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Perio > Fall 2024 Midterm > Flashcards

Fall 2024 Midterm Flashcards

1
Q

The __ classification system is an older system (1999) that was used in the development of a classification system for periodontal disease and conditions

A

Armitage

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2
Q

What are the 2 advantages of the Armitage classification system

A

Comprehensive review of periodontology
Clinical attachment levels highlighted

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3
Q

Patients under 25 must be evaluated for a differential diagnosis of

A

Molar/incisor pattern periodontitis
(aka: aggressive periodontitis; localized juvenile periodontitis)

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4
Q

In people under 25 with molar/incisor pattern periodontitis, assess for localized bone loss associated with the __

A

first molar and incisor teeth
(also assess OH relative to disease)

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5
Q

__ calculus is a frequent finding with chronic periodontitis

A

Subgingival calculus

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6
Q

Chronic periodontitis has a slow to moderate rate of progression, but may have periods of __

A

rapid destruction

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7
Q

What systemic disease is chronic periodontitis most often associated with

A

Diabetes mellitus and HIV

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8
Q

Chronic periodontitis can be modified by factors other than systemic diseases such as __ and __

A

Cigarette smoking and emotional stress

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9
Q

Whether chronic periodontitis is localized or generalized depends on the

A

percentage of sites affected (6 sites per tooth : mesial, buccal, lingual, distal ..)

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10
Q

What classifies generalized chronic perio

A

> 30% of sites affected
On both anterior and posterior teeth

(Can also be defined as perio without a clear pattern of disease distribution of affected teeth)

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11
Q

What classifies localized perio

A

<30% of sites affected
Usually only on posterior teeth - no anterior

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12
Q

What is the exception to localized chronic perio

A

Aggressive incisor and molar pattern

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13
Q

If a pattern exists with chronic perio, is it generalized or localized

A

Neither, descriptive terminology is more accurate
(Ex: chronic periodontitis localized to max. molars with severe lesions on the premolars)

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14
Q

We do NOT use this classification system, but it can be seen in older chart note. Severity of clinical attachment loss and armitage system of diagnosis
Slight chronic perio =
Moderate chronic perio =
Severe chronic perio =

A

1-2 mm of attachment loss
3-4 mm of attachment loss
>5mm of attachment loss

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15
Q

Disadvantages of Armitage

A

Time consuming
Inaccuracies from probing angles
Root length disregarded
Difficult to determine CEJ
Systemic disease and local factors ignored
Doesn’t account for pseudopockets

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16
Q

CAL stands for

A

Calculated attachment loss

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17
Q

Measurements taken for CAL are in relation to the

A

CEJ

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18
Q

If the patient has gingivitis there is

A

NO attachment loss
The gingiva is inflamed; assume the negative reciprocal for pocket depth that are 1-3mm
(Do NOT need to enter this in the chart)
PIC in notes

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19
Q

When there is gingivitis and theres a pseudo-pocket of 4+ mm (the probe did not contact the CEJ) what must you do

A

You MUST put the negative reciprocal into axium (cant leave it out of the chart like with 1-3mm depths on gingivitis). Failure to do so will indicate a true pocket

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20
Q

Why is is important to chart correctly for gingivitis patients

A

Distinguishes prophys (D4341) from SRPs (D4342) or scaling with inflammation (D4346)

(Scaling with inflammation is used when theres no root to scale, or with younger patients that have sub gingival calculus and edema, or patients with associated pharmacologic effects)

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21
Q

If the patent has chronic periodontitis (true pocket) with a gingival margin above the CEJ what do we chart for GM

A

Assume -2mm for the gingival margin measurement to account for the gingiva above the CEJ
(Does NOT contribute to the true pocket depth)

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22
Q

Patients with sub-gingival calculus on enamel without CAL loss are __ for SRP

A

not appropriate

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23
Q

When there is recession present, how is GM charted

A

with a positive number instead of a negative number to show the true attachment loss
(Pocket + GM = attachment loss)

