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Periodontology > Gingivitis and Periodontitis > Flashcards

Gingivitis and Periodontitis Flashcards

1
Q

What are the clinical manifestations of plaque-induced gingivitis?

A

Erythematous gingivae
Oedematous gingivae
Loss of knife-edged margin
Loss of stippling
BOP or bleeding on brushing
Plaque present at the gingival margin
No clinical attachment loss or alveolar bone loss
Gingival sulcus measures 3mm or less from the gingival margin to the base of the junctional epithelium which is still at the CEJ
Clinical changes are reversible at this stage

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2
Q

What are the clinical manifestations of periodontitis?

A

Loss of periodontal connective tissue attachment

Gingival sulcus measures greater than 3mm from the gingival margin to the base of the junctional epithelium, which has migrated apically with the formation of a rue periodontal pocket.

Alveolar bone loss

Irreversible changes.

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3
Q

What might someone complain of if they have periodontitis?

A

Drifting teeth
Mobile teeth
Sensitivity if root surface exposed
Recession
Aesthetics
Unable to chew properly
Spacing
Abscesses

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4
Q

What is the BPE?

A

Basic periodontal examination- screening tool for perio.

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5
Q

What probe would you use for a BPE?

A

WHO probe- 0.5mm wide ball on the end, black band 3.5-5.5mm, second black band is 8.5mm-11.5mm.

UNC probe- 15mm long, markings at 5th, 10th and 15th mm.

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6
Q

What probing force should be used?

A

20-25g.

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7
Q

What are the pros and cons of BPE?

A

Pros- advises on potential further investigations and treatment, quick and easy to do.

Cons- gives no indication for the degree of bone loss, progression of periodontitis.

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8
Q

What are the name of the BSP guidelines?

A

BSP Clinical practice guidelines for the treatment of periodontal diseases.

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9
Q

What are the two general approaches to BPE code of 3?

A

Option 1- if a sextant scores 3, that sextant should be reviewed after treatment and a 6 point pocket chart completed for that sextant only after initial therapy is complete (3 months)

Option 2- 6PPC done for that sextant before treatment and after.

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10
Q

What would warrant a full mouth 6PPC?

A

Code 4 or evidence of interdental recession.

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11
Q

According to BSP, what radiographs should be taken in a perio patient?

A

Gold standard is full mouth PA or PA of sextants with code 3.

Can use OPT instead- quicker, less uncomfortable for the patient, useful assessment of other pathologies.
- may need supplemented in anterior region.

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12
Q

What should be included in the radiographic assessment of perio patients?

A

Degree of bone loss: if the apex is visible then bone loss should be measured and reported as a percentage
* Pattern or type of bone loss: e.g. horizontal bone loss or angular (vertical) defects
* Presence of furcation defects
* Presence of subgingival calculus
* Other features: e.g. perio-endo lesions; widened periodontal ligament spaces; abnormal root length or root morphology; overhanging restorations.

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13
Q

What other risk factors are present for perio?

A

Cardiovascular disease
Smoking
Poorly controlled diabetes

Potentially- RA, Chronic kidney disease

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14
Q

During a 6PPC- what parameters are you assessing?

A

Gingival margin
Probing depth
BOP
Mobility
Furcation
LOA

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15
Q

During a review 6PPC, what are you assessing?

A

Pocket depth
Furcations
Mobility
BOP

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16
Q

Describe the grading of mobility.

A

0- 0.1-0.2mm in a horizontal position.

1- increased mobility of the crown of the tooth to at the most 1mm in a horizontal direction.

2- Visually increased mobility of the crown of the tooth exceeding 1mm in a horizontal direction.

3- Severe mobility in both horizontal and vertical direction impinging on the function of the tooth.

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17
Q

Describe the measurement of furcation involvement.

A

Can use a Nabers furcation probe.

1- less than 1/3 of the tooth width

2- loss of support exceeds one third of the tooth width but does not include the total width of the furcation.

3- Through and through involvement.

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18
Q

Why might manual probing depth measurements be influenced by?

A

Patient discomfort
Calculus deposits
Resistance of the tissues
Size and angle of the probe
Pressure applied

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19
Q

What forms part of the HPT of treatment?

A

OHI- brushing technique, size interdental brushes, use disclosing tablets to show patient areas they’re missing

Mouthwashes- fluoridated mouthwashes that are alcohol free
Can prescribe chlorhexidine 0.2% but only in patients where pain limits mechanical plaque removal.

Single tufted brushes- clean maligned teeth, clean distal aspect of last molar teeth
Superfloss

20
Q

What instructions would you give for interdental cleaning?

A

Should be a snug fit but not touching the wire.
8-10 back and forth strokes.

21
Q

Why is it important to have good supra and subgingical plaque control?

A

If supra gingival plaque removal was done aline- decreased gingival inflammation but no change in attachment levels, no change to the microflora in deep pockets, limited effect on probing depth.

If sub gingival plaque control was done alone- initial reduction in inflammation and deep pocket but pockets would quickly re-colonise by bacteria from supragingival plaque.

22
Q

After Supra and sub gingival plaque removal, what are you aiming for?

A

Decreased gingival inflammation
Decreased probing depths
Gain in probing attachment levels
Marked changes in the subgingival microbial flora.

