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exam notes (big doc) Flashcards

1
Q

clinical and lab investigations

A 
thorough history (inc FH)
pocket chart
microbial analysis of sample (swab of crevicular fluid)
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2
Q

deciding prognosis of individual teeth

A

loss of attachment
mobility
furcation involvement

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3
Q

Why would mechanical root surface debridement not be successful in eliminating pocket bacteria?

A

difficulty with access esp furcation
pt not adhering to OH requirements
inadequate RSD/lack of operator experience
pt immunocompromised
may not be able to remove pathogens as sites inaccessible to instruments e.g. invaded dentinal tubules
failure to disrupt biofilm

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4
Q

why may ABs not be effective?

A

may be resisted by biofilms
may have inadequate drug concentration and retention (not in therapeutic range)
may not reach site of disease activity

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5
Q

clinical signs of improved health

A

reduced probing depths <4mm

BOP <10%

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6
Q

requirements for implant placement

A

space (7mm)
bone levels
periodontal health

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7
Q

bacteria in NG

A

p intermedia
fusobacterium
spirochetes e.g. treponema

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8
Q

NG S+S

A 
blunting papillae
halitosis
grey slough wipes off to reveal ulcerated tissue
crater like ulcers
reverse gingival architecture
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9
Q

OFD information to give to pt

A

risks - gingival recession, infection (+ post-op ones)
benefits - effectively debride area with direct vision
outcomes - possible reduction of pocket depth
other options - NSPT
risks if don’t get tx - increase in pocket depth, increase in mobility, increased likelihood of losing teeth

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10
Q

reviewing pt after OFD

A

at least 8 weeks to allow time frame for healing

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11
Q

OFD clinical findings indicating successful tx

A

<4mm probing depths
plaque scores <15%
BOP <10%

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12
Q

why might antibiotics not work for chronic periodontal disease?

A

biofilm resistance to antibiotics
inactivated by first pass metabolism
poor pt adherence to regimen
antibiotic resistance

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13
Q

SIRS

A

any 2 or more of :

  • temp <36 or >38 degrees
  • resp rate >20/min
  • WBC <4000 or >12000 cells/mm3
  • hr >90bpm
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14
Q

what is a periodontal abscess?

A

acute exacerbation of an existing periodontal pocket e.g. trauma or obstruction
caused by food packing or inadequate RSD

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15
Q

S+S of PD abscess

A 
pain on biting/spontaneous
TTP
swelling
pus
pocketing at swelling
mobility
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16
Q

differentiating PD abscess from PA abscess

A

sensibility test non-vital vs vital

also consider perio condition in rest of mouth

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17
Q

how do you manage occlusal trauma in a pt with periodontal disease?

A

address cause (remove high Rxs, parafct)
bite raising appliance nighttime wear
HPT

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18
Q

what factors can influence localised mobility?

A 
existing PDD
occlusal trauma causing widening of PDL
morphology and length of roots
alveolar bone loss
resorption/trauma
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19
Q

when might splinting be advised?

A

mobility due to advanced LOA
causing discomfort or difficulty in chewing
to facilitate RSD

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20
Q

why is there a decrease in mobility after tx?

A

increased tissue tone and long junctional epithelium attachment

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21
Q

what can you do if the PDL is still widened after successful Rx?

A

reduce contact in occlusion

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22
Q

what are the findings for aggressive periodontitis?

A

severe periodontal destruction not consistent with oral hygiene
familial aggregation
pt otherwise clinically fit

