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Perio > Final > Flashcards

Final Flashcards

1
Q

ASA 1

A

Normal healthy patient. Excludes the very young and very old.

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2
Q

ASA 2

A

Pregnant women and smokers are already in this category. Mild, controlled systemic disease. No functional limitations. Hypertension, diabetes, mild obesity, etc.

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3
Q

ASA 3

A

Severe systemic disease. Some functional limitation. No immediate danger of death. CHF, stable angina, previous heart attack, poorly controlled hypertension, morbid obesity, chronic renal failure, etc.

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4
Q

ASA 4

A

Severe systemic disease that is a constant threat to life. Poorly controlled or at end stage severe disease. Unstable angina, symptomatic COPD, symptomatic CHF, etc.

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5
Q

ASA 5

A

Moribound patients who are not expected to survive without the operation. Probably won’t last more than 24 hours without surgery. Multi-organ failure, sepsis syndrome with hemodynamic instability, hypothermia, poorly controlled coagulopathy, etc.

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6
Q

ASA 6

A

Brain dead patient.

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7
Q

What ASA level do we treat?

A

ASA 1-3.

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8
Q

What local factors lead to attachment loss?

A

Overhanging restoration (usually not a problem if 5 mm from the bone), restoration encroaching on the biological width, defective crown margins, open contacts and food impaction, cervical enamel projections (usually lead to furcation invasion), enamel pearls, palatal radicular grooves, 3rd molars, marginal ridge discrepancies, malocclusion, root pathology such as fractures and perforations.

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9
Q

Where are enamel pearls most often found? What pathology are they associated with?

A

MX 2nd and 3rd molars, often lead to furcation invasion. CT cannot attach to the enamel.

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10
Q

What is the prevalence of palato-radicular grooves and what tooth do they most often occur on?

A

Prevalence: 8.5%

Lateral incisor: 4.4%

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11
Q

What percentage of cervical enamel projections occur on MN and MX molars?

A

MN: 28.6% of all molars
MX: 17% of all molars

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12
Q

Why are cervical enamel projections more susceptible to periodontal breakdown and bacterial infiltration?

A

The enamel, which continues further down the root, often into a furcation, is unable to have a CT attachment.

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13
Q

What are the descriptors we use for gingiva?

A

Color, contour, consistency, texture.

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14
Q

What is the color of gingiva determined by?

A

Vascular supply, thickness, keratinization.

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15
Q

What color is healthy gingiva vs. diseased gingiva?

A

Pink vs. Dark red/brown/purple/black due to excess vascular supply, increased keratinization.
pink, red, cyanotic

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16
Q

What is the contour/shape of gingiva determined by?

A

Location of the proximal contact.

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17
Q

What is the contour of healthy vs. diseased gingiva?

A

Knife-edged papilla vs. blunted papilla. (rolled, rounded, blunted, bulbous, cratered, clefted)

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18
Q

What is the consistency of gingiva determined by?

A

Collagenous lamina propria.

firm, fibrotic, spongy, soft

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19
Q

What is the consistency of healthy vs. diseased gingiva?

A

Firm vs. soft (usually due to edema)

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20
Q

What is the texture of the gingiva determined by?

A

Stippling. Does not indicate the presence or absence of disease.

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21
Q

What is the texture of healthy vs. diseased gingiva?

A

Stippled, smooth, shiny. DOES NOT INDICATE DISEASE.

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22
Q

How do you do a PSR exam?

A

You split the dentition into sextants: Upper right, upper anterior, lower left, etc. Use a who probe to record the deepest pocket depth per sextant. Also, note other findings such as mobility, furcation, bleeding, plaque, etc. If the patient has 2 or more code 3’s or asterisks, then a CPE is indicated.

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23
Q

What are the markings on the WHO probe and what do they mean?

A

Ball tip that measures 0.5 mm.
First section measures 3 mm in length.
2nd section (colored band) measures 3.5-5.5 mm.

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24
Q

Code 0

A

Colored band is completely visible, no BOP, no calculus, no defective margins.

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25
Q

Code 0 treatment?

A

Appropriate preventative care.

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26
Q

Code 1

A

Colored band completely visible, no calculus or defective margins, SOME BOP.

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27
Q

Code 1 treatment?

A

Supra and subgingival plaque removal and OHI.

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28
Q

Code 2

A

Colored band completely visible. BOP present. Supra or subgingival CALCULUS and or DEFECTIVE MARGINS.

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29
Q

Code 2 treatment?

A

Plaque and calculus removal, correct plaque retentive margins and OHI.

