First 20 pages sdcep Flashcards
1
Q
what does smoking do for signs?
A
The reduced blood flow caused by smoking can suppress the signs and symptoms of disease activity
2
Q
what effect does diabetes have and successful tx?
A
- Diabetes also has an adverse effect on wound healing
- successful non-surgical periodontal treatment can improve glycaemic control.
3
Q
what are other risk factors?
A
- stress, diet, obesity, osteoporosis, rheumatoid arthritis –
- socio-economic status
4
Q
what are risk factors for gingival inflammation and enlargement
A
- pregnancy – hormonal changes and modified immune response implicated in gingivitis and gingival enlargement;
- puberty – hormonal changes can cause increased inflammatory response to plaque, causing gingivitis and gingival enlargement;
- medications – calcium channel blockers for hypertension, phenytoin for epilepsy and ciclosporin, an anti-rejection drug, which can also be prescribed for some autoimmune disorders, may increase the risk of gingival enlargement.
5
Q
what medications cause reduced saliva
A
(tricyclic antidepressants, beta blockers) leading to increased plaque accumulation and risk of disease
6
Q
explain dental plaque biofilm as local risk factor
A
o biofilm provides protection for the microorganisms from both the inflammatory and immune systems and from chemical agents.
o Prescence of this biofilm necessary for perio diseases
o Biofilm - describe the structurally and functionally organised community of microorganisms and supporting matrix adhering to the tooth surface
7
Q
what are other local risk factors?
A
- Calculus
- malpositioned teeth
- overhanging restorations
- partial dentures
8
Q
Conduct and record a visual examination of the patient’s oral tissues and assess?
A
- recession on smooth and interdental surfaces;
- gingival inflammation;
- crowded, drifting or malpositioned teeth;
- restorations/prostheses (if present);
- levels of dental plaque biofilm
- presence of calculus deposits, both supra- and subgingival;
- presence of dental sinuses or suppuration;
- occlusion
9
Q
how to assess plaque biofilm and bleeding
A
- Inflammation of the periodontal tissues occurs in response to the presence of dental plaque biofilm and results in bleeding. Bleeding from the gingival margin is mainly related to inadequate oral hygiene while bleeding from the base of the pocket may indicate that active periodontal disease is present
10
Q
what does full perio exam used to?
A
o determine a diagnosis;
o educate the patient;
o inform treatment choice;
o monitor treatment outcomes;
o assess periodontal status and prognosis on an annual basis for patients with periodontitis during maintenance.
11
Q
what is required for baselines charting and review charting?
A
12
Q
how to do full perio exam chart
A
- record missing teeth
- measure probing depth 6 sites around each tooth
- record bleeding (0 or 1)
- record any suppuration
- record any furcation
- record degree tooth mobility
- Record at least one measure of the greatest extent of gingival recession observed, in millimetres, for both the buccal and lingual surfaces of each tooth
- Consider recording any other observations, such as presence of dental caries, occlusal discrepancies or problems with restorations
- Consider whether a radiographic examination to assess alveolar bone levels is appropriate
13
Q
what does BOP do?
A
- bleeding from the base of the pocket is measured and indicates that active, progressive disease may be present
14
Q
explain probing depth?
A
- Probing depth is the distance from the gingival margin to the base of the pocket
- The position of the gingival margin can change due to swelling or recession so probing depth measurement alone is not recommended for assessment of changes in periodontal support over time.
- Changes probing depth give good indication of response to perio tx in short term
15
Q
explain clinical attachment loss
A
- clinical attachment level (CAL) combines the measurements of probing pocket depth and any gingival recession to give an overall indication of where the periodontal tissues attach to the root surface
- measured from a fixed point usually CEJ to base of perio pocket
- best measure of changes in residual periodontal support over time
16
Q
explain furcation involvement and grades and probe?
A
- use nabers probe
- grade
o 1 - Initial furcation involvement. The furcation opening can be felt on probing but the involvement is less than one third of the tooth width.
o 2 - Partial furcation involvement. Loss of support exceeds one third of the tooth width but does not include the total width of the furcation.
o 3 - Through-and-through involvement. The probe can pass through the entire furcation.
17
Q
explain how tooth mobility assessed and grade?
A
- Tooth mobility is assessed both horizontally and vertically. Horizontal mobility is measured by applying gentle pressure in a buccal-lingual direction,
- Vertical mobility is measured by applying gentle pressure on the crown of the tooth with a rigid instrument handle in a vertical direction.
