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Perio clinic > Oral exam > Flashcards

Oral exam Flashcards

1
Q

Primary factors
(2)

A

Bacterial plaque in a susceptible host
Calculus is a contributing factor or SECONDARY etiologic factor
A plaque biofilm is essential

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2
Q

Contributing factors
Systemic
(3)
Local
(5)

A

Diabetes
HIV/AIDS
smoking

Trauma from occlusion
Root proximity
Overhangs
Calculus
Smoking
Socio economic factors
Others

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3
Q

Primary periodontal pathogens
(5)

A

Aggregatiabacter actinomyces
Porphyromonas gingivalis
Tannerella forsythia
Treponema denticola
Prevotella intermedia

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4
Q

Definition of biofilm ???

A

inorganic components of biofilm are calcium, phosphorus, and trace amounts of sodium, potassium, and fluoride

A biofilm is defined as a community of microorganisms attached to an inert or living surface by a self-produced polymeric matrix or an assemblage of microbial cells associated with a surface and enclosed in a matrix of primarily polysaccharide material.

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5
Q

Difference between supra/subgingival calculus
(2)

A

Supragingival: gram (+) cocci and short rods, aerobic environment, slight diversity, calculus formation and root caries
Subgingival: both tooth-attached and unattached, epithelium association, gram (-) rods and spirochetes, anaerobic environment, great diversity, tissue destruction

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6
Q

Name any muco-cutaneous diseases affecting the periodontium

A

Lichen planus, erythema multiforme, pemphigoid? (this one says it’s cutaneous, not specifically mucocutaneous)

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7
Q

Main periodontal manifestations with:
Pregnancy/diabetes/leukemia/HIV/AIDS/transplant pts/epilepsy/hypertension

A

?

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8
Q

Genetic diseases affecting the periodontium
Associated with immunologic disorders: (5)
Affecting oral mucosa and gingival tissue: (1)
Affecting CT: (1)
Metabolic and endocrine disorders: (4)

A

Down’s syndrome, leukocyte adhesion deficiency, Papillon-Lefevre syndrome, Chediak-Higashi Syndrome, congenital neutropenia

epidermolysis bullosa

Ehlers-Danlos syndrome

hypophosphatasia, osteoporosis, diabetes mellitus, obesity

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9
Q

Predominant cells of early lesion, established lesion
Early: (2)
Established: (5)

A

PMNs*, macrophages

PMNs, macrophages, T lymphocytes, B lymphocytes, plasma cells*

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10
Q

Does age make a difference? Same attachment loss in different ages?
(2)

A

Prevalence, extent, and severity of recession increases with age
Prevalence of non-severe and total periodontitis increased with age

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11
Q

How are the periodontal tissues destroyed in periodontal disease

A
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12
Q

What does bleeding on probing mean? What is happening in the pocket with BOP?
(2)

A

Indicates ulceration of the JE → indicating inflammation; bleeding index is a standardized way to interpret bleeding present with probing that would put patients at risk for oral health disease like gingivitis and periodontitis
Dilation and engorgement of the capillaries and thinning or ulceration of the sulcular epithelium; vasculitis of the blood vessels adjacent to the JE; progressive destruction of the collagen fiber network

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13
Q

Gingivitis vs periodontitis
Gingivitis:
Periodontitis:

A

“the inflammation of the gingival tissues without loss of CT attachment”

“the inflammation of the gingival tissues with apical migration of junctional epithelium with concomitant loss of CT attachment and bone”

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14
Q

Staging and Grading
Staging:

A

Based upon severity of the case and complexity of the case management. Consider CAL, amount and % of bone loss, PD, presence and extent of ridge defects, furcation involvement, tooth mobility, tooth loss due to periodontitis

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15
Q

Grading:

A

consider biologic features like the rate of disease progression, risk of further advancement, potential threats to general health
Grade A = low risk of progression
Grade B = moderate risk
Grade C = high risk

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16
Q

Trauma from occlusion (TFO) (primary vs secondary and controlled orthodontics now included)
Primary:
Secondary:

A

traumatic occlusal forces applied to a tooth or teeth with normal periodontal support; clinically may see adaptive mobility but does not progress (ex: “high” restoration with mobility resolving following reduction)

injury resulting in tissue changes from normal or traumatic occlusal forces applied to a tooth or teeth with reduced periodontal support

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17
Q

Mobility (I, II, III)
(4)

A

I: first distinguishable sign of movement greater than normal (physiologic)
II: movement which allows crown to move 1 mm from its normal position in any direction
III: tooth may be rotated or depressed in alveoli
Must use 2 rigid instruments, one on either side (like mirror handles, NOT fingers)

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18
Q

Furcation classifications (I-IV)
Grade I:

A

control of inflammation through plaque control and root preparation; adjustment of occlusion if indicated at reevaluation; odontoplasty if indicated