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24
Q

Exposure of the root surface by an apical shift in the position of the gingiva

A

Recession

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25
Q

With root exposure these 2 things shift apically

A

Junctional epithelium
Gingiva

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26
Q

The actual recession is measured as

A

from the CEJ to the level of attachment

(The level of the attached periodontal tissue, not directly visible but determined by probing)

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27
Q

Visible on clinical examination from the gingival margin to the CEJ

A

Apparent recession

(The level of the gingival margin or crest of the free gingiva that is seen by direct vision)

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28
Q

3mm PD or less place the __ in the GM or __

A

negative of that number
blank

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29
Q

Enter __ for GM for pseudo-pockets

A

negative numbers

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30
Q

Enter __ when the GM is at the CEJ

A

0

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31
Q

4mm or greater pocket with CAL place a __

A

negative 2 GM or blank (??)

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32
Q

Causes of Recession

A

Patient self-care ( hard/incorrect brushing, abrasive dentifrice/toothpaste, hard brush)

Anatomical (eruption patterns, position of the tooth within the alveolus)

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33
Q

Fenestration vs dehiscence
(both are anatomical predispositions to recession)

A

Fenestration = window of bone loss exposing root
Dehiscence= alveolar bone loss and complete root exposure

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34
Q

Know how to identify
Early recession
Stillman cleft
palatal recession
McCall Festoon
Localized recession

A

Stillman cleft = narrow shaped triangular recession on buccal
McCall Festoon= scalloped GM that protrudes or buldges out near the tooth

Look at PIC

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35
Q

Gingival phenotype

A

Prob visible = thin, < or at 1 mm
Probe not visible = thick, >1mm

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36
Q

Recession Type I (RT1)

A

Gingival recession with no loss of interproximal attachment
Inter-proximal CEJ is not clinically detectable at both mesial and distal aspects of the tooth

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37
Q

Recession Type 2 (RT2)

A

Gingival recession WITH loss of interproximal attachment
The amount of interproximal attachment loss (from the interproximal CEJ to the depth of the pocket) is less than or equal to the buccal attachment loss (from buccal CEJ to the apical end of the buccal pocket)

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38
Q

Recession Type 3 (RT3)

A

Gingival recession associated WITH loss of interproximal attachment
The amount of interproximal attachment (from the interproximal CEJ to the apical end of the pocket) is HIGHEr than the buccal attachment loss

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39
Q

Miller Class 1 recession

A

Recession is NOT to the MGJ
NO interproximal bone or papilla loss
100% coverage possible with bone graft (B/c interproximal coverage offers a blood supply)
PIC

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40
Q

Miller Class 2 recession

A

Recession past the MGJ
NO interproximal bone or papilla loss
100% coverage possible with bone graft (B/c interproximal coverage offers a blood supply)
Possibility of root coverage
PIC

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41
Q

Miller Class 3 recession

A

Recession past the MGJ
Interproximal bone or papilla loss
Malposition
Partial coverage
PIC

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42
Q

Miller Class 4 recession

A

Recession past the MGJ
Severe interproximal bone or papilla loss
Malposition
NO coverage
PIC

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43
Q

Why might the free gingival margin be at the level of the CEJ

A

Previous Perio
Recession
Attrition with age
Malposition of teeth

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44
Q

If the embrasure space between 2 teeth is NOT filled with gingival tissue/papilla = black triangle, this indicates

A

GM at the CEJ

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45
Q

When the GM is at the CEJ what do we chart for GM

A

0

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46
Q

What do we use to find a furcation

A

Nabers probe

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47
Q

Class I furcation

A

A depression that does not catch the probe

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48
Q

Class II furcation

A

A furcation deep enough to catch the probe but not contiguous with other furcation on the same tooth

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49
Q

Class III furcation

A

Bone loss through and through but covered with gingival tissue

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50
Q

Class IV furcation

A

Bone loss through and through and directly exposed to the oral environment, the gingival margin is apical to the entrance of the furcation

