Plaque and calculus
  • Bone loss associated with acute or chronic injury
A
  • Aggressive “juvenile”
  • Inflammation not present despite the disease severity
  • Almost absent
  • Chronic infection
37
Q

Individual tooth prognosis/pocket depths:
Shallow
Moderate
Severe

A

Shallow: 1-3 mm
Moderate: 4-6 mm
Severe: > or = 7 mm

38
Q

Following SRP at PD>5 mm, residual calculus will remain what % of the time

39
Q

SRP curette efficiency & Instrumentation limit

A

Curette: 3.73 mm

Instrumentation limit: 5.52 mm

40
Q

T or F, Probing depths are less important than attachment loss/bone loss

41
Q

T or F, PD > or = 6 are not difficult to maintain without surgery

A

False, Are difficult

**But prognosis should be based on CAL, not by PD

42
Q

Individual tooth prognosis criteria

A
  1. Pocket depth
  2. Consideration of bone loss
  3. Tooth morphology
43
Q

Crown to root ratio for a tooth with average root length is what?

44
Q

Furcation involvement and individual tooth prognosis for Class I, Class II & Class III/IV

A

Class I: Fair prognosis
Class II: Questionable
Class III/IV: Poor/Hopeless

45
Q

Reasons for tooth mobility beyond physiologic range:

A

Loss of support
Inflammation
Trauma

46
Q

Prognosis based on degree of tooth mobility: Class I, Class II & Class III

A

Class I: Fair (slight mobility)
Class II: questionable (moderate more than normal)
Class III: hopeless (severe mobility + depressive)

47
Q

Classifications of prognosis:

A 
A. Good
B. Fair
C. Poor
D. Questionable
E. Hopeless

Periodontics (10 decks)

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