OSCE Book - Periodontology Flashcards
You are a dentist in general practice. A fit and healthy 52 year old man attends your practice as a NP complaining of wobby back teeth. HE is a non-smoker. Below is his OPT.
Please explain to the patient what you think the most likely periodontal diagnosis is. Also explain what your aim of non surgical periodontal treatment will be and how you aim to achieve this.
- Intoduce yourself to the patient
- Explain that the patient has periodontal disease and explain this is lamens terms. (You have widespread gum disease as a result of plaque in your mouth, which has over time causes the bone to resorb and the teeth to become wobbly)
- Give the patient there offical diagnosis. Generalised periodontal disease, stage 4, grade C, currently unstable with no risk factors. (Explain that this means that the disease is pretty advanced and needs to be treated.)
- The aim of treatment is to stablise the disease and hence reduce the rate of further loss of bone and periodontal attachment
- Treatment is inline with BSP S3 guidelines. Take 6PPC initally and then explain important of OH, Give OHI, Takes MP&BS to motivate patient, manage risk factors and PMPR supraginigvally of clinical crown (step 1) and subginigvally (step 2), arrange follow up.
Extraction of hopeless teeth?
Your trainee dental surgery assistant asks you what root surface debridement is (subgingival PMPR)? and what are the advantages and disadvantages of using ultrasonic instrumentation during subgingival PMPR?
PMPR(subgingival) is the professional mechanical plaque removal of root surface plaque in areas which the patient cannot clean. It may or may not require LA.
Advanatge
- Quick
- Easy
- Improved visibility and removal of loose debris due to the lavage effects
- Cavitation effects may act beyond instrument tip so better access to deep sites
- More comfortable to patient as less pressure
Disadvantage
- Requires assitant to aspirate
- Aerosol producing procedure
- Less tactile feeback
- Vibrations can cause damage to restorations by loosening cement.
What is the difference between attachment loss and probing depths?
Attachment loss is the degree of recession of the ginigval margin and the probing depths added together. To measure recession you take the distance from the ginigval margin to the cemento-enamel junction. The distance from the ginigval margin to the base of the pocket is the probing depth. Added together these give you the total attachment loss
Total attachment loss = recession + probing depth
This 50 year old man attends your practice CO painful gums. Along with metallic taste. On examination he has poor OH with yellow-white ulcers, in particular in the interdental papillae.
How would you manage this patient. What is the most likely diagnosis?
ACUG/P
Acute necrotising ulcerative gingivitis.
Treatment:
* Ultrasonic debridement + removal of necrotic tissue- encourages healing
* CHX 0.2% x 2 daily
* If systemic symptoms present = 400mg metronidazole x 3 daily for 3 days (9 tablets)
* Ibuprofen if fever
* Provide smoking cessation, diet advice and vitamin supplements
* PMPR- after acute symptoms subside
* Consider referral to specialist
ANUG is very painful and assoicated with spirochaetal infection, HIV, Smoking and stress.
Alternative AB
500mg Amoxycillin 3x daily for 3 days (9 tablets) 250mg Penicillin V 3x daily for 3 days
use doxycycline if patient on warfarin = 1x 200mg tablet on first day then 1x 100mg tablet for 21 days
Please give OH advice to this adult patient shown below with a plaque distribution chart.
- Introduce yourself to the patient
- Explain the importance of brushing for prevention of gum disease and decay
- Advise the pt that they should brush 2x a day morning and night with fluoride toothpaste.
- Explain that they should spit and not rinse as it washes the fluoride away
- When brushing at night should be just before they go to bed
- Use TIPPS (talk, instruct, Practise, plan, support) to show modifyed bass technique.
- Use other aids like disclosing tablets to show the amount of plaque and the areas in the mouth that the patient is missing.
- Use chart to show the areas that the patient is missing. The interproximal areas dn the molars. Give OHI on floss, ID brushes and single tuffed brushes.
- CHX mouthwash can help preventing formation of supraginigval plaque but does not effect established ginigvitis when subgingival plaque is present.
What are some side effects of long term use of CHX mouthwash?
- Altered taste
- Staining of teeth
The patient presents with pain in the 45. Radiographs show a PA radiolucency and loss of bone height.
How would you determine whether this is a periodontal or endo lesion.
- Intorduce yourself to the patient
- Very important to take a history. Specifically a pain history to establish the nature of the pain.