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51
Q

How do you approach maximally molars for feeling furcations

A

Since there are 3 roots (palatal) of maxillary molars, you should treat each root as a separate tooth (feel mesial and distal aspects of the root)
(same for 2 roots

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52
Q

When entering furcations into axium, place number in the __ box only

A

middle
(Except on the lingual of max molars where you have a palatal root, then you would put it mesial or distal)

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53
Q

What is an anatomical anomaly that can be felt when feeling for furcations

A

enamel pearls

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54
Q

This is a marker of disease activity and must be noted in the chart

A

BOP
Bleeding on Probing

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55
Q

Measures actual positives correctly identified (% of population which has a condition)

A

Sensitivity

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56
Q

Measures the actual negatives correctly identified (% of population which does not have a condition)

A

Specificity

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57
Q

BOP has high __ and low __

A

Specificity
Sensitivity

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58
Q

__ is the degree of looseness of a tooth when we move it. It is due to __ or is prior to perio treatment due to __

A

Mobility
inflammation and/or bone loss
trauma

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59
Q

Two ways we evaluate a tooth for mobility

A

Incisal - apical
buccal- lingual

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60
Q

Grades of mobility 0-3

A

0= within physiological limits
1= less than 1 mm BL/MD direction
2 = 1mm or more in BL/MD direction
3 = exceeding 1 mm and depressible (up/down) in an occluso-apical direction

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61
Q

The movement of teeth during function or parafunction

A

Functional mobility

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62
Q

__ can often be detected earlier than bidigital tooth mobility and has been associated in the presence of inflammation, with increased bone and attachment loss (pocket formation)

A

Fremitus

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63
Q

The index finger is placed on the labial surface of the tooth or teeth and the patient is asked to grind in later and protrusive movements. Any movement seen or felt is termed __

A

Fremitus (displacement of a tooth from the bite)

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64
Q

Attached gingiva measurement

A

Measure from GM to MGJ outside of the pocket, and then subtract the pocket depth
PIC
(also look at pic of calculating in axium)

65
Q

Recession enter the __ in the GM

A

Positive number

66
Q

3mm or less PD enter the GM as the __

A

negative of the PD (or leave blank)

67
Q

Pseudopockets place the __ in the GM

A

negative of the PD

68
Q

IF periodontitis, then 4 PD or greater a __ GM

A

negative 2 (always give -2 when >/= 4mm)

69
Q

__ GM when the FGM is at the CEJ

A

0

70
Q

What to do if you cannot probe

A

Inform faculty
Radiographs - extractions ?
Plan an SRP if appropriate ( obtain quad by quad) - complete chart on last SRP
NEVER full mouth debridement (can blow and abcess)

71
Q

3 major components of a periodontal examination

A

Diagnosis (ID)
Treatment plan (plan of action)
Prognosis (expected therapy)

72
Q

The new classification system is based on an __ model

A

oncology (stage and grade)

73
Q

Severity and extent of disease

A

Stage

74
Q

Complexity assessment (CAL and Radiographic bone loss) - reflects what you have to treat

A

Stage

75
Q

Estimates of future risks, rate of progression, response to therapy and systemic implications.

A

Grade

76
Q

Reflects the prognosis

A

Grade

77
Q

The severity of the periodontal diagnosis will be based on the __

A

most severe tooth

78
Q

Periodontal health and gingival health= clinical gingival health on an __ or __ periodontium

A

intact
reduced (stable periodontitis or non-stable periodontist patient)

79
Q

Gingivitis is __ induced and mediated by __ or __ risk factors. Can also have __ gingival enlargement

A

dental biofilm
systemic or local
drug-induced

80
Q

Can also have gingival disease that are __

A

non-dental biofilm induced

(Genetic/developmental disorders, infections, immune conditions, reactive process neoplasms, endocrine, nutritional and metabolic diseases, traumatic lesions, gingival pigmentation)