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19
Q

Grade II (shallow):

A

all of the above plus flap debridement/osseous surgery or potential regeneration

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20
Q

Grade II (deep):

A

control of inflammation (difficult), adjustment of occlusion, flap debridement/osseous surgery, root resection, osseous regeneration, tunnel preparation, extraction

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21
Q

Grade III:

A

all of the above except osseous regeneration

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22
Q

Goldman-incipient/Glickman Grade I:

A

pocket formation into the flute (beginning) of the furca, but interradicular bone is intact

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23
Q

Goldman cul-de-sac/Glickman Grade II:

A

loss of interradicular bone with pocket formation of varying depths into the furca, but not completely through to the other side (can be shallow or deep)

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24
Q

Goldman through-and-through/Glickman Grade III:

A

complete loss of interradicular bone with pocket formation allowing probe to pass completely to the other side

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25
Q

Mucogingival defects (and classification)

A
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26
Q

What is keratinized gingiva? What is alveolar mucosa?

A

?

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27
Q

Attached gingiva vs free gingiva
Marginal/free gingiva:
Attached gingiva:

A

what you can pick up with the probe; sulcus epithelium adjacent to the tooth, about 1 mm in depth (up to 3 mm is still considered normal); in 50% of cases, it is demarcated from the attached gingiva by a free marginal groove

bordered apically by the mucogingival junction; bound to underlying periosteum of alveolar bone; firm and resilient; varies in width between maxilla and mandible
Keratinized gingiva - probing depth = attached gingiva

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28
Q

Plunger cusp? What is it?

A

Cusps that tend to forcibly wedge food into interproximal embrasures of opposing teeth

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29
Q

What is fremitus?

A

Palpable or visible movement of a tooth when subject to occlusal forces

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30
Q

What factors affect prognosis?
Patient related
(5)

A

Systemic disease
Age
Habits
Oral hygiene
Compliance

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31
Q

What factors affect prognosis?
Tooth related
(9)

A

Attachment loss
Furcation involvement
Mobility
Trauma from occlusion
Pocket depth
Fremitus
Anatomical considerations
Restorability
Bleeding on probing

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32
Q

Describe the sequence of tx plan for periodontal pt
Phase 1:
Phase 2:
Phase 3:

A

disease control:
SRP, plaque control, and OHI, removal or overhangs, removal of hopeless teeth, etc

personalized periodontal therapy (surgery, local delivery agents)

maintenance

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33
Q

Molar incisor pattern?

A

Bone loss is found around molar (usually first) and anterior incisors
Generally applies to “old” classifications of localized aggressive periodontitis which was known before that as localized juvenile periodontitis
Now Stage 3 Grade C (periodontitis)

34
Q

Necrotizing diseases?

A

A destructive form of periodontal disease caused by microorganism in the context of an impaired host response

35
Q

Necrotizing gingivitis (NG)

A

Nonsurgical therapy
Improve oral hygiene and debridement
0.12 % chlorhexidine pre/post treatment rinse
Antibiotics
Metronidazole 250 mg 3x/day for 7 days
Amoxicillin 500 mg 3x/day for 7 days

36
Q

Necrotizing periodontitis (NP)

A

Consult patients’ physician
Prevent drug interaction

37
Q

Necrotizing periodontitis (NP)
Tx

A

Consult patients’ physician
Prevent drug interaction
Nonsurgical therapy
0.12 % chlorhexidine pre/post treatment rinse
Debridement with hand instruments
Antibiotics
Metronidazole 250 mg 5x/day for 7-10 days
Antifungal therapy if indicated
Surgical correction may be indicated

38
Q

Necrotizing stomatitis (NS)
(4)

A

Consult patients’ physician
Prevent drug interaction
Nonsurgical therapy
0.12 % chlorhexidine pre/post treatment rinse
Debridement to remove oral necrotized tissue
Scaling with hand instruments
Antibiotics
Metronidazole 250 mg 5x/day for 7-10 days
Antifungal therapy if indicated
Surgical correction

39
Q

What is srp?
Scaling:
Root planing:
Objective of SRP

A

instrumentation of crown and root surfaces to remove plaque, calculus, and stains

definitive treatment procedure designed to remove cementum and/or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms
Can only be performed if attachment loss is present

create a root that is biologically acceptable to its environment by removing local etiological factors and enhancing plaque control

40
Q

Difference between SRP, prophy, perio maintenance and scaling in the presence of inflammation
Prophy:

A

Removal of plaque, calculus and stains from the supragingival and subgingival surfaces of the teeth by scaling and polishing as a preventive measure for the control of local irritating factors

41
Q

Scaling in the presence of inflammation:

A

Generalized gingivitis cases, no bone loss or attachment loss

42
Q

SRP:

A

Periodontitis with bone loss and attachment loss

43
Q

Perio maintenance:

A
44
Q

What do you do at re-evaluation? What are you looking for?