- Grade
o 0 ‘Physiological’ mobility measured at the crown level.
o 1 Increased mobility of the crown of the tooth to at the most 1 mm in a horizontal direction.
o 2 Increased mobility of the crown of the tooth exceeding 1 mm but less than 2 mm in a horizontal direction.
o 3 Mobility of the crown of the tooth in both horizontal and vertical directions.
18
Q
what is full mouth plaque biofilm assessment?
A
- Plaque disclosing tablets or solutions can aid in the detection of plaque biofilm and act as a visual demonstration of plaque levels for patients. Plaque charts can be used to assist with oral hygiene instruction
19
Q
what do radiographs allow you to do?
A
- Radiographs allow the practitioner to assess:
oroot length and morphology;
oThe level of alveolar bone and remaining bone support;
othe periodontal ligament space and periapical region;
ofurcation involvement of molar and premolar teeth;
orestorations/caries and sometimes subgingival calculus.
20
Q
what do PA’s give you and when to consider bitewing
A
- PA’s info
oextent of bone loss, apical status, endodontic-periodontal lesions, root fractures and deposits on root surfaces. - Consider bitewing
oUniform probing depths >=4 and <6mm (max bpe 3 in any sextant) and little or no recession
21
Q
what to do radiograph perio report?
A
- the degree of bone loss - if the apex is visible this should be recorded as a percentage of the root surface affected;
- the type of bone loss - horizontal or angular/infrabony defects;
- distribution/extent of bone loss – localised or generalised (where radiographic views of multiple teeth are available);
- the presence of any furcation defects;
- the presence of subgingival calculus;
- other features including endodontic-periodontal lesions, widened periodontal ligament spaces, abnormal root length or morphology, overhanging restorations, root fillings, caries.
22
Q
what are used for other diag tools
A
- study models - useful in the monitoring of gingival recession.
- Clinical photographs - useful way of monitoring gingival recession
23
Q
what to do for occlusal exam?
A
- Occlusal trauma does not cause periodontitis
- May accelerate periodontal bone loss or increase tooth mobility
- Where teeth are drifting or increasing in mobility
- Testing for the presence of fremitus
ovibration or movement of a tooth when teeth come into contact - Trauma from the occlusion can increase the complexity of management and periodontal or prosthodontic specialist referral may be necessary
24
Q
what to do for patient risk assessment?
A
- tools include age
- smoking status
- systemic disease status (most notably diabetes)
- pocket depth
- furcation involvement
- bone loss in relation to age.
25
how to ensuring patients' understanding of their risk is considered part of ongoing informed consent
26
what is basic classification of perio diseases?
27
explain perio health?
- characterised by minimal bleeding on probing (<10% of sites) erythema, oedema and patient symptoms, with no attachment loss or and bone loss
- where no bone loss has been lost due to perio other bone loss for other reasons is fine
- 2018 classification
odefines periodontal health as <10% bleeding on probing and all sites with probing depths <=3mm on an intact periodontium or a periodontium that is reduced for reasons other than periodontitis
- for diagnosis relevatant risk factors should also be noted
28
explain gingivitis
- Gingivitis is characterised by the presence of bleeding on probing, erythema and oedema, but no loss of attachment or bone loss
- diagnosis of gingivitis can be applied to patients with an intact periodontium and those with a reduced periodontium for reasons other than periodontitis
- 2018 classification
o gingivitis as ≥10% bleeding on probing and all sites with probing depths ≤3 mm on an intact periodontium or a periodontium that is reduced for reasons other than periodontitis. 8 Patients with gingivitis can be further stratified by the extent of disease, with localised gingivitis defined as 10-30% bleeding sites and generalised gingivitis defined as >30% bleeding sites
o Dental plaque-associated gingivitis can be modified by systemic or local risk factors
29
explain periodontitis
- Periodontitis is characterised by the loss of gingival and periodontal tissues Patients present with a variety of signs including interproximal recession, increased periodontal probing depths, bleeding on probing, mobility of teeth, drifting or loss of teeth and signs of infection with pus on probing. Periodontitis is a result of plaque-induced inflammation that results in loss of periodontal attachment
- 2018 classification
o interdental clinical attachment loss detected at ≥2 nonadjacent teeth. Typically, patients with periodontitis will present with pockets ≥4 mm and/or evidence of interdental recession