81
Q

3 forms of periodontitis

A

Necrotizing periodontal disease (dead tissue)
Periodontitis as manifestation of systemic diseases
Periodontitis (stages and grades)

82
Q

Other conditions affecting the periodontium

A

Systemic diseases or conditions affecting perio supporting tissue
Other perio conditions (abscess, lesions)
Mucogingival deformities and conditions around teeth
Traumatic occlusal forces
Prostheses and tooth-related factors that predispose to plaque induced gingival/perio

83
Q

How to stage and grade periodontitis is based on the __ World workshop on the classification of periodontal and peri-implant disease

A

2017

84
Q

The new staging a grading system of periodontal disease is __, but not __

A

simple, but not simplistic

(incorporates presence and control of risk factors in the diagnosis, highlights patient response to treatment, eliminates overlap of former disease categories, strives for more diagnostic precision)

85
Q

The new disease classification system uses clinical attachment loss primarily at __ sites but may also include __ sites

A

interdental
buccal/oral

86
Q

The apical migration of the attachment apparatus, measured as the distance from the CEJ to the base of the periodontal pocket/sulcus

A

Clinical Attachment Loss

87
Q

Periodontitis definition based on CAL

A

Interdental CAL detected at >= 2 non-adjacent teeth OR buccal or oral (lingual) CAL >= 3 with pocketing >3mm is detectable at >=2 teeth

(Clinical judgement should be used; if there is an excessively large CAL on 1 tooth this can still be considered periodontitis)

88
Q

An observed CAL cannot be ascribed to non-periodontitis-related causes. These are all things that cause a fake CAL

A

Gingival Recession of traumatic origin

Dental caries extending in the cervical area of the tooth

Presence of CAL on the distal aspect of a second molar and associated with malposition or extraction of a third molar

An endodontic lesion draining through the marginal periodontium

The occurrence of a vertical root fracture from endo treatment

89
Q

The stage reflects the severity of disease at the __ and is expressed through __ and __

A

most affected area
attachment and bone loss

90
Q

This reflects the tooth loss that has occurred as a result of periodontitis and the anticipated complexity of treatment required

A

Stage

91
Q

How many stages can be assigned to a patient

A

Only one, stage is patient based not tooth-based

92
Q

3 categories of staging

A

Severity
Complexity
Extent and distribution

93
Q

What is included in the severity of staging

A

Interdental CAL
RBL
Tooth loss due to periodontitis

94
Q

What is included in the complexity of periodontitis staging

A

Probing depths
type of bone loss
furcation involvement
ridge defects
masticatory disfunction
occlusal trauma
bite collapse, drifting, flaring

95
Q

What does extent and distribution mean in the staging of periodontitis

A

extent describes the % of teeth affected by the severity level that defines that stage
Localized or generalized
Molar-incisor pattern of distribution

96
Q

What are the interdental cals for stages I-IV

A

Stage I = 1-2mm
Stage II = 3-4 mm
Stage III = >=5mm
Stage IV= >=5mm

97
Q

Stage I-IV of RBL

A

Stage I = coronal third
Stage II = coronal third
Stage III = extending to middle third of root and beyond
Stage IV = extending to middle third of root and beyond

98
Q

Stage I-IV of tooth loss

A

No tooth loss - stage I and II
<=4 teeth = stage III
>=5 teeth = Stage IV

99
Q

Mostly horizontal bone loss

A

Stage I and II

100
Q

Max probing depths for stage I -stage IV

A

Stage I = <=4mm
Stage II = >5mm
Stage III = >6mm

101
Q

If less than 20 teeth remaining

A

Stage IV

102
Q

If depth all 4 but patient is grade A its probably __ so do a __ not an SRP

A

pseudopockets
4346

103
Q

Only stage and grade with

A

active perio

104
Q

These patients show periodontitis of mild to moderate severity and have not lost any teeth due to disease

A

Stage I and II patients

105
Q

These are more complex cases, they require more advanced periodontal treatment, extent of tooth loss requires extensive rehabilitation in