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23
Q

localised aggressive periodontitis

A

localised LOA
6s, incisors
circumpubertal onset
robust antibody response

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24
Q

generalised aggressive periodontitis

A 
generalised LOA
6s, incisors and 3+ other teeth
usually onset under 30years
poor serum antibody response
episodic nature
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25
bacteria in aggressive periodontitis
``` aggregatibacter actinomtcetemcomitans (AA) porphyromonas gingivalis ```
26
why does mobility indicate poor prognosis?
reduced bone support
27
why does furcation involvement indicate poor prognosis?
more difficult to keep clean for pt
28
why does LOA indicate poor prognosis?
less supporting structures for tooth
29
factors which indicate poor prognosis for a tooth
mobility furcation involvement LOA non-vitality
30
further info needed from pt before determining poor prognosis teeth
smoking drug history systemic disease
31
how is localised angular periodontitis caused?
when pathway of inflammation travels directly into PDL space, localised PRFs
32
classifying localised angular periodontitis
mild <30% moderate 30-50% severe >50%
33
3 clinical/radiographic signs of healing
gingival recession - black triangles clinical reattachment - reduced probing depth reduced BOP
34
difference between horizontal and angular bone loss
radius of destruction of plaque is approximately 2mm horizontal bone loss found where plaque destroys bone completely between 2 roots, angular is where the radius is still bone on one side
35
how does a healthy periodontium react to traumatic occlusion?
PDL widening so mobility no LOA or inflammation will resolve once occlusion sorted
36
how does a healthy but reduced periodontium react to traumatic occlusion?
same but due to less PDL mobility is increased
37
how does a periodontitis periodontium react to traumatic occlusion?
plaque still primary etiological factor but may make rate of LOA faster widened PDL and mobility same
38
what is CHX?
biguanide antiseptic
39
CHX mode of action
dicationic >1 cation adheres to pellicle and 1 cation disrupts bacterial membrane antibacterial and antiseptic so bacteriostatic and bacteriolytic works against gram + and - bacteria, fungi and viruses
40
CHX substantivity
12 hours
41
give 2 common doses of CHX
0. 2% 10ml/20mg 2x daily | 0. 12% 15ml/18mg 2x daily
42
side effects of CHX
``` staining taste disturbance salivary gland enlargement anaphylaxis interacts with SLS ```
43
uses of CHX
``` surgical pre-op rinse post IO surgery OHI pts with jaw fixation NG recurrent oral ulceration denture stomatitis tx of dry socket endo irrigant medically compromised high caries risk ```
44
how is HPT provided?
non-surgical periodontal therapy - scaling and RSI remove PRFs OHI
45
HPT success
pockets <4mm plaque scores <15% bleeding scores <10%
46
TIPPS
``` OHI Talk Instruct Practise Plan Support ```
47
things recorded on a PD pocket chart
``` teeth missing gingival margin pocket depth LOA mobility furcation BOP ```
48
give 2 disadvantages of a pocket chart
assumes all pts have same root length so may appear worse than they are probing depths are subjective/variation between operators
49
local factors for gingival recession
``` periodontal disease habits traumatic tooth brushing abrasive toothpaste high frenal attachment traumatic overbite orthodontics poor marginal fit restorations ```
50
how can you measure recession?
photos study models pocket chart
51
how is localised recession managed?
``` atraumatic tooth brushing technique minimise other risk factors monitor treat sensitivity free/pedicle ST graft (from palate) coronal advancement flap ```
52
what would you look for in a pt who wants an implant?
``` bone quantity and quality pt motivation OH smoking MH e.g. bisphosphonates restorative options ```
53
intervention for inadequate bone levels
GTR bone graft biological mediator = Emdogain (enamel matrix derivative) sinus lift
54
mechanism of a vertical bone defect
radius of destruction of plaque determines this | approx 1.5-2mm and if the IP bone loss is greater than this then the pattern is vertical/angular
55
how are vertical defects classified?
by number of walls: 1,2 or 3 wall defects | - 2 and 3 wall defects heal better
56
indications for regenerative periodontal surgery
2 and 3 walled defects grade 2 furcation in mandibular teeth grade 2 buccal furcation in maxillary molars
57
why might NST for PDD be unsuccessful?
``` inadequate RSI furcation/angular defects that are difficult to effectively clean motile anaerobes moving into tissues pt not adhering to OHI pt immunocompromised smoking ```
58
why is diabetes a risk factor in PDD?
WIPA 1 - poor wound healing 2 - both pro-inflammatory diseases 3 - immunosuppression: impaired PMN neutrophil fct 4 - advanced glycation end (AGE) products causing increased tissue destruction
59
give 2 tests to test for diabetes
RPG - random plasma glucose | FPG - fasting plasma glucose
60
RPG values
normal <11.1 mol/L | diabetes >11.1mmol/L on 2 separate occasions
61
FPG values
normal <7mmol/L | diabetes >7mmol/L on 2 separate occasions
62
test for diabetic control
Hb1AC - gylcated haemoglobin
63
normal Hb1AC value
<7%
64
how does smoking affect the periodontal tissues?
``` CCEB 1 - impaired chemotaxis and phagocytosis 2 - affects cytokine production 3 - affects enzyme catalases 4 - blood flow restricted ```
65
what is IL-1?
a pro-inflammatory cytokine | stimulates the release of enzymes and osteoclasts causing increased tissue destruction
66
desquamative gingivitis
inflamed gingiva extending beyond the mucogingival jct
67
conditions associated with desquamative gingivitis
lichen planus pemphigoid pemphigus
68
local factors that may exacerbate desquamative gingivitis
SLS plaque smoking
69
topical txs for desquamative gingivitis
topical steroids e.g. betamethasone or beclomethasone | tacrolimus MW
70
medications associated with gingival hyperplasia
phenytoin cyclosporine nifedipine
71
managing medication associated gingival hyperplasia
plaque is still the primary aetiological factor so OHI and RSI first if no improvement and pt still has good OH then consider surgery and liase w/GP to discuss changing meds
72
Grade 0 mobility
physiological movement (<0.2mm)
73
Grade 1 mobility
<1mm horizontal
74
Grade 2 mobility
1-2mm horizontal
75
Grade 3 mobility
>2mm and vertical movement (rotations and depressions)
76
Grade 1 furcation
<3mm horizontal
77
Grade 2 furcation
>3mm horizontal but not through and through
78
Grade 3 furcation
through and through
79
how is gingival recession graded?
Miller's classification
80
how would you decide the prognosis of individual teeth?
``` symptoms level of bone loss furcation involvement mobility angular defects making RSI more difficult difficult for pt to maintain short tapered roots ```

perio (8 decks)

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