A

The evaluation or assessment of treatment. It’s used to determine the effectiveness of SRP and to review the proficiency of plaque control
4-6 weeks after last quad of SRP
Review medical history, perio charting and perio form, patient education/OHI, consults (re-SRP, surgery, maintenance)
Objectives
Arrest disease
Regenerate lost periodontium
Maintain periodontal health
Reduce “critical mass” of plaque
Allow host to control the bacteria

45
Q

How much healing do you expect from SRP?

A

Formation of long junctional epithelium appears 1-2 weeks after therapy
Clinical presentation with less inflammation, redness, and swelling
Gradual reductions in inflammatory cell population, crevicular fluid flow, and repair of connective tissue
Gingival inflammation is usually reduced or eliminated within 3-4 weeks after removal of calculus and local irritants

46
Q

When would you use local delivery antibiotics?

A

Local antimicrobial delivery (LAD) is the medicament placed in a periodontal pocket with a delivery system and released in a controlled manner, allowing minimum inhibitory concentration for 7 days
Indications:
When local sites with inflammation have no responded to periodontal or maintenance therapy
Residual isolated pockets >5 mm, not responding favorably to initial SRP with BOP at re-evaluation
Residual pockets after periodontal surgery
Recurrent isolated pockets >5 mm with BOP at maintenance
Adjunctive therapy, never use alone

47
Q

Specific cases?

A

Periochip (chlorhexidine gluconate 2.5 mg)
Pocket >5 mm
Atridox (doxycycline hyclate 50 mg)
Delivered subgingivally by cannula to flow to the base of the pocket and adapt to root morphology
Arestin (minocycline hydrochloride 1 mg)
Reduces red complex bacteria in smokers greater improvement in PD, CAL, regardless of smoking status
Acisite (tetracycline hydrochloride 12.5 mg)
Improve PD, BOP, CAL when combined use with SRP in 6 months but no difference after 5 years

48
Q

Is local better than systemic? When do you use systemic and when local?

A

LAD is not effective with implants
May partially detoxify the implants but no long-lasting effects
May be used aas a step in implant recovery for regeneration of bone around implants in conjunction with grafting and GTR but there is still no evidence in literature
Tetracyclines, penicillins, azithromycin, metronidazole
Local treatment is preferred according to Google

49
Q

When and why do you refer for periodontal sx?

A

The PD >5 mm is proposed as current guideline for referral
Refer if the pt has Grade C progression
Early referral of advanced case is critical to provide the best outcome
PD of 5-8 mm, treatment by a periodontist is usually successful
PD >9 mm: limited success

50
Q

What is the rate of infection after periodontal surgery?

A
51
Q

When is premedication necessary?

A

HIV/AIDs patients ANC <500
Dose/type/adverse reaction/alternatives

52
Q

Patient management

A

Heart murmur/diabetes/allergy/hypertension/immunocompromised/bleeding disorder/joint prosthesis/myocardial infarction/CHF/kidney disease/pain/infection/inflammation

53
Q

Ultrasonic/sonic scalers

A

Utilize rapidly vibrating, water cooled tips to remove deposits from tooth surfaces and to debride periodontal plaques
Produces less operator wrist fatigue than hand scaling
Benefits the gingiva by removing biofilm and calculus deposits
Frequently used, higher frequency than sonic scalers
Utilizes water lavage that deplaques/washes away debris from within the periodontal pocket
Cavitation occurs, causing bubbles to form and collapse which disrupts the cell walls of harmful bacteria resulting in lysis (cell death)

54
Q

Hand instruments
(4)

A

Periodontal explorers
Universal curettes
Sickle scalers
Area specific curettes

55
Q

Oral irrigation

A

Can disrupt loosely attached or unattached supra/subgingival plaque
Irrigation not indicated for pts who have effective OH or no inflammationIrrigation alone is ineffective in reducing inflammation
Best benefit is seen when irrigation is combined with toothbrushing
Pts with ortho appliances, bridges, implants

56
Q

Mouthrinses, active ingredients, effectiveness

A

Chlorhexidine 0.12% CHX
35-40% decrease in plaque and gingivitis
Phenolic compounds (Listerine antiseptic)
Essential oils: thymol, eucalyptol, methyl salicylate, menthol
18-25 % decrease in plaque and gingivitis
Listerine Zero
Cosmetic, not therapeutic
CPC 0.5 %: cosmetic
Quaternary ammonium compound
Marginally effective in reduction of plaque and gingivitis
CPC 0.7%: therapeutic
Plaque and gingivitis reduction comparable to Listerine Antiseptic
Hydrogen peroxide based (1.5%)
Needs more data
Viadent
Former active ingredient: sanguinarine
PLAX
Surfactants (detergents), sodium bicarbonate, glycerin, alcohol (7.5%)
Data does not support use
Smart Mouth
Zinc
Unclear evidence