A

Stage III and IV patients

106
Q

__ is the most accurate parameter for staging, we will use __ for staging if we don’t have this

A

Inter-proximal CAL
RBL

107
Q

Vertical bone loss >= 3 mm

A

automatic stage III

108
Q

Furcation involvement of class II or class III

A

automatic stage III

109
Q

These cases we send to grad perio

A

Stage III and IV

110
Q

This allows the clinician to incorporate individual patient factors into the diagnosis, which are crucial to comprehensive case management

A

Grade

111
Q

What three things does grade describe

A

observed/inferred progression rate

risk for further deterioration due to environmental factors (smoking) and co-morbidities (diabetes)

Risk that disease/treatment may adversely affect general health

112
Q

Grading is based on 3 fundamental principles

A

Not all individuals are equally susceptible to periodontitis

Multiple factors interact to influence the clinical phenotypes

Some cases require more intensive control of the biofilm and inflammation

113
Q

Grade A-C

A

Rate of progression
Grade A = slow
Grade B = moderate
Grace C = rapid

114
Q

Assume grade __ until clinical or medical history provide evidence of more rapid or slower progression or risk factors increase the probability of more rapid progression

A

B

115
Q

Usually a patient who is grade C is

A

over responding

116
Q

What are the 2 grade modifiers

A

Smoking and diabetes

117
Q

smoking grade A vs B vs C

A

A = doesnt smoke
B = < 10 cigs a day
C = > 10 cigs a day (more than 1/2 a pack)

118
Q

Diabetes grade A vs B vs C

A

A = no diabetes
B = HbA1c < 7% (horizontal bone loss)
C = HbA1c >7% (vertical bone loss)

119
Q

To establish the grade/ rate of progression you need direct evidence of progression by __

A

RBL or CAL over 5 years

120
Q

Indirect evidence of grade

A

% bone loss / age
- IF % bone loss is more than their age = Grade C
- If around 1/2 = Grade B

Biofilm deposits or level of destruction

121
Q

Revision of the Grade upwards is possible if the __ increases or the risk profile of the patient deteriorates

A

% bone loss / age ratio

122
Q

3 steps to staging and grading a patients

A

Step 1 : Case overview (screening - probing depths, full mouth radiographs, missing teeth)
Step 2 : establish stage
Step 3 : establish grade

123
Q

15% root length
>30% root length

A

Grade B
Grade C

124
Q

Peri-implant diseases
Diagnostic aids

A

Visual inspection
Probing (plastic)
X-rays (at time of placement and 1 yr after abutment connection)

125
Q

Absence of erythema, BOP, swelling and suppuration (discharge of pus) with implant
NO bone loss <2 mm

A

Peri-implant health

126
Q

Not possible to define a range of probing depths compatible with health for an implant due to

A

NO long junctional epithelium attachment to implant

127
Q

Main characteristic = BOP with gentle probing of an implant
Erythema, swelling/inflammation and or suppuration may be present

A

Peri-implant mucositis

128
Q

Absence of additional bone loss beyond initial bone remodeling
<2mm of bone loss

A

Peri-implant mucositis

129
Q

Peri-implant mucositis etiological factor =

A

plaque

130
Q

Plaque associated pathological condition
Characterized by inflammation of the peri-implant mucosa and subsequent progressive bone loss
Clinical signs of inflammation, increased probing depths, and or mucosal recession in addition to loss of supportive bone

A

Peri-implantitis

131
Q

Peri-implantitis in the absences of previous examination

A

PD at 1 year postload
In absence of exam:
PD >= 6 mm
BOP
BL >= 3 mm

132
Q

Conditions following the normal healing process of tooth loss that leads to diminished dimensions of the alveolar process/ridge, resulting in both hard- and soft tissue deficiencies

A

Peri-implant soft and hard tissue deficiencies

133
Q

Your assessment of the expected outcomes of suggested treatment

A

Prognosis

134
Q

KWOK, Caton Et Al 2007

A

Guidelines for prognosis

135
Q

The periodontal status of the tooth can be stabilized with comprehensive periodontal treatment and maintenance
Future loss of the periodontal supporting tissues is unlikely if these conditions are met