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30
Q

Code 3

A

COLORED BAND PARTIALLY SUBMERGED.

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31
Q

Code 3 treatment?

A

Will need CPE of affected sextant if only one sextant is affected. If two or more sextants are affected, a full mouth CPE is indicated.

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32
Q

Code 4

A

COLORED BAND COMPLETELY DISAPPEARS. Depth is greater than 5.5 mm.

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33
Q

Code 4 treatment?

A

Automatically, full CPE.

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34
Q

What does an asterisk mean on a PSR score?

A

Furcation involvement, tooth mobility, mucogingival problems, gingival recession extending to the colored band (3.5 or greater). So, even if a PSR score is low, but they have one of the above criteria, that means they need a CPE.

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35
Q

In what instances do you need a CPE?

A

If 2 or more sextants having a PSR of 3, if 1 sextant has a PSR of 4, if any sextant has an asterisk.

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36
Q

If you were to have a PSR code of 2 in all sextants or just 1 sextant with a PSR code of 3, what would be the treatment?

A

6 month recall, scheduled as an adult prophy.

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37
Q

What are the main components of a perio exam?

A

Medical history, dental histroy, intra/extra oral exam, check for presence of plaque and calculus (plaque index), perio charting with probing, FGM, furcation, suppuration and mobility. PSR score.

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38
Q

Where does the probe stop in health?

A

In healthy gingiva, the probe stops at the apical extent of the epithelium. You will experience resistance.

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39
Q

Where does the probe stop in disease?

A

You will lose resistance that you normally have from the junctional epithelium. Therefore disease leads to you having deeper probing depths.

40
Q

What are the factors that can influence changes in probing depths?

A

Inflammation, probing force calculus, location, angulation and probe design.

41
Q

What is the difference between attachment levels and attached tissues?

A

Clinical attachment level is the distance between the base of the pocket and the CEJ. You use probing depth and FGM to calculate. Negative FGM numbers indicate that the position of the gingiva is coronal to the CEJ and positive FGM values mean that the gingiva is apical to the CEJ.

Attached tissue is the amount of gingiva attached to the alveolar process.

42
Q

How do you calculate attachment levels?

A

Probing depth + FGM

43
Q

How do you calculate Attached Gingiva?

A

Gingival Margin to the MGJ - Probing depth

44
Q

Class 1 mobility?

A

Mobility is greater than normal.

45
Q

Class 2 mobility?

A

Mobile, but less than 1 mm in any direction.

46
Q

Class 3 mobility?

A

Mobile. Greater than 1 mm. Rotation, depressible.

47
Q

Grade 1 furcation?

A

Incipient.

48
Q

Grade 2 furcation?

A

Furcal bone loss, but not through and through. You can feel the “roof” but can’t get to the other side.

49
Q

Grade 3 furcation?

A

Through and through, but not clinically visible.

50
Q

Grade 4 furcation?

A

Through and through AND visible clinically.

51
Q

What are some predictors of disease activity?

A

BOP, suppuration, increase in probing depth, increased mobility.

52
Q

What is the BEST predictor of disease activity?

A

A combination of several of the predictors such as BOP and probing depth.

On it’s own BOP is the better of the predictors. Bleeding frequency greater than or equal to 75% is a good indication of disease and the absence of BOP has a high probability of health.

53
Q

Does an absence of pus indicate health?

A

NO!

54
Q

What does the Modified O’Leary Plaque index indicate?

A

The percentage of how many PLAQUE FREE surfaces that you have.

55
Q

What are bone levels in health?

A

1-2 mm in health

56
Q

What is the most common form of horizontal bone loss?

A

Crater.

57
Q

Infraboney vs. Supraboney

A

Vertical vs. horizontal defects.

58
Q

How long does it take for alveolar bone loss to be visualized radiographically?

A

30-50%. 6-8 months.

59
Q

How much does measuring bone loss through x-ray vary from clinical examination?

A

1.4 mm

60
Q

What are the average lengths of short, medium and long MX molar root trunks?

A

Short-3
Medium-4
Long-5

61
Q

What are the average lengths of short, medium and long MN root trunks?

A

Short-2
Medium-3
Long-5

62
Q

What are the radiographic signs of occlusal trauma?

A

Widened PDL, poorly defined lamina dura, bone loss, altered trabeculation, hypercementosis, root fractures, cemental tears.

63
Q

What are the clinical signs of occlusal trauma?

A

Mobility, fremitus and wear facets.

64
Q

What are the limitations of radiographs?