57
Q

Plaque control (toothpastes) and oral hygiene aids

A

NaF is the most effective dentifrice system for caries prevention

58
Q

Describe parts of the (5)

A

periodontium
PDL
Cementum
Gingiva
Alveolar bone

59
Q

Components of supracrestal attached tissue (and appropriate measurements) formerly biologic width

A

Biologic width: 2.04 mm
Junctional epithelium: 0.97 mm
Connective tissue attachment: 1.07 mm

60
Q

Stippling
(5)

A

Stippling
Stippling on attached gingiva
Texture of health
Microscopic elevations and depressions created by connective tissue projections within the gingival tissue
40% of the population
Adaptive specialization or reinforcement for function

61
Q

Bundle bone

A

Component of the alveolar process
Inner socket wall: thin cortical bone, composed of
Alveolar bone proper
Bundle bone
Lamina dura

62
Q

Cortical bone/cancellous bone

A

Found in the interdentinal and interradicular areas, less commonly found buccal/lingual
More in the maxilla than mandible

63
Q

Rests of Malassez

A

Remnants of Hertwig’s root sheath

64
Q

CEP
(4)

A

Cervical enamel projections
Found most commonly on mandibular second molars
Grade 1, 2, 3 depending on extension towards and into the furcation
Effects epithelial attachment

65
Q

Palatal gingival groove
(3)

A

4-8% on maxillary incisors
Localized osseous lesion
“Peri-pulpal” line on radiograph

66
Q

Root trunk

A

Part of the root from the CEJ to where the root divides
Furcation root trunk length
Maxillary molars
Mesial: 3 mm
Facial: 4 mm
Distal: 5 mm
Mandibular molars
Buccal: 3 mm
Lingual: 4 mm
Maxillary 1st bicuspid
Mesial: 8 mm

67
Q

Accessory canals
(2)

A

Endo-perio physical route of communication
28% in molar furcations

68
Q

kg distribution

A
69
Q

Free gingival groove

A

Divides the free gingiva from the attached gingiva
Shallow depression
Found only in 50% of patients

70
Q

Attachment of JE

A

Attachment to the tooth via hemidesmosomes and non-collagenous proteins (proteoglycans and glycosaminoglycans)

71
Q

PDL fibers

A

A complex vascular and highly cellular connective tissue that surrounds the tooth root and connecting to the alveolar bone proper
Periodontal fibers
Cellular elements
Ground substances
Contains collagen 1, 3, & 4
Sharpey’s fibers:
terminal collagen fibers embedded in the root cementum and bundle bone
Types:
Alveolar crest
Horizontal
Oblique
Apical
Interradicular

72
Q

Types of cementum
(2)

A

Cellular (primary)
Found in the coronal portion of the root
Acellular (secondary)
Found in the apical portion of the root

73
Q

Muscles of mastication
(4)

A

Masseter
Temporalis
Lateral pterygoid
Medial pterygoid

74
Q

SRP

A

Periodontitis cases with bone loss and attachment loss

75
Q

Scaling the presence
(3)

A

The removal of plaque, calculus, and stains from the supra- and subgingival tooth surfaces when there is generalized moderate to severe gingival inflammation in the absence of periodontitis.
It is indicated for patients who have swollen inflamed gingiva, generalized suprabony pockets, and moderate to severe bleeding on probing.
Generalized gingivitis cases; no bone loss or attachment loss

76
Q

Root sensitivity

A

Transient root hypersensitivity and recession of the gingival margins will frequently be seen during SRP healing

77
Q

Root sensitivity
Transient root hypersensitivity and recession of the gingival margins will frequently be seen during SRP healing
Mechanism

A

Decrease in probing depth consists of two components: clinical attachment gain and recession

78
Q

Root sensitivity
Transient root hypersensitivity and recession of the gingival margins will frequently be seen during SRP healing
Mechanism
Decrease in probing depth consists of two components: clinical attachment gain and recession
Treatment
(4)

A

Plaque control
Sensitivity toothpastes
Prescription fluoride
Professionally applied fluoride varnish

79
Q

Re-evaluation

A

4-6 weeks after last quad of SRP
Review medical history, perio charting and perio form, patient education/OHI, consults (re-SRP, surgery, maintenance)
Criteria for success:
No pockets =/> 5 mm and none >4 mm with BOP

80
Q

Surgical treatment

A

Rationale for surgery and indications
Osseous resective vs. regeneration (know definitions)
Mucogingival
Endo/Perio; Perio/Endo; Combined
Implant therapy, including peri-implant-mucositis and Peri-implantitis

81
Q
A

Perio clinic (1 decks)

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