Management of Patients with Gingivitis & Periodontitis Flashcards
What is the pathogenesis of periodontitis?
It is mediated by the inflammatory-immune response to bacteria in the dental biofilm
What genetic factors can increases susceptibility to periodontitis? (2)
- Congenital defects of immune system
- Age
What environmental factors can increases susceptibility to periodontitis? (3)
- Smoking
- Diet
- Stress
What systemic diseases can increases susceptibility to periodontitis? (4)
- Diabetes
- Obesity
- Cardiovascular diseases
- Immunodeficiency
How do we define a healthy periodontium? (2)
- <10% bleeding sites
- With probing depths ≤3 mm
What are the 4 levels of healthy paeriodontium?
1) Pristine periodontal health, with a structurally sound and uninflammed periodontium (ideal)
2) Well-maintained clinical periodontal health with a structurally and clinically sound (intact) periodontium
3) Periodontal disease stability with a reduced periodontium
4) Periodontal disease remission/control, with a reduced periodontium
Which levels of health periodontium have attachment loss
1 = No attachment loss
2 = No attachment loss
3 = Attachment loss
4 = Attachment loss
How can bleeding sites help us define cases of gingivitis?
- Localised is 10%≤BOP%≤30%
- Generalised BOP%≥30%
What is gingivitis
- Inflammation of the gums due to plaque accumulation
- No bone loss
- Reversible
What are some clinical characteristics of gingivitis?(8)
- Erythema
- Oedema
- Tenderness
- Enlargement
- Swelling
- Redness
- Halitosis
- Altered taste
How do we define a case of periodontitis? (2)
- Interdental attachment loss is detectable at ≥2 non- adjacent teeth
OR
- Buccal or oral attachment loss ≥3 mm with pocketing ≥3mm is detectable at ≥2 teeth
What is periodontitis?
- Supra and sub gingival plaque/calculus accumulation
- Loss of periodontal attachment
- Irreversible
What are some clinical characteristics of periodontitis? (10)
- Erythema
- Oedema
- Tenderness
- Enlargement
- Swelling
- Redness
- Suppuration
- Tooth mobility
- Gum recession
- Halitosis
What are periodontal probes used to assess?
The presence of pockets and attachment loss, as well as the presence of inflammation
What will you see when probing healthy periodontium?
The depth of the sulcus is 1-3 mm
What will you see when probing healthy periodontium?
Why does this occur?
- Probing depth is > 3mm
- A periodontal pocket is a gingivalsulcus that has been deepened by disease
Define Probing pocket depth (PPD)
Distance from the gingival margin to the tip of the probe
Define Probing attachment level (PAL)
- Distance from the CEJ to the tip of the probe
- Requires the measurement of the distance between free gingival margin (FGM) and CEJ
- Formula: PPD-distance CEJ-FGM
Define Gingival recession (REC)
Distance from gingival margin to the CEJ
What are the therapeutic objectives of gingivitis? (4)
- Control risk factors
- Improvement in patient’s compliance and life-style
- Improve the effectiveness of oral hygiene and motivate the patient
- Reduce/eliminate gingival inflammation
What are the therapeutic objectives of periodontitis? (5)
- Control risk factors
- Improvement in patient’s compliance and life-style
- Improve the effectiveness of oral hygiene and motivate the patient
- Reduce/eliminate gingival inflammation
- Stop periodontitis and reduce PPD
What are the casual therapies fro treatment of periodontitis
- To guide behaviour change by motivating the patient to undertake successful removal of supra gingival dental biofilm and risk factor control
- To control the sub gingival biofilm and calculus
How can you mechanically control supragingival dental biofilm? (2)
- Toothbrush
- Interdental aids
How can you chemically control supragingival dental biofilm (4)
- Dentifrices
- Mouth rinses
- Gels
- Sprays
What are some situations where chemical plaque control might be useful? (5)
- Prevention of biofilm after surgery
- After/during SRP
- Acute gingival inflammation
- Disabled patients
- Necrotising lesions
What are the 2 most proven risk factors of periodontitis?
- Smoking
- Diabetes
What are some local plaque retentive factors? (4)
- Overhanging restorations
- Tooth malposition
- Incongruent prosthesis
- Tooth crowding
What is debridement?
Removal of soft (plaque) sub gingival deposits
What is scaling?
Removal of hard calcified (tartan) deposits
What is root planing?
Removal of pathological cement through the reshaping of the root surface
What do you use in debridement? (2)
- Laser
- Air polishing
What do you use in scaling?
Ultrasonics
What do you use in scaling?
Curette
What do we except from sub gingival instrumentation? (4)
- Decrease in plaque levels
- Decrease in inflammation levels
- Decrease in PPD
- Gain in attachment level