A

You cannot use radiographs alone to make a differential diagnosis. Need to combine clinical exam. 2D view of 3D structure. Periodontal pockets. Suggests, not confirm morphology of bone deformities. No tooth mobility. Can’t tell whether or not there has been treatment. Position or condition of facial or lingual structures. Soft-tissue to hard tissue relationships.

65
Q

Furcation arrow.

A

Small triangular radiographic shadow across mesial or distal roots of MX molars. Suggests furcation invasion. However, absence of arrow does not mean absence of furcation involvement.

66
Q

What are the best radiographs for making periodontal diagnosis?

A

VERTICAL BITEWING. Most often use PA. Can’t use a pano.

67
Q

What are the magnifications of the different types of radiographs?

A

Periapical-7%
Bitewings-7%
Pano-26%

68
Q

ALARA principle

A

As low as reasonably achievable.

69
Q

What does radiation exposure mean in pregnant women?

A

Try not to do it especially in the first trimester. Protective apron means that fetal radiation is immeasurable.

70
Q

How often do you repeat radiographs?

A

HBW: 1-2 years
VBW: 2 years
Individualized and dependent upon presence or absence of disease and based on clinical judgment.

71
Q

What are the primary etiological factors in periodontal disease?

A

PLAQUE!!!

72
Q

What are secondary etiological factors of periodontal disease?

A

Calculus, genetics, smoking, occlusal trauma, local factors.

73
Q

Are hypertension or pregnancy etiological factors?

A

NO.

74
Q

What bacteria are involved in the Red Complex?

A

Porphyromonas Gingivalis
Trepenoma Denticola
Tanerella Forsythia

75
Q

How much loss of attachment occurs with smoking? Bone loss?

A

LOA: 2.05-4.75
Bone: 5.25-7.28

76
Q

What happens to the mouth when you smoke?

A

Calculus, PD and bone loss. Periodontitis is more prevalent and severe. Altered fibroblast attachment. Decrease in circulating Ab’s, PMN chemotaxis and phagocytosis, and gingival blood perfusion.

77
Q

Early-Onset Periodontitis

A

Aggressive Periodontitis AgP

78
Q

Prepubertal Periodontitis

A

MSD Manifestations of systemic disease

79
Q

Localized Juvenile Periodontitis

A

Localized Aggressive Periodontitis. LAgP

80
Q

Generalized Juvenile Periodontitis

A

Generalized Aggressive Periodontitis. GAgP

81
Q

Rapidly Progressive Periodontitis

A

GAgP

82
Q

Adult Periodontitis

A

Chronic Periodontitis.

83
Q

What are the 3 components of a diagnosis?

A

Extent, severity, type.

84
Q

Describe extent

A

Localized: Less than 30% of the sites

Generalized more than 30% of the sites.

85
Q

Describe severity

A

Mild (1-2 mm), moderate (3-4 mm), severe (5 mm or more)

86
Q

Describe aggressive Periodontitis

A

Rapid progression, no relevant systemic disease, familial.

87
Q

Describe chronic periodontitis

A

Most common, seen at any age, severity and prevalence increase with age.

88
Q

Describe MSD periodontitis

A

Associated with either genetic or hematological disorders.

89
Q

What are Becker’s Classifications?

A

Good, fair, questionable, hopeless.

90
Q

How do you assign prognosis to teeth?

A

Good: None to slight attachment/bone loss. PD 4 mm or less. No mobility to class 1 mobility. No furcation involvement.

Fair: Slight to moderate attachment/bone loss. (1-2) PD 4-6 mm. Class 1 mobility. Grade 1 to shallow to shallow grade 2 furcations.

Questionable: Moderate attachment loss. (3-4) PD 6-8 mm. Class 1-2 mobility. Grade 2 furcations with good access.

Hopeless: Severe attachment loss. (5) Grade 3 furcation. Class 2 to 3 mobility, poor crown/root ratio, root proximity problems.

91
Q

Short term vs long term prognosis

A

Short is less than 5 years. Long term is 5-10 years.

92
Q

What do you need in order to do SRP?

A

Evidence of attachment loss.

93
Q

What are the limitations of scaling and root planing?

A

If you have probing depths averaging 6.2 mm, the maximum depth you will have free of calculus is 3.73 mm and the limitation of the instruments is 6.21.

94
Q

How much probing depth reduction can you expect after SRP?

A

(decreased inflammation and attachment gain improve probing depth)
Initial 5–>.25 AG to 1 PD
Initial 7–>1 AG to 2 PD.

95
Q

Arestin + Sc/RP

A

Addition PD reductions

96
Q

PerioChip + Sc/RP

A

Additional clinical attachment level gains

Perio (1 decks)

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