A

Favorable prognosis

136
Q

The periodontal status of the tooth is influenced by local and/or systemic factors that may or may not be able to be controlled
The periodontium can be stabilized with comprehensive treatment and maintenance if these factors are controlled; otherwise, future periodontal breakdown may occur

EX: High HbA1c that is being treated, or quitting smoking, changing meds

A

Questionable Prognosis

137
Q

The periodontal status of the tooth is influenced by local and/or systemic factors that cannot be controlled
Periodontal breakdown is likely to occur even with comprehensive periodontal treatment and maintenance

EX: not quitting smoking, uncontrolled diabetes, patients who are developmentally challenged and are unable to brush teeth

A

Unfavorable Prognosis

138
Q

Tooth must be extracted

A

Hopeless prognosis

139
Q

The only evidence based prognosis scheme for molars with furcations

A

Miller prognosis

140
Q

These teeth have the worst miller prognosis

A

Max 2nd molars
Automatically mark as 2

141
Q

With miller prognosis, numbers are plugged in to get __ year and __ year perio prognosis (which is helpful in informing patients of likelihood of success/failure of crowns, abutments etc. from a perio health standpoint)

A

15 year
30 year

Helps Legally if a tooth fails
DOES not help if tooth id carious (must do E&E)

142
Q

Ideally want a miller score of

A

below 5

143
Q

May have minimal recession without pre-existing active periodontal disease

A

Health

144
Q

A healthy state in a patient with previously diagnosed periodontal disease (attachment loss)

A

Stability

145
Q

4 categories of periodontal health

A

Pristine Periodontal Health
Clinical Periodontal Health
Periodontal Disease Stability
Periodontal Disease Remission/Control

146
Q

Denotes the absence of pocket depths >3mm, attachment loss, BOP <10%, clinical erythema,edema or pus

A

Pristine Periodontal Health

147
Q

Can contain attachment loss die to recession, BP <10%, no edema, erythema, or pus. NO pocket depth of clinical importance. Absence of minimal levels of clinical inflammation. Normal osseous support

A

Clinical Periodontal Health

148
Q

Absence of inflammation and infection. Reducing predisposing factors
Control modifying factos
On a reduced periodontium (over brushing, trauma, ortho)

A

Periodontal disease stability

149
Q

Goal of periodontitis patients

A

Periodontal disease stability

150
Q

Cannot fully control modifying/predisposing factors. Decreased inflammation, improvement in clinical parameters, stabilization of disease progression to low disease activity, may be an acceptable alternative therapeutic goal in long standing periodontal disease

A

Periodontal disease remission/control

151
Q

Preferred term for gingivitis

A

inflammation of reduced periodontium

152
Q

Diagnosis sequence for chronic periodontitis

A

Generalized or localized
stage or grade
chronic periodontitis at end

EX: generalized stage I Grade B chronic periodontitis

153
Q

D0180

A

Dental examination
- will not charge patient
- updated annually
- liquid stain for plaque index
- Diagnosis, TX, prognosis
- probing is an invasive procedure

154
Q

D1330

A

Oral hygiene instructions

ALL competencies MUST have an approved plaque index entered in axium

155
Q

D1110

A

Dental Prophylaxis
- usually on gingivitis cases
- recall every 6 m
- remove plaque calculus and staining
- do not polish calculus

156
Q

D4341 and or D4342

A

Scaling and Root planing
- MUST have attachment loss documented
- PD >4mm
- MUST anesthetized
- 1 quad at a time
- Dont polish

157
Q

D4346

A

Scaling for gingivitis/ in presence of inflammation
- subgingival calc no bone loss
- anesthesia when/where indicated
- re-eval 4-6 wks

158
Q

D4910

A

Perio maintenance

Limited SRP w/ anesthesia is part of the code

Perio (2 decks)

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