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perio > exam notes (big doc) > Flashcards

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
Q

bacteria in aggressive periodontitis

A 
aggregatibacter actinomtcetemcomitans (AA)
porphyromonas gingivalis
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26
Q

why does mobility indicate poor prognosis?

A

reduced bone support

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27
Q

why does furcation involvement indicate poor prognosis?

A

more difficult to keep clean for pt

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28
Q

why does LOA indicate poor prognosis?

A

less supporting structures for tooth

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29
Q

factors which indicate poor prognosis for a tooth

A

mobility
furcation involvement
LOA
non-vitality

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30
Q

further info needed from pt before determining poor prognosis teeth

A

smoking
drug history
systemic disease

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31
Q

how is localised angular periodontitis caused?

A

when pathway of inflammation travels directly into PDL space, localised PRFs

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32
Q

classifying localised angular periodontitis

A

mild <30%
moderate 30-50%
severe >50%

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33
Q

3 clinical/radiographic signs of healing

A

gingival recession - black triangles
clinical reattachment - reduced probing depth
reduced BOP

34
Q

difference between horizontal and angular bone loss

A

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
Q

how does a healthy periodontium react to traumatic occlusion?

A

PDL widening so mobility
no LOA or inflammation
will resolve once occlusion sorted

36
Q

how does a healthy but reduced periodontium react to traumatic occlusion?

A

same but due to less PDL mobility is increased

37
Q

how does a periodontitis periodontium react to traumatic occlusion?

A

plaque still primary etiological factor but may make rate of LOA faster
widened PDL and mobility same

38
Q

what is CHX?

A

biguanide antiseptic

39
Q

CHX mode of action

A

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
Q

CHX substantivity

A

12 hours

41
Q

give 2 common doses of CHX

A
  1. 2% 10ml/20mg 2x daily

0. 12% 15ml/18mg 2x daily

42
Q

side effects of CHX

A 
staining
taste disturbance
salivary gland enlargement
anaphylaxis
interacts with SLS
43
Q

uses of CHX

A 
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
Q

how is HPT provided?

A

non-surgical periodontal therapy - scaling and RSI
remove PRFs
OHI

45
Q

HPT success

A

pockets <4mm
plaque scores <15%
bleeding scores <10%

46
Q

TIPPS

A 
OHI
Talk
Instruct
Practise
Plan
Support
47
Q

things recorded on a PD pocket chart

A 
teeth missing
gingival margin
pocket depth
LOA
mobility
furcation
BOP
48
Q

give 2 disadvantages of a pocket chart

A

assumes all pts have same root length so may appear worse than they are
probing depths are subjective/variation between operators

49
Q

local factors for gingival recession

A 
periodontal disease
habits
traumatic tooth brushing
abrasive toothpaste
high frenal attachment
traumatic overbite
orthodontics
poor marginal fit restorations
50
Q

how can you measure recession?

A

photos
study models
pocket chart

51
Q

how is localised recession managed?

A 
atraumatic tooth brushing technique
minimise other risk factors
monitor
treat sensitivity
free/pedicle ST graft (from palate)
coronal advancement flap
52
Q

what would you look for in a pt who wants an implant?

A 
bone quantity and quality
pt motivation
OH
smoking
MH e.g. bisphosphonates
restorative options
53
Q

intervention for inadequate bone levels

A

GTR
bone graft
biological mediator = Emdogain (enamel matrix derivative)
sinus lift

54
Q

mechanism of a vertical bone defect

A

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
Q

how are vertical defects classified?

A

by number of walls: 1,2 or 3 wall defects

- 2 and 3 wall defects heal better

56
Q

indications for regenerative periodontal surgery

A

2 and 3 walled defects
grade 2 furcation in mandibular teeth
grade 2 buccal furcation in maxillary molars

57
Q

why might NST for PDD be unsuccessful?

A 
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
Q

why is diabetes a risk factor in PDD?

A

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
Q

give 2 tests to test for diabetes

A

RPG - random plasma glucose

FPG - fasting plasma glucose

60
Q

RPG values

A

normal <11.1 mol/L

diabetes >11.1mmol/L on 2 separate occasions

61
Q

FPG values

A

normal <7mmol/L

diabetes >7mmol/L on 2 separate occasions

62
Q

test for diabetic control

A

Hb1AC - gylcated haemoglobin

63
Q

normal Hb1AC value

A

<7%

64
Q

how does smoking affect the periodontal tissues?

A 
CCEB
1 - impaired chemotaxis and phagocytosis
2 - affects cytokine production
3 - affects enzyme catalases
4 - blood flow restricted
65
Q

what is IL-1?

A

a pro-inflammatory cytokine

stimulates the release of enzymes and osteoclasts causing increased tissue destruction

66
Q

desquamative gingivitis

A

inflamed gingiva extending beyond the mucogingival jct

67
Q

conditions associated with desquamative gingivitis

A

lichen planus
pemphigoid
pemphigus

68
Q

local factors that may exacerbate desquamative gingivitis

A

SLS
plaque
smoking

69
Q

topical txs for desquamative gingivitis

A

topical steroids e.g. betamethasone or beclomethasone

tacrolimus MW

70
Q

medications associated with gingival hyperplasia

A

phenytoin
cyclosporine
nifedipine

71
Q

managing medication associated gingival hyperplasia

A

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
Q

Grade 0 mobility

A

physiological movement (<0.2mm)

73
Q

Grade 1 mobility

A

<1mm horizontal

74
Q

Grade 2 mobility

A

1-2mm horizontal

75
Q

Grade 3 mobility

A

> 2mm and vertical movement (rotations and depressions)

76
Q

Grade 1 furcation

A

<3mm horizontal

77
Q

Grade 2 furcation

A

> 3mm horizontal but not through and through

78
Q

Grade 3 furcation

A

through and through

79
Q

how is gingival recession graded?

A

Miller’s classification

80
Q

how would you decide the prognosis of individual teeth?

A 
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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