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BDS1 > Management of gingival and periodontal disease > Flashcards

Management of gingival and periodontal disease Flashcards

1
Q

Define gingival health

A

<10% bleeding sites with probing depths <= 3mm (with no loss of attachment/radiological bone loss/interdental recession)

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2
Q

Appearance of gingival health

A

knife edge, scalloped gingival margin, stippling (30%), pink

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3
Q

Range of physiological bone level in gingival health

A

1.0 - 3.0 mm apical to cemento-enamel junction (ACJ)

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4
Q

What can be used to visualise plaque?

A

disclosing tablet

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5
Q

Definition of gingivitis

A

> 10% bleeding sites with probing depths <=3mm (no loss of attachment/radiological bone loss/interdental recession)

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6
Q

Appearance of plaque induced gingivitis

A

rolled-appearance of gingival margin (lost knife edge), stained/rough tooth surface

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7
Q

Why is it important to identify gingivitis?

A

can be reversed to periodontal health, preventing progression to periodontitis

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8
Q

What is the risk associated with gingivitis?

A

increases chance of loss of attachment (periodontitis) and tooth loss

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9
Q

What can be done to treat a patient with periodontitis?

A

Periodontitis is irreversible but can be stabilised by treating the inflammation

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10
Q

What is periodontitis?

A

loss of periodontal attachment

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11
Q

Most common features of periodontitis

A

increased probing pocket depths (>3mm), increased bleeding on probing, tooth sensitivity to hot/cold

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12
Q

Other features of periodontitis

A

gingival recession, tooth mobility, halitosis, bad taste, abscesses, diastema, loss of papilla

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13
Q

What are the clinical features of periodontitis?

A

gingival inflammation, subgingival plaque biofilm, attachment loss, deep pockets, bone loss

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14
Q

What is unstable periodontitis referred to as?

A

active periodontitis

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15
Q

What are the features of active (unstable) periodontitis?

A

probing pocket depth >4 mm (with or without bleeding or 4mm with bleeding), loss of attachment, may suppurate on probing

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16
Q

Where does the probing pocket depth (PPD) measure from and to?

A

gingival margin to base of pocket

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17
Q

Where does the clinical attachment level (CAL) measure from and to?

A

CEJ (should be below gingival margin in health) to base of pocket

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18
Q

Why is the clinical attachment level (CAL) greater than the probing pocket depth (PPD) in periodontitis?

A

CEJ remains constant. Both the gingival margin and base of the pocket have receded (due to bone loss)

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19
Q

Why may a probing pocket depth greater than 3mm still be characterised as gingivitis?

A

false pocket

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20
Q

Cause of false pocket

A

gingival swelling (no attachment loss or bone loss)

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21
Q

What is the determining feature of a true pocket?

A

loss of attachment

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22
Q

What percentage of the whole population has periodontitis?

A

50%

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23
Q

What percentage of the population has severe periodontitis?

A

10-11%

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24
Q

Is periodontitis related to age?

A

prevalence increases with age but 1.7% of cases in younger populations

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25
Why may some patients be predisposed to developing periodontitis despite good OH?
Immune response may be more easily triggered by small levels of plaque
26
What percentage of the adult population is affected by some degree of periodontitis?
50-90%
27
What percentage of adults have no periodontal disease and very health gums?
17%
28
Risk factors for periodontitis
smoking, diabetes
29
What is the sequence of the treatment plan for periodontitis?
immediate/emergency care -> initial/disease control -> re-evaluation -> reconstructive -> maintenance/supportive care
30
How are dentists able to influence prevent progression to periodontitis?
removing biofilm (cannot affect host response)
31
What are the steps of periodontal treatment?
Basis of treatment - exam, assess risk factors, diagnose 1. control factors, OHI, Professional Mechanical Plaque Removal (PMPR) 2. Subgingival instrumentation 3. Repeated subgingival instrumentation, periodontal surgery 4. supportive periodontal therapy, continuous monitoring of factors
32
Which steps of periodontal treatment are involved in initial treatment/disease control?
Basis of therapy (exam, assess risk factors, diagnose), Step 1 (OHI, PMPR, control factors), Step 2 (subgingival instrumentation)
33
Which steps of periodontal treatment are involved in immediate/emergency care?
Basis of therapy - exam, assess risk factors, diagnose
34
Which steps of periodontal treatment involve re-evaluation?
Before and after step 2 (subgingival instrumentation)
35
Which step of periodontal treatment involves reconstruction?
Step 3 - repeated subgingival instrumentation and periodontal surgery
36
Which step of periodontal treatment involves maintenance/supportive care?
Step 4 - supportive periodontal therapy, continuous monitoring
37
How is periodontitis diagnosed early?
using Basic Periodontal Examination (BPE) as a screening tool
38
When is the Basic Periodontal Examination (BPE) carried out?
as part of examination
39
Function of BPE
rapid screening for periodontal disease, reach diagnosis of gingivitis or periodontitis, formulate treatment plan, determine whether further investigations required (radiograph, periodontal charting)
40
How is the dentition divided for a BPE?
into 6 sextants - 3rd molars not examined unless 1st and 2nd molars absent, sextant must contain at least 2 teeth to qualify for recording.
41
How is a BPE carried out?
Probe walked around sulcus/pockets in each sextant, highest (worst) score recorded
42
Which probe is used for a BPE?
UNC-15 probe
43
What is the scoring system for BPE?
0 (no BOP, PPD < 3.5mm) to 4 (PPD >5.5mm)
44
What does an * indicate on a BPE?
furcation
45
What organisation developed BPE and sequalae guidelines for each score?
British Society of Periodontology (BSP)
46
Sequalae for score of 0 in BPE
nothing
47
Sequalae for score of 1 in BPE
OHI
48
Sequalae for score of 2 in BPE
OHI, removal of plaque retentive factors (inc supra- and subgingival calculus)
49
Sequalae for score of 3 in BPE
OHI, root surface debridement (RSD), radiograph?
50
Sequalae for score of 4 in BPE
OHI, RSD, assess need for more complex treatment/referral
51
Sequalae for * in BPE
OHI, RSD, assess need for more complex treatment/referral to specialist, (radiographic assessment, full perio assessment)
52
Which BPE codes indicate gingivitis?
code 1/2
53
Which BPE scores indicate periodontitis?
code 3/4
54
How can risk factors for periodontitis be reduced?
removal of plaque retentive factors, smoking cessation, diabetes control intervention
55
What is the new term for scaling and polishing?
supra-gingival PMPR (professional mechanical plaque removal)
56
What is the new term for root surface debridement?
subgingival PMPR /instrumentation (professional management plaque removal)
57
Which stage of periodontitis therapy is most effective (greatest reduction in diseased sites)?
stage 1 (OHI, PMPR, correction of plaque retention factors)
58
Possible plaque retention factors
overhang, calculus
59
What are the possible effects of successful step 1 and 2 periodontitis treatment?
2/3 (66-75%) of sites with increased pocket depths (>4mm) can be treated to be 4mm or less with no BOP.
60
Why is it important to successfully conduct periodontitis treatment?
by reducing pocket depth and inflammation (<=4mm and no BOP), the patient has a higher chance of retaining tooth

BDS1 (107 decks)

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