23
Q

How often should BPE and MPBS be carried out?

A

MPBS- at every visit
BPE- first visit and then at every check up visit, unless already established as a o perio patient

24
Q

What do MPBS assess?

A

oral hygiene.

Bleeding scores- marginal bleeding.
Plaque- how well the patient is removing plaque from different surface.

25
Q

What are Ramfjord’s teeth?

A

16, 21, 24, 36, 41, 44.

26
Q

What are the pros and cons of a full 6PPC?

A

Advantages- gives a full picture of periodontal attachment loss

Disadvantages- more time consuming

27
Q

What are the pros and cons of an abbreviated/review pocket chart?

A

Advantages- quicker, can efficiently highlight areas requiring further treatment

Disadvtnages- does not record LOA, therefore, this could progress unnoticed.

28
Q

What is recommended in terms of pocket charts and when to use them?

A

Use the full 6PPC as a baseline and then can use review charts at the review appointments.

29
Q

What are guidelines called for classification of perio diseases?

A

2017 classification of periodontal disease to reach a diagnosis in clinical practice.

30
Q

What would you warn the patient about prior to commencing treatment?

A

Sensitivity of exposed root surface to hot, cold, sweet
Recession of gums and exposure of root surfaces
Increased susceptibility to root surface decay
Lengthening of teeth
Temporary increases in tooth mobility
Black triangle appearance and shadowing between the teeth.

31
Q

Why do you get these side effects after perio treatment?

A

They arise as the gums heal and deep pockets below the gum reduce- this can cause the gums to shrink back slightly.

32
Q

What does S3 mean?

A

Evidence and consensus-based guideline.
- based on systematic review and representative guideline group.

33
Q

According to SDCEP, what are the ideal outcomes following perio treatment?

A

Achieve signs of periodontal stability which are easy to sustain.

Plaque scores of below 15%

Bleeding scores (BOP) of below 10%

Probing depths of less than 4mm

34
Q

What is classified as a non-responding site?

A

No reduction in pocket depth

Pockets greater than or equal to 5mm

BOP at 4mm site

35
Q

Why are shallow pockets more likely to be responsive than larger pockets?

A

Less granulation tissue present within the pocket, less tissue to be removed during sub gingival PMPR- more likely to heal.

Clinically very difficult to remove all the granulation tissue in a deep pocket.

36
Q

In terms of risk factor management, what would you want to know about Diabetes?

A

Is it well controlled? When was the last time you got your HbA1c checked? What was it? How often do you get it checked?

37
Q

In terms of smoking, what would you want to know from the patient?

A

DO you smoke?
What do you smoke?
How many per day?
How long have you been a smoker?
Have you tried to quit before?
What madę you start again?
Are you interested in getting help to stop?

38
Q

After step 2, what factors at re-evaluation would make you go straight to step 4?

A

Plaque score- less than or equal to 20%
Bleeding score- less than or equal to 30%
Pockets less than or equal to 4mm
No BOP

39
Q

After re-evaluation of step 2, if the patient still has residual pockets, what are your options?

A

Step 4- maintenance
Repeat step 2- non-surgical instrumentation
Surgical access

40
Q

What size pockets might you consider surgical access?

A

Greater than or equal to 6mm.

41
Q

If there are residual pockets, why might this be the case?

A

Overhanging restorations
Poor margins on crowns and bridges
Periodontal abscess
Non-compliance with OH

42
Q

What factors influence referring a patient for perio surgery in non-reponding sites?

A

Smoking status
Compliance
Oral hygiene
Systemic disease
Suitability of site- access, soft and hard tissue factors
Prognosis of tooth
Importance of tooth
Availability go specialist treatment
Patient preference

43
Q

Why is supportive perio care required?

A

treated patients who do not return for regular recall ar at 5.6 times risk of tooth loss than compliant patients.

Recurrent periodontitis will occur- increased pocket depths, inflammation.

44
Q

How often should a patient be recalled for their perio maintenance?

A

depends on the risk assessment for each individual patient

Use periotools.org or Previser.

45
Q

What factors does periotoold.org use to determine a patient’s risk assessment interval?

A

Tooth loss
Smoking status
Systemic disease
Sites with BOP
Pockets greater than 5mm
Environment

46
Q

What factors may cause perio to recur during the maintenance phase?

A

Patient factors-
- Poor compliance with OH
- Failure of the patient to return for regular check ups
- Change in habits- smoking
- Change in dentition- extraction sites
- Change in cognitive level or skill
- Systemic disease

Clinical factors-
- Inadequate treatment that has failed to remove all calculus and granulation tissue
- Inadequate restorations
- OHI not clear or misunderstood

47
Q

What is involved in supportive perio care?

A

Ascertain risk level- periotools or previser.

Update MH and SH- determine HbA1c levels, any changes medically.

Oral examination- MPBS, pocket charts.

Personalised OHI

Smoking cessation device, control of diabetes

Discuss findings of examination with patient, show radiographs, photos.

Supra and subgingival PMPR- pockets greater than 4mm, BOP, obvious calculus deposits.

Correct plaque retentive factors,

Risk assessment again.

Periodontology (7 decks)

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