- for staging if no radiographs available measurement of attachment loss can be used for diagnosis if no other indication to take radiograph
30
explain necrotising perio diseases
- Necrotising periodontitis is characterised by marginal gingival ulceration with loss of the interdental papillae and a grey sloughing on the surface of the ulcers
31
explain endo perio lesion? signs symptoms risk factors
- Endodontic-periodontal (endo-perio) lesions occur as a result of a pathologic communication between the pulpal and periodontal tissues
- Risk factors for endo perio
o advanced periodontitis,
o trauma
o iatrogenic events (e.g. root perforation)
- may occur in acute or chronic form
- characterised by
o deep periodontal pockets
o and/or negative/altered response to pulp sensibility tests
- may be evidence of damage to the root surface
- Other signs and symptoms may include
o history of trauma
o or root canal treatment
o spontaneous pain
o pain on palpation/percussion
o Pus
o tooth mobility
o sinus tract/fistula
o crown and/or gingival colour alterations
- radiograph determine is root damage and determine site and extent of perio bone loss
32
explain periodontal abscesses? signs symptoms
- Periodontal abscesses are lesions associated with localised accumulation of non-draining pus within the gingival wall of the periodontal pocket associated with rapid tissue destruction
- Signs and symptoms
o localised pain and swelling
o bleeding
o and/or suppuration on probing
o deep periodontal pocket
o increased tooth mobility
33
plan perio treatment and aim and goals
- aim
o control patients’ symptoms;
o reduce inflammation;
o provide advice on risk factor control to reduce the risk of ongoing or future disease;
o stabilise disease;
o support the patient after treatment is complete to either limit further tissue loss or prevent recurrence of disease.
- In a patient with periodontitis, the goal may be to achieve:
o high levels of plaque control;
o complete resolution of gingival bleeding;
o probing pocket depths of ≤4 mm throughout the mouth;
o absence of bleeding at 4 mm sites.
34
how to plan treatment for pmpr
- there is no difference between providing PMPR over one or two long appointments within a 24 hour period
- spreading PMPR over several shorter appointments (quadrant approach).
- BSP-S3 guideline6 suggests that subgingival periodontal instrumentation can be performed either using a traditional quadrant approach or a full mouth approach using a 1 or 2 stage technique within a 24-hour period.
35
what do you need for LA for referral?
36
what to do for smoking cessation?
37
what is control of diabetes?
- Preventing complications associated with the disease,
o retinopathy, coronary heart disease and renal failure
- patients with diabetes should be informed of their increased risk of periodontal disease and the ways in which this can be mitigated.
- Testing to determine the level of glycated haemoglobin (HbA1c) gives an indication of the average blood glucose level in the previous 8-to-12-week period. HbA1c levels of between 48 and 58 mmol/mol (6.5-7.5%) indicate that the patient has good control of their condition, with levels greater than 58 mmol/mol (7.5%) associated with an increased risk of diabetes-related complications.
- The guidelines recommend that adults with diabetes:
o have regular oral health reviews;
o are informed that they are at higher risk of periodontitis;
o are advised that if they do develop periodontitis, managing it can improve their blood glucose control and can reduce their risk of hyperglycaemia;
o are offered dental appointments to manage and treat their periodontal disease.
38
what is managing local risk factors of plaque biofilm?
o Plaque biofilm is the principal local modifiable risk factor for development of gingival inflammation and periodontitis. Plaque biofilm retentive factors (e.g. calculus, local dental crowding, dentures, etc.)
o considered risk factors for disease initiation and progression as they increase the likelihood that oral hygiene will be compromised, and that plaque will accumulate.
o behaviour change approaches are viewed as being important in improving patients’ plaque control
o Oral hygiene instruction (also described as ‘coaching’):
should be individually tailored to suit each patient;
should assist and encourage the patient to improve their oral hygiene skills as well as their understanding of the value of good self-care routines;
should be delivered in a manner that actively involves the patient in skill acquisition rather than passively delivering information, for example, giving the patient the opportunity to practice in their own mouth with support from the dental team.
o motivation to change behaviour has to originate from the patient
39
adverse effects of chx?
o dry mouth and tooth staining. In addition, although rare, allergic reactions, including anaphylaxis, are a recognised adverse effect.
40
what is TIPPS?
