Midterm 2 Flashcards
Loe and Silness Plaque Index
-assesses the amount of plaque at the gingival margin, examining the same anatomical units as the GI
-Plaque score range from {0} to {3}
-A probe is used to distinguish between scores {0} and {1}. Visible plaque is scored a {2} or {3}
-The Pl-I is computed for a tooth (4 surfaces), subject, or population
-It parallels the Gingival Index (GI) of Loe & Stilness
-First published by Silness & Loe
Problem with PI: very subjective, need a lot of training
Silness and Loe Gingival Index
- The severity of inflammation is assessed in 4 distinct gingival areas: distofacial papilla, facial margin, mesiofacial papilla, lingual gingival margin.
- Scores: 0 to 3; BLEEDING is considered. Presence of bleeding automatically leads to a score >=2
- Useful for the calculation of prevalence and severity in population and individual
- Score for tooth –> subject –> population
- frequently used index in clinical trials
- First published by Loe and Loe & Silness
increase PI, increase GI
If you have high GI but low PI – systemic issues?
PSR
- Purpose: periodontal screening and recording is a rapid and effective way to screen patients for periodontal diseases and summarizes necessary information with minimum documentation
- Endorsement: the ADA and the AAP support the use of PSR by dentists as a part of oral examinations
PSR Codes
0 - colored area visible, no calculus or defective margins, no BOP
1 - colored area visible, no calc/defective margins, + BOP
2 - colored area visible, + calc/defective margins, +/- BOP
3 - colored area partially visible, +/- calc/defective margins, +/- BOP
4 - colored area not visible, +/- Calc/defective margins, +/- BOP
PSR Benefits
- Early Detection: PSR includes evaluation of all sites. For this reason, it is highly sensitive technique for detecting deviations from periodontal health and a uniquely appropriate screening tool for periodontal diseases that are, by nature, site specific and episodic
- Speed: once learned, PSR takes only a few minutes to conduct for each patient
- Simplicity: PSR is easy to administer and comprehend. The simplicity of the scoring system aids in monitoring a patient’s periodontal status
- Cost-effectiveness: PSR utilizes a simple periodontal probe designed specifically for use with this screening system. It does not require the use of expensive equipment.
- Recording Ease: Documentation for PSR requires the recording of six numerical scores, one for each sextant of the mouth. It does not require extensive charting or lengthy narrative explanation
- Risk Management: Proper, consistent, and documented use of PSR shows that the dentist is evaluation a patient’s periodontal status
PSR Limitations
- PSR is a screening system designed to DETECT periodontal disease. It is not intended to replace comprehensive periodontal examination when indicated.
- Patients who have been treated for periodontal diseases and are in a maintenance phase of therapy required periodic COMPREHENSIVE periodontal examinations
- in addition, PSR is designed primarily for use with ADULT patients and has limited utility in screening children and adolescents
Papilla Marginal Attached Index (PMA)
- Background: “The number of units affected correlates with the severity of gingival inflammation”
- – not talking about bleeding or redness
- Facial gingival surface is divided in 3 scoring units P - M - A
- Gingival units affected with gingivitis are counted. Presence or absence of inflammation is counted as {1} and {0}, respectively
- Severity component can be considered
- Score computed for tooth –> subject –> population
- First published by Schour & Massler
incisors, canines, and premolars
NIDR Calculus Index
0 - calculus is absent
1 - supragingival calculus, but no subgingival calculus is present
2 - supragingival and subgingival, or subgingival calculus only is present
O’Leary Index
Percentage of tooth surfaces positive for plaque
- what we use in clinic
- disclose, rinse, then count red surfaces
Gingival Index Scores
[0=normal
1=mild inflam, slight color change, no bleeding, edema
2=BOP, moderate inflam, redness, edema 3=severe inflam, marked redness & edema, ulceration, spontaneous bleeding]
Plaque Index Scores
0 - No plaque
1 - a film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may be seen only by using the probe on the tooth surface
2 - moderate accumulation of soft deposits within the gingival pocket, or the tooth and gingival margin which can be seen with the naked eye
3 - abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin
Reliability
an index to measure a condition in the same subject repeatedly and obtain the same score results each time
Validity
sensitivity and specificity of various diagnostic tools used to create an index
sensitivity
the probability that a test result will be positive when the test is administered to people who actually have the disease in question
- Pr(T+/D+) :: (+) –> (+)
specificity
the probability that a test will be negative when administered to people who are free of the disease in question
ex. no bleeding = healthy
exception = smokers – dont bleed as much
Specificity: Pr(T-/D-)
(-) —> (-)
Positive Predictive Value
the probability of disease in a subject with a positive test result
PVP =Pr(D+/T+)
Predictive Value Negative
The probability of not having the disease when the test is negative
PNV= Pr(D-/T-)
Gingival lesions of viral origin
- herpes simplex viruses type 1 and 2
- varicella-zoster virus
Herpes simplex 1 usually causes oral manifestation – main group
primary herpetic gingivostomatitis
through oral mucosal epithelium, virus penetrates a neural ending and travels to the trigeminal ganglion (comes back in stress/sickness/etc)
symptoms of primary herpetic gingivostomatitis
- painful severe gingivitis with redness
- ulcerations with SEROFIBRINOUS EXUDATE
- edema accompanied by STOMATITIS
Characteristics of primary herpetic gingivostomatitis
- incubation period is one week
- formation of vesicles, which rupture, coalesce and leave fibrin-coated ulcers
- healing within 10-14 days
areas where herpes virus can be found
gingivitis, necrotizing ulcerative diseases (NUG/NUP) and periodontitis
more primary infections occur at older ages in industrialized society
recurrent intraoral herpes infection
in 20-40% of individuals with primary infection
-vesicles will rupture and expose tissue
herpes labialis - recurrent HSV
-more than once a year
-recurrent herpes infection
-vermillion border and or the skin adjacent to it
-20-40% of individuals with primary infection
-trauma, UV light exposure, fever, menstruation (immune system down)
DIAGNOSIS:
intra oral lesions generally considered/mistaken for an APHTOUS ulceration (restricted to mouth)
differential diagnosis: aphthous ulcers do not affect keratinized mucosa
-ulcers in attached gingiva and hard palate