- Examine the aptient and asess response to precussion(TTP) and vitality testing
- Assess pocket depth
A patient presents with grade 1 mobility of the 46. There is clinical evidence of furcation involvement.
A - How would you classify furcation involvment
B - What treatment is available for this condition.
Furcation Involvement:
Grading:
1 = < 1/3rd (<3mm) Tx - Scaling and RSD +/- furcationplasty
2 = > 1/3rd but not all the way through (>3mm) Tx - Furcationplasty, +/- tunnel preperation +/- root resection or extraction
3 = through and through Tx - tunnel preperation +/- root resection or extraction
What is a furcationplasty? and when is it used?
This is a surgical procedure involving a mucoperiosteal flap that allows root surface debridement followed by removal of tooth structure in the furcation area. This enables access for cleaning . Recontouring of the bone may be required. There is risk of sensitivity and caries.
Furcation grades 1 and 2
What is a tunnel preperation?
Buccal and lingual flaps are raised, the entire furcation area is exposed and the flaps and approximated with inter radicular sutures leaving a large exposed furcation. There is a risk of sensitivity, caries and pulpal exposure
What is a root resection? and when would it be used?
This involves the amputation of one or more roots of a multirooted tooth. Leaving the crown and root stump. The root to be retained has to be rct.
Used for furcations of grade 2 and 3
10mins
An 18 year old women presents with a missing upper central incisor following trauma. She currently wears an acyrlic partial denture and does not want a removeable option. She wishes to know what treatment options are available to replace her missing tooth.
Please explain the alternative treatment options to the patient.
- Introduce yourself to the patient
- Find out what the patients main concern is. Is it the appearance, or the smile line? Acknowledge she does not want a removeable option
- Check the patients MH eg conditons such as diabetes or is she a smoker which may effect treatment options. Or if she has certain bone diseases.
- Explain to examiner that you would then conduct a exam on the patient
- Discussing then the following options. Resin bonded bridge, conventional bridge and single tooth implant.
Resin bonded bridge
Advantages - Minimal invasive, no need for LA, cheaper than conventional and is fixed
Disadvantages - Can debond, shorter lifespan, metal can be seen through abutments sometimes
Conventional bridge
Advantages - Good aesthetics, better retention compared to resin, fixed pros
Disadvantages - More invasive have to prep tooth, requires full coverage crown, risk of pulpal death on abutment (20% of all crwoned teeth will have pulpal death)
Single tooth implant
Advantage - Fixed pros, goos aesthetics and functional outcome, no prep of adjacent teeth, good long lasting success rates reported
Disadvantage - Expensive, takes long time to complete, needs temp during osseo-integration stage, may require bone augmentation depending on alveolar bone volume.
A 14 year old girl attends your practice as a NP. On examination she has resonable OH, but there are pockets around her central incisors and first molars with drifting of the incisors.
A - What disease could she have and how would you manage it?
This patient has localised aggressive periodontits (LAP). Management of LAP includes
- Meticulous OH
- Scaling and RSD +/- access flap surgery
Poor question
B - What possible complications are associated with tetracyclines and who shouldnt it be given too?
Staining
Should not be given to under 12s or pregnant patients as it causes hpoplasia and staining in developing teeth.
BPE probe is shown at what level does the coloured black band lie? Closest to the tip of the probs.
3.5-5.5mm
A patient attends your practice and requires extensive scaling. She has previously only experienced hand scaling and wishes to know why you are planning on using ultrasonic scaler.
Please explain the advantages and disadvantages of the hand versus ultrasonic scaler.
A 50 year old man presents to your practice with a bridge extending from the 14 - 24. The abutment teeth are mobile, as are the remaining molar teeth. The patient has a strong gag reflex and has non insulin dependent diabetes.
He wishes to know whether he could have dental impants and what factors influence the success or failure of dental inplants. Please discuss with him the pros and cons of replacing his tooth retaining brudge with a implant retained bridge.
Diabetes
Loss of the periodontal attachment occurs more frequently in people with moderate or poorly controlled diabetes. (type 1 or 2) than in those with better control. DIabetic patients with more advanced systemic complications hace greater frequency and severity of peridontal disease. Although implants do not have a periodontal ligament they are still subject to peri-implantitis, and as such there is a greater risk in a diabetic patient. The better controlled the diabetes the better the prognosis of